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ABSTRACT Introduction: Fournier's gangrene (FG) is an infection of the subcutaneous tissue and fascia that progresses quickly and leads to necrosis. It is more prevalent in male patients and immunocompromised individuals, such as those suffering from uncontrolled diabetes. It has a high mortality rate, which makes its early identification and clinical suspicion critical. This study aimed to compare two laboratory parameters, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), and to predict the mortality of FG in a tertiary care hospital. Methods: In a retrospective study, data was retrieved from medical records for the period from January 2014 to December 2020, of patients diagnosed with FG. Recorded data that is age, sex, comorbidities, mortality, and laboratory results (PLR and NLR) were used to assess determinants of survival. Results: There were 23 (17.04%) nonsurvivors among the 135 subjects studied. The mean age was 50.9 ± 14.9 years and men were 103 (83%) patients. Among the participants, diabetes mellitus was the most frequent comorbidity at 74 (54.81%) patients. NLR ≥8 was statistically significant (P = 0.013) for identifying mortality, while PLR >140 was not. In multivariate analysis, NLR ≥8 was found to be a reliable predictor of the FG mortality rate (adjusted odds ratio 12.062, confidence interval 95% 2.115-68.778, P = 0.005). Conclusion: NLR had prognosis predictive value for FG, whereas PLR did not.

Neuroendocrine Tumors (NETs) are a diverse range of neoplasms with various biological and histologic features and therapeutic responses. The prevalence of primary renal carcinoids is scarce worldwide. At the moment, complete surgical resection is the primary treatment against primary neuroendocrine tumors of the kidney. Nephrectomy followed by the lymph node dissection is a standard procedure for localized primary renal NETs. Since renal carcinoid tumor is extremely rare, we decided to present a unique case of a 25-years-old male with neuroendocrine renal carcinoid tumor following radical nephrectomy. The results indicated a solid, solitary tumor verified on the frozen section because a postoperative CT–scan showed a recurring mass in the renal fossa following radical nephrectomy. The case emphasized the need to investigate primary renal NET in the workup and histological examination of renal tumors and also contributed to our understanding of this infrequent clinical entity.

Pain and discomfort may occur in catheterization during a urodynamic examination. A lidocaine gel combined with a water-based lubricant is sometimes used to reduce pain during catheterization. Several studies claimed that intraurethral lidocaine administration could cause inaccurate urodynamic parameters results. However, its definite effects in urodynamics testing on humans are still not clear. We aimed to evaluate the effects of intraurethral lidocaine on pain and urodynamic study parameters in patients undergoing an invasive urodynamic examination. A systematic search adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol was performed in the MEDLINE, PubMed, and ScienceDirect databases for randomized controlled trials (RCTs). The bias of the studies is evaluated using the Cochrane risk of bias tool by two independent reviewers. The analyses of continuous outcomes were displayed as mean difference (MD), whereas odds ratio is used to analyze dichotomous data. Heterogeneity between studies is determined using the I2 value. A total of three RCTs out of 622 discovered that articles were eligible for analysis. Forest plot analysis of the mean visual analogue scale difference of the studies indicated an insignificant difference between the lidocaine and placebo group (MD –7.68; 95% CI –34.04 to –18.68, P ¼ .57). All urodynamic parameter results were also similar between the two groups (P > .05). Routine intraurethral lidocaine injection prior to a urodynamic study does not affect pain intensity and urodynamic parameters. Cite this article as: Paramita Oktaviani D, Ayodhia Soebadi M, Pradnyan Kloping Y, Hidayatullah F, Aulia Rahman Z, Soetojo S. Intraurethral lidocaine use during urodynamics in female patients: A systematic review and meta-analysis. Turk J Urol. 2021; 47(5): 366-374.

Interim analysis of phase I and phase II clinical trials of personalized vaccines made from autologous monocyte-derived dendritic cells (DCs) incubated with S-protein of SARS-CoV-2 show that this vaccine is safe and well tolerated. Our previous report also indicates that this vaccine can induce specific T-cell and B cell responses against SARS-CoV-2. Herein, we report the final analysis after 1 year of follow-up regarding its safety and efficacy in subjects of phase I and phase II clinical trials. Adult subjects (>18 years old) were given autologous DCs derived from peripheral blood monocytes, which were incubated with the S-protein of SARS-CoV-2. The primary outcome is safety in phase I clinical trials. Meanwhile, optimal antigen dosage is determined in phase II clinical trials. Corona Virus Disease 2019 (COVID-19) and Non-COVID-19 adverse events (AEs) were observed for 1 year. A total of 28 subjects in the phase I clinical trial were randomly assigned to nine groups based on antigen and Granulocyte-Macrophage Colony Stimulating Factor (GM-CSF) dosage. In the phase II clinical trial, 145 subjects were randomly grouped into three groups based on antigen dosage. During the 1-year follow-up period, 35.71% of subjects in phase I and 16.54% in phase II had non-COVID AEs. No subjects in phase I experienced moderate-severe COVID-19. Meanwhile, 4.31% of subjects in phase II had moderate-severe COVID-19. There is no difference in both COVID and non-COVID-19 AEs between groups. After 1 year of follow-up, this vaccine is proven safe and effective for preventing COVID-19. A phase III clinical trial involving more subjects should be conducted to establish its efficacy and see other possible side effects.

Background/Objectives: The dengue virus remains endemic in over 100 countries, transmitted by mosquito bites. Current management relies on supportive care, as no highly effective vaccine or approved antiviral exists. The CYD-TDV (Dengvaxia®) vaccine, licensed since 2015 with around 60% efficacy, raises the risk of severe dengue in seronegative children. The newer “Qdenga” vaccine offers up to 80% efficacy after a year but provides suboptimal protection against DENV-3 in seronegative individuals. Over the past two decades, virus-like particles (VLPs) have gained attention as safe, replication-incompetent vaccine platforms. This study evaluates the toxicity profile of dengue VLP-based antigens in BALB/c mice. Methods: A total of 80 BALB/C mice were randomly divided into two experimental groups: acute and chronic. Each group consisted of a treatment subgroup (10 males and 10 females) and a control subgroup (10 males and 10 females). In the acute group, the VLP was administered intramuscularly on day 1, while in the chronic group, a second VLP dose was given on day 14. The study was conducted over a 28-day period. Throughout the experiment, body temperature, body weight, mortality, and clinical signs were monitored regularly to assess the functional condition of various organs. Results: The results showed no notable alterations in mortality rates, body temperature, body weight, clinical signs, or histopathological observations of the examined organs across all groups, including in the hematological and blood biochemical parameters. Conclusions: The administration of tetravalent dengue VLP vaccine in BALB/c mice did not result in adverse effects in acute or chronic toxicity evaluations. Therefore, the VLP supports progression toward clinical evaluation, with dendritic cell activation providing additional rationale.

Background The clinical characteristics, therapy, and outcome of Fournier Gangrene (FG) in patients using sodium-glucose cotransporter-2 inhibitors (SGLT2i) were examined in this systematic review. Methods Without a publication year restriction, we searched PubMed, ScienceDirect, and Cochrane. Additionally, we manually searched bibliographies using the terms \"Fournier's gangrene\" and \"SGLT2 inhibitors.\" The requirements for inclusion were the English language case reports with specific patient data and FG patients with diabetes who were using SGLT2 medication. The risk of bias was analyzed utilizing the Joanna Briggs Institute checklists. Results A total of 78 studies were identified, and 14 of them were included in this review. The duration of SGLT2i use varied from 6 months to 6 years. The patients’ age varied from 34 to 72 years, with 10 studies including male participants only and patients with obesity. All studies have discontinued SGLT2i and replaced them with other anti-diabetic drugs. Therapy options included perianal ring block, insulin, rigid sigmoidoscopy, aggressive debridement, antibiotics, fluid resuscitation, incision, drainage, surgery, hyperbaric oxygen therapy, plastic surgery, and fasciocutaneous flaps. Seven studies reported patients discharged in the range of 9–51 days. Conclusions The incidence of FG following SGLT2i use is rare. Therapy was performed by replacing SGLT2i with other anti-diabetic drugs. The patient's outcome improved after treatment.

In the case of advanced stage gynecological disorders, most patients have a disturbance in the upper urinary tract. Most patients with uterine cervical carcinoma are already in stage 3B and require urine diversion. The purpose of this study is to find and determine the profile of gynecological disorders that require urine diversion, the type of urine diversion, and urine diverted output in patients with cervical carcinoma. This descriptive analytical retrospective study was conducted at Dr. Soetomo Hospital, Surabaya, Indonesia, between 2012 and 2015. The samples of this study were all patients with gynecological disorders who underwent retrograde DJ stent procedures, underwent ureterocutaneostomy and nephrostomy at the Integrated Central Surgery Building, Dr. Soetomo Hospital, Surabaya, for three years between 2012 and 2015. Data was collected based on the medical record number of patients with gynecological disorders who underwent urine diversion procedures and were recorded in the book on the operation schedule. We find that the most common cause of gynecological abnormalities in kidney obstruction is cervical carcinoma. There are three types of urine diversions used, namely DJ stent, percutaneous nefropyelostomy, and ureterocutaneostomy, with DJ as the most commonly performed. Urine diversion can improve creatinine without being influenced by the type of diversity.

Foreign objects may be present in the bladder due to deliberate insertion or displacement of the surrounding organs. There have been multiple cases of sharp objects such as nails, hair pins, and screws, as well as large objects such as AAA batteries, toothbrushes, and ballpoint pens found in the urethra and the bladder, which must have been aimed to induce sexual satisfaction associated with mental and psychic disorders. The diagnosis was established by means of radiological examinations, ie thoracic x- ray, KUB, and urethrography. This article reported a 32-year-old man with headset inserted to penile until bladder and could not be pulled out again. The patient complained pain and bleeding out of the urinary tract. We performed vesicotomy and pulling the out headset from bladder. The operation was succesful. In conclusion, the case of a headset in the bladder has been treated successfully with vesicotomy.