Naohiko Ueno is the Director of Ueno Internal Medicine and Diabetes Clinic, and a Visiting Lecