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Summary: Multiple sclerosis (MS) is an immune-mediated disease whose precise etiology is unknown. Several studies found alterations in the microbiome of individuals with MS, but the mechanism by which it may affect MS is poorly understood. Here we analyze the microbiome of 129 individuals with MS and find that they harbor distinct microbial patterns compared with controls. To study the functional consequences of these differences, we measure levels of 1,251 serum metabolites in a subgroup of subjects and unravel a distinct metabolite signature that separates affected individuals from controls nearly perfectly (AUC = 0.97). Individuals with MS are found to be depleted in butyrate-producing bacteria and in bacteria that produce indolelactate, an intermediate in generation of the potent neuroprotective antioxidant indolepropionate, which we found to be lower in their serum. We identify microbial and metabolite candidates that may contribute to MS and should be explored further for their causal role and therapeutic potential.

Objectives: To examine gender-related differences in the presentation, management, and outcomes of patients admitted to the emergency department ED with ureteral stones., Methods: Retrospective analysis of all patients admitted to the ED at our institution, found to have a ureteral stone on CT. Clinical, laboratory, imaging parameters, and outcomes were collected., Results: 778 patients were admitted with ureteral stones between January 2018 and December 2020. 78% ( n  = 609) were males and 22% ( n  = 169) were females. The mean ages were 49.4 (SD 14.4) and 51.6 (SD 15.7) in males and females, respectively ( p  = 0.08). Female patients presented with a higher body temperature ( p  = 0.01), pulse rate ( p  < 0.0001), nausea and vomiting ( p  < 0.0001), elevated serum C-reactive protein (CRP) ( p  = 0.002) compared to males. The prevalence of elevated serum creatinine was higher in males ( p  < 0.0001). Alpha-blockers were recommended on discharge in 54.8% (334) of males, compared to only 29.6% (50) of females ( p  < 0.0001). Spontaneous stone expulsion was significantly higher in males compared to females ( p  = 0.01)., Conclusions: Our results demonstrate that gender does effect presentation and outcome of patients presenting with renal colic. Females were found to have elevated infectious parameters, more nausea and vomiting and a higher incidence of positive urine cultures. Males admitted to the ED were found to have significantly higher serum creatinine levels. Medical expulsive therapy (MET) with alpha-blockers was prescribed significantly less in female patients, which may have resulted in a lower spontaneous stone expulsion rate., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: To examine differences in the presentation, management, and outcomes of patients admitted to the emergency department (ED) with ureteral stones, with prior history of urolithiasis compared to patients with a first stone event., Patients and Methods: Retrospective analysis of patients who visited the ED that were found to have a ureteral stone on CT. Patients were stratified into two groups: without history of urolithiasis (Group 1) and with history of urolithiasis (Group 2)., Results: Between 2018 and 2020, 778 patients were admitted with ureteral stones. Patients in group 1 presented with a higher mean serum creatinine ( p  = 0.02), larger mean stone size ( p  < 0.0001), and a higher proportion of proximal ureteral stones ( p  < 0.0001) than patients in group 2. The 30 day readmission rate was significantly higher in group 1 ( p  = 0.02). Spontaneous stone expulsion was higher in group 2 ( p  < 0.0001), whereas the need for endourological procedures was higher in group 1 ( p  < 0.0001). On multivariable analysis serum creatinine (OR 0.264, 95% CI 0.091-0.769, p  = 0.01) and stone size (OR 0.623, 95% CI 0.503-0.771, p  < 0.0001) were associated with a lower spontaneous stone expulsion rate. History of prior endourological procedures (OR 0.225, OR 0.066-0.765, p  = 0.01) was associated with a higher spontaneous stone expulsion rate., Conclusions: Our data suggests that patients who are first time stone formers present with larger and more proximal ureteral stones, with a lower likelihood of spontaneous stone expulsion and a subsequent need for surgical intervention. Previous stone surgery and not previous stone expulsion was found to be a predictor for spontaneous stone passage.

Tuberculous epididymitis is uncommonly encountered and is a very rare complication of Bacillus Calmette-Guérin (BCG) intravesical therapy for the treatment of bladder urothelial cancer. With the increased use of BCG, it is conceivable that practicing urologists will see more patients presenting with this infection. Herein, we describe an unusual presentation of tuberculous epididymitis treated successfully in a conservative fashion with anti-tuberculotic medications and describe current diagnostic, as well as medical and surgical management strategies., Competing Interests: None., (© 2023 The Authors.)

Objectives: To examine the age-related differences in the presentation, management, and outcomes of patients admitted to the emergency department (ED) with ureteral stones., Patients and Methods: A retrospective analysis of all patients who visited the ED at a single institution that were found to have a ureteral stone on CT. Clinical, laboratory, and imaging parameters were collected, including outcomes. Patients were subdivided into age groups: 18-30, 31-50, 51-70, and >70 years., Results: Between January 2018 and December 2020, 778 patients were admitted to the ED with a ureteral stone. About 78% (609) were males and 22% (169) were females. The mean ages were 49.4 (SD 14.4) and 51.6 (SD 15.7) in males and females, respectively ( p  = 0.08). Patients in the 36-50 age group, had significantly higher visual analogue scale (VAS) scores ( p  < 0.0001). Patients older than 70 years old presented with significantly higher serum creatinine levels ( p  < 0.0001), C-reactive protein (CRP) ( p  < 0.001) and leukocyte levels ( p  = 0.002). These patients were also found to have significantly larger stones (mean size of 6.2 mm (SD 4.8) ( p  < 0.0001)) and underwent percutaneous nephrolithotripsy (PCNL) in significantly higher numbers (56.3% vs 43.8%, ( p  < 0.0001)). Less than half of the patients older than 50 years were given medical expulsive therapy (MET) with alpha-blockers, compared to more than 50% in the other age groups ( p  = 0.002). Spontaneous stone expulsion was noted in 70.2% of the 18-35-year group, 62.4% of the 36-50-year-old group, 51.8% of the 51-70-year-old group, and 37% of the >70-year-old group ( p  < 0.0001). The ED re-admission rates at 7 and 30 days were not significantly different among all age groups., Conclusions: Our data suggests that older patients presented with larger stones, elevated inflammatory markers and creatinine and were more likely to require surgical intervention. The spontaneous stone expulsion rate was inversely associated with age.

Introduction: Renal colic due to ureterolithiasis is a frequent reason for visiting the emergency departments (ED). The majority of those patients are managed non-surgically and will experience a spontaneous stone expulsion. The ED at our hospital works as a unified department, which is a well-established practice in Europe and North America., Aims: Assess the outcome of urological consultation in the ED for patients with urolithiasis., Methods: A retrospective cohort examined 402 ureterolithiasis patients proven by abdominal CT-scan at the ED. Patients were divided into 3 groups: Group1: patients were discharged after evaluation by ED physician alone. In Group 2: patients were discharged after being evaluated by an ED physician and urologist. In Group 3: patients who were admitted to the Urology Department. Clinical, laboratory and imaging parameters were examined as well as patients' outcomes: spontaneous stone expulsion, re-visit to ED and surgical intervention., Results: There were not significant differences between group 1 and 2 regarding age, stone size, stone location, WBC levels, stone expulsion rate or surgical intervention. Group 1 had a significant higher rate of ED re-visits compared with group 2 (79 (43.3%) vs. 12 (17.9%). p=0.0002). Group 3 had significantly higher stone size, creatinine levels, inflammatory markers, proximal stone location and surgical interventions., Conclusions: ED working as a unified department provides excellent management to patients with renal colic due to ureterolithiasis, with a high rate of spontaneous stone expulsion and urologist referral to admissions and surgical interventions. Nevertheless, urological consultation significantly decreases re-visits to ED.

Introduction: Community forum participants voted for an education and resource distribution program (using a baby box) to help reduce local infant mortality. Although multiple sites have implemented similar programs, there is limited peer-reviewed literature about outcomes., Methods: A retrospective pre- and immediate post-survey design with an intervention (video and written education and resource distribution) in between was utilized with a follow-up survey. The primary research objectives were whether viewing educational videos led to change in self-reported likelihood of select maternal behaviors. Other objectives were whether demographic characteristics were associated with self-reported likelihood of behaviors, and to assess the actual self-reported postpartum behavior., Results: Participants reported a change in likelihood in: asking a WIC counselor for help (p < 0.001); talking with a provider about substance use (p = 0.014), postpartum depression (p < 0.001) and birth control (p = 0.025); and using the baby box as a sleeping space (p < 0.01). After watching the educational videos, college-educated participants were significantly more likely than participants with high school education or less to report likelihood to breastfeed (p = 0.039). Over half of the participants (59.2%) in the follow-up survey reported breastfeeding most to all of the time, compared to 91.5% who reported they were more likely to breastfeed in the post-education survey. The proportion of participants at the follow-up survey who reported bed-sharing most or all of the time (5.7%) was lower than those participants who had said they were likely or very likely to bed-share in the post-education survey (11.3%). Although nearly all participants (98.6%) in the post-education survey reported that they were likely to use the baby box, at the postpartum follow-up, 39.1% reported actual use of the baby box., Conclusions for Practice: The program positively impacted self-reported likelihood of several health behaviors. A community-driven approach to maternal education and resource distribution may be beneficial in other cities., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

During the last decade, growing efforts have focused on human papillomavirus (HPV) detection using liquid hybridization, conventional PCR, and real-time PCR-based methods to increase the overall proportion of patients participating in cervical cancer screening procedures. We proposed a new general HPV DNA real-time PCR on the Mx4000 (Stratagene) and LightCycler (Roche Diagnostics) systems usable for both cervical scrape specimens and urine samples. A linear range was obtained from 5 DNA copies to 8 log(10) DNA copies/ml, and intra- and interassay variations were between 1.8 and 4%. Cervical carcinoma and HPV DNA screening was performed in 333 individual women referred for gynecological examination at the university hospitals of Angers and Brest and enrolled in the PapU study. Among cervical specimens (n = 333), 45% were positive for HPV DNA, with a mean viral load at 5.00 log/ml (+/- 1.73). Among urine samples (n = 177), 37% were positive with a significant 50-fold-lower mean viral load (3.77 +/- 1.32 log/ml; P < 0.0001). Kappa agreement for HPV DNA between cervical and urine specimens was excellent (93%). Thus, we developed a highly sensitive and quantitative general HPV DNA real-time PCR method that allows mass screening of patients with HPV infection. The ongoing longitudinal and prospective multicenter PapU study should give us the opportunity to validate this method adapted to HPV DNA screening in urine samples in a larger population.