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Impact of Varicocele on Pregnancy and Live Birth Outcomes in Men with Clinical Varicocele: Systematic Review of Controlled Studies
No full textPURPOSE: To investigate the impact of varicocele on pregnancy and live birth outcomes in men with clinical varicocele in controlled studies.
MATERIALS AND METHODS: A comprehensive literature search was conducted across the PubMed and Scopus databases using Boolean operators, covering all available records from each database\u27s inception through June 30, 2024. The inclusion criteria focused on controlled studies that compared pregnancy-related outcomes-including pregnancy, miscarriage, and live birth rates-between men with clinical varicocele and those without. These studies included participants attempting conception either spontaneously or through assisted reproductive techniques.
RESULTS: Out of 3,532 articles screened, only two controlled studies met the inclusion criteria. The findings revealed no significant differences between men with and without varicocele in terms of time to achieve pregnancy (5.3 vs. 5.4 months, respectively; p=0.92) or the proportion of men who had previously conceived with their partner (58.9% vs. 63.4%, respectively; p=0.47). However, a significant difference was observed in live birth rates, with men with varicocele showing a lower rate than those without (71.2% vs. 76.4%; p=0.04).
CONCLUSIONS: The relationship between varicocele and conception remains contentious, primarily due to the limited number of controlled studies available for analysis. Despite an extensive systematic search for controlled studies comparing pregnancy-related outcomes in men with and without clinical varicocele, only two studies met the inclusion criteria. These studies showed no significant differences in time to achieve pregnancy or previous conception rates between the two groups. However, men with varicocele exhibited a slightly lower, statistically significant, live birth rate compared to men without varicocele. This highlights the need for further research on this topic to provide evidence-based guidance on the impact of varicocele on fertility outcomes
New Insights into Upper Tract Urothelial Carcinoma: Lessons Learned from the ROBUUST Collaborative Study
No full textUpper tract urothelial carcinoma (UTUC) is a rare malignancy, representing only 5-10% of urothelial carcinoma. The mainstay of treatment for high-risk patients is radical nephroureterectomy. Given the aggressive behavior of this disease, additional treatments could be required perioperatively in terms of chemotherapy (CHT), either in a neoadjuvant or adjuvant setting. On the other hand, low-risk and selected cases can be managed with kidney-sparing surgery (KSS). The ROBotic surgery for Upper tract Urothelial cancer STudy (ROBUUST) is an ongoing international, multicenter registry of patients undergoing surgery for UTUC. After conducting a literature search in February 2025 using the MEDLINE (via PubMed) and Embase databases, we identified 14 studies based on the ROBUUST data analyses. There are several key topics concerning UTUC that remain under debate and were therefore addressed in these studies, focusing on preoperative evaluation and planning, surgical techniques and intraoperative procedures, additional perioperative treatments, and outcomes. The ROBUUST registry has served as a valuable source for a growing body of investigations focusing on various aspects of UTUC treatment planning, decision-making, and outcomes, providing innovative tools and enabling large-scale, novel analyses
Effect of Red Blood Cell Transfusion Strategy on Clinical Outcomes Among Patients With Acute Myocardial Infarction Undergoing Revascularization: A Prespecified Analysis of the MINT Trial
No full textBACKGROUND: The MINT trial (Myocardial Ischemia and Transfusion; N=3504) randomized patients with acute myocardial infarction (MI) and hemoglobin ≤10 g/dL to liberal (maintain hemoglobin ≥10 g/dL) or restrictive (maintain hemoglobin ≥8 g/dL) red blood cell transfusion. The results suggested a benefit on 30-day death or MI with a liberal transfusion strategy. The effect of transfusion in patients with acute MI undergoing revascularization is unclear.
METHODS: In this prespecified analysis of the MINT trial, patients who underwent revascularization (n=1002) before randomization but during index hospitalization were compared with those who did not (n=2442). The primary outcome was 30-day death or MI; secondary outcomes included 30-day death, recurrent MI, the composite of death, recurrent MI, ischemia-driven unscheduled revascularization, or readmission for ischemic cardiac diagnosis, heart failure, and cardiac death. Multivariable log-binomial regression was used to determine the relative risks of the primary and secondary outcomes by transfusion strategy for revascularized and nonrevascularized patients with interaction terms.
RESULTS: Patients undergoing revascularization were younger, more often female, and had fewer comorbidities than those who did not. There was no significant interaction between revascularization and assigned transfusion strategy for any outcome except cardiac death. Compared with liberal transfusion, restrictive transfusion increased the risk of 30-day cardiac death among nonrevascularized patients (relative risk, 2.45 [1.58-3.81]) but not among revascularized patients (relative risk, 0.97 [0.59,-1.60]; interaction P=0.006).
CONCLUSIONS: In this analysis of the MINT trial, revascularization did not alter the effect of the randomized transfusion strategy on 30-day death or MI. The hypothesis-generating finding that a restrictive transfusion strategy was associated with an increased risk of cardiac death among patients with anemia and acute MI who do not undergo revascularization requires confirmation.
REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02981407
Clindamycin Phosphate 1.2%/Adapalene 0.15%/ Benzoyl Peroxide 3.1% for Acne: Results From A 6-Month Open-Label Study
No full textBACKGROUND: Treatment of acne may require many months of treatment before maximal benefits are observed, and acne sequelae (eg, scarring, dyspigmentation) can persist long after lesion resolution. In 12-week clinical trials, triple-combination clindamycin phosphate 1.2%/adapalene 0.15%/benzoyl peroxide 3.1% gel (CAB) demonstrated efficacy and tolerability in the treatment of moderate to severe acne. This study assessed CAB long-term efficacy/tolerability and reductions in acne scarring/dyspigmentation.
METHODS: This 24-week, single-center, open-label study assessed once-daily CAB in participants (N=25) aged ≥ 12 years with moderate acne (Investigator’s Global Assessment [IGA] score=3). Endpoints included change from baseline in IGA score, inflammatory/noninflammatory lesions, skin appearance (dryness, postinflammatory hyperpigmentation [PIH], and postinflammatory erythema [PIE]), and scarring. Tolerability parameters (itching, burning, redness, swelling) and adverse events were assessed. At baseline and week 24, participants’ foreheads were swabbed to assess Cutibacterium acnes.
Results: At week 24, 68% of participants achieved treatment success (≥ 2-grade IGA score reduction from baseline and clear/almost clear skin), and significant inflammatory/noninflammatory lesion reductions from baseline were observed (89%; 70%; P\u3c 0.001, both). Decreases from baseline in investigator- and participant-assessed PIH (77%; 82%) and PIE (84%; 88%) and investigator-assessed scarring severity (33%) were statistically significant (P ≤ 0.001, all). There were no significant increases in skin dryness or any tolerability parameter, and no adverse events occurred. C. acnes assessment indicated no development of antibiotic resistance with long-term CAB treatment.
Conclusions: With 24 weeks of once-daily use, CAB was efficacious, well-tolerated, and significantly improved acne-related scarring and dyspigmentation. These results support the long-term use of CAB in the topical treatment of acne
Patient-Reported Outcomes by Baseline Body Surface Area Involvement Among Individuals Initiating Biologic Therapy: Results from the CorEvitas Psoriasis Registry
No full textINTRODUCTION: Psoriasis body surface area (BSA) of 10% or more has been a major criterion for determining systemic therapy eligibility. However, patients with BSA \u3c 10% and even ≤ 3% may have high disease burden and difficulties accessing biologics. To assess psoriasis burden among patients with BSA ≤ 10%, this study characterized patient-reported outcomes (PROs) across BSA categories among systemic treatment-naïve patients initiating biologic therapy.
METHODS: Patients from the CorEvitas Psoriasis Registry initiating biologics between April 2015 and September 2023 were categorized according to low (\u3c 3%), medium (3-10%), or high (\u3e 10%) BSA involvement. Measures assessed at initiation of biologic therapy included health-related quality of life, itch, pain, fatigue, psoriatic arthritis, psoriasis disease characteristics, and medical history. Overlap between BSA groups for each outcome was calculated via non-parametric Mann-Whitney statistic transformation (range 0.0-1.0; 0.5 indicates complete similarity [i.e., for a comparison between low and high BSA groups, overlap of 0.5 means there is 50% probability that a randomly selected patient with low BSA would have the same or greater PRO burden as one with high BSA]; 0 or 1 indicates complete dissimilarity) to determine whether each measure differed in randomly selected patients with low or medium versus high BSA.
RESULTS: Of 1640 patients who initiated biologics, 7.0% had low BSA, 46.9% had medium BSA, and 46.2% had high BSA involvement. PRO overlap statistics ranged from 0.52 to 0.59 and from 0.60 to 0.70 for randomly selected patients with high versus medium and low BSA, respectively, indicating patients with high and medium BSA are likely to have similar levels of disease burden, and patients with high BSA are slightly more likely to have higher disease burden than those with low BSA. Near complete overlap (range 0.44-0.58) was observed for psoriasis disease characteristics and medical history in the low versus high and medium BSA groups.
CONCLUSION: Observed overlap in PROs across BSA categories shows that patients with low BSA can experience similarly poor quality of life and high symptom burden to those with higher BSA. These findings support the appropriateness of considering biologic therapies for patients with low BSA and indicators of high disease burden.
TRIAL REGISTRATION: ClinicalTrials.gov: NCT02707341
Predictors for true Actinomyces bacteraemia
No full textIntroduction: Actinomyces species colonizing the human oropharynx and gastrointestinal and urogenital tract are associated with a wide range of infections. The isolation of Actinomyces spp. from sterile clinical samples is regarded as significant.Gap Statement. Increased use of advanced diagnostics has caused an increased detection of Actinomyces in the bloodstream, the clinical significance of which is unclear.
Aim: To investigate the clinical factors associated with true Actinomyces bacteraemia that could aid in differentiating it from transient Actinomyces bacteraemia.
Methodology: We conducted a retrospective study of all inpatients with Actinomyces bacteraemia from two tertiary care centres from 1 January 2006 to 26 September 2021. Data were collected on demographic and clinical characteristics, comorbidities, primary source of infection and outcomes. True bacteraemia was defined as Actinomyces bacteraemia with systemic manifestations of infection.
Results: A total of 82 cases of positive blood cultures were identified, of which 33 (40.2%) were true bacteraemia, based on clinical criteria. Patients with true bacteraemia were more likely to be older (P=0.007), have chronic skin ulcers (P\u3c 0.001), have a history of central line placement within 3 months of their presentation (P=0.04), have had a fever within 72 h of admission (P=0.05) and have presented with an abscess (P\u3c 0.001) compared with patients with transient bacteraemia. True bacteraemia was more likely to be associated with positive tissue cultures (P=0.02) and an infectious disease consultation than transient bacteraemia. Skin and soft tissue (27.3%) was the most common source followed by intra-abdominal (21.1%). Among true bacteraemia, the most common species was Actinomyces meyeri with a ratio of 1:8 (transient versus true bacteraemia). All-cause mortality was 30.3% in patients with true bacteraemia compared with 4.1% in patients with transient bacteraemia (P\u3c 0.001).
Conclusion: Predictors of true Actinomyces bacteraemia included older age, fever within 72 h of admission, presence of abscess and chronic skin disease. Actinomyces species exhibit varying degrees of invasiveness, with A. meyeri potentially showing higher invasive potential. Better awareness and involvement of infectious disease specialists is recommended in determining the clinical significance of transient Actinomyces bacteraemia and can help implement antibiotic stewardship and patient safety and improve outcomes. Further research will help to identify the true importance of these isolates
Management of postoperative complications after lateral sinus floor augmentation: A multidisciplinary clinical consensus utilising the Delphi method
No full textPURPOSE: To achieve a consensus among international experts regarding the management of postoperative complications after maxillary sinus floor elevation.
MATERIALS AND METHODS: A total of 32 experts were enrolled and divided into dental implant providers (21), experts with a well-established reputation as sinus specialists (8), ear, nose and throat specialists (2), and experts with a well-established reputation as ear, nose and throat specialists (1). Before starting, a systematic literature search was conducted on the topic, and a list of articles was sent to the panel. The development group formulated 20 statements, which were sent out in the form of a survey. After each round, the statements upon which a consensus was not reached were reformulated based on anonymous comments from participants. A total of three rounds were planned.
RESULTS: After the third round, a consensus was reached on 15 key statements regarding the management of postoperative complications following sinus floor elevation. Agreement was established on issues including common postoperative symptoms, use of radiographic assessments, the necessity of surgical interventions such as partial or total graft removal, and the potential need for functional endoscopic sinus surgery. Near-consensus was achieved on additional points concerning normal postoperative symptoms, timing of total graft removal and approaches to late graft infections.
CONCLUSIONS: The present Delphi consensus suggests that postoperative symptoms such as pain and swelling are generally manageable with appropriate pharmacological treatment. It also outlines conditions where radiographic evaluation is recommended for further assessment. Surgical options, including partial or total graft removal and functional endoscopic sinus surgery, are recommended based on the clinical scenario and response to initial treatments. Variability in practices, particularly regarding antibiotic use and specific intervention timing, suggests a need for further research to be conducted in order to standardise treatment protocols and address gaps in evidence
Phenotypes of Atopic Dermatitis and Development of Allergic Diseases
No full textIMPORTANCE: Atopic dermatitis (AD) is the most common inflammatory disease in childhood, and children with AD are more likely to develop other allergic diseases, including food allergy, allergic rhinitis, and asthma.
OBJECTIVE: To determine the phenotypes of AD expression across 12 US birth cohorts and identify factors associated with phenotype and development of allergic diseases.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study compiled longitudinal data from 12 observational US birth cohorts across decades (children born from April 1980 to June 2019) in the Environmental Influences on Child Health Outcomes (ECHO) Children\u27s Respiratory and Environmental Workgroup with follow-up to September 2022. Participants were enrolled prenatally; children with 3 or more AD assessments across the first 84 months of life were included in analyses. Data were analyzed from December 2020 to April 2024.
EXPOSURES: Exposures included decade of birth, cohort type (population-based or high-risk), family history of asthma (mother, father, or sibling), birth order, gestational age at birth, delivery mode, breastfeeding, pet exposure, antibiotic use, environmental tobacco smoke exposure, allergic sensitization, peripheral blood eosinophil count, and total IgE.
MAIN OUTCOMES AND MEASURES: Primary outcomes were AD phenotype, food allergy, allergic rhinitis, asthma, and wheeze. Longitudinal latent class analysis was used to identify underlying longitudinal patterns of AD expression, and associations of AD phenotype with allergic outcomes were examined using logistic regression, multinomial logistic regression, and linear regression.
RESULTS: In 5314 children from 9 cohorts (1896 born in the 2000s [35.7%]; 2585 female [48.6%]; 1083 Black or African American [20.4%]; 3344 White [62.9%]; 350 other reported race [6.6%; including 8 American Indian or Alaska Native (0.2%); 58 Asian (1.1%); 4 Native Hawaiian or Pacific Islander (0.1%) and 280 multiracial or with any race not otherwise specified (5.3%)]), 3382 (63.6%) were from a population-based cohort, while 1932 (36.4%) were from a high-risk cohort. AD prevalence ranged from 24.1% (540 children) to 28.4% (1156 children) at each time point, and 5 phenotypes of AD were identified: transient early AD, early AD with potential reoccurrence, late-onset AD, persistent AD, and minimal or no AD. Compared with White children, Black children were at higher risk for AD (transient early AD: aOR, 3.26; 95% CI, 2.06-5.18; early AD with potential reoccurrence: aOR, 3.72; 95% CI, 2.35-5.90; persistent AD: aOR, 2.01; 95% CI, 1.54-2.63), as were children with other reported race (transient early AD: aOR, 2.31; 95% CI, 1.13-4.70; early AD with potential reoccurrence: aOR, 3.27; 95% CI, 1.73-6.18). Female children were significantly less likely to have early AD with potential reoccurrence (aOR, 0.45; 95% CI, 0.27-0.74) and persistent AD (aOR, 0.60; 95% CI, 0.49-0.74) than male children. Compared with miniml or no AD, phenotypes with early AD expression were associated with food allergy (transient early AD: adjusted odds ratio [aOR], 2.15; 95% CI, 1.48-3.08; early AD with potential reoccurrence: aOR, 2.43; 95% CI, 1.66-3.50; persistent AD: aOR, 2.26; 95% CI, 1.84-2.78), later AD expression was associated with allergic rhinitis (late-onset AD: aOR, 1.84; 95% CI, 1.38-2.43; persistent AD: aOR, 2.02; 95% CI, 1.64-2.48), and any AD disease was associated with asthma.
CONCLUSIONS AND RELEVANCE: In this birth cohort study of 5314 children, timing of AD expression was associated with increased risk for atopic march pathways. Identifying risk factors for AD phenotypes may inform targeted therapeutic prevention strategies
Purulent pericarditis and septic shock secondary to a hepatic-pericardial fistula in a patient with complex oncologic and cardiac history
No full textBACKGROUND: Hepatic-pericardial fistulas are extremely rare complications typically arising from hepatic abscesses, trauma, or invasive procedures. These fistulas can lead to clinical manifestations such as pericarditis, cardiac tamponade, and septic shock. We report a case of purulent pericarditis and septic shock secondary to a hepatic-pericardial fistula in a patient with complex cardiac and oncologic history.
CASE PRESENTATION: A 76-year-old man with a history of pancreatic, renal cell and prostate cancer presented with acute chest pain and dyspnea. Initial investigations revealed a moderate pericardial effusion and a suspicious hepatic lesion. The patient developed cardiac tamponade and underwent emergency pericardiocentesis, draining 750 ml of purulent fluid. A CT-guided biopsy confirmed a hepatic abscess with fistulization to the pericardium. Despite antibiotic therapy and drainage procedures, the patient\u27s condition deteriorated, resulting in septic shock and death.
DISCUSSION: This case highlights the challenges in managing hepatic-pericardial fistulas, particularly in patients with significant comorbidities. Bacteroides fragilis was identified as the causative pathogen, which underscores the importance of timely identification and management of these rare infections. Early surgical intervention and targeted antibiotic therapy are critical, although prognosis remains poor in patients with compromised cardiovascular and respiratory status.
CONCLUSION: Hepatic-pericardial fistulas, though rare, should be considered in patients with unexplained pericarditis or septic shock, particularly in the presence of hepatic abscesses. Early recognition, multidisciplinary management, and individualized treatment are essential to improve outcomes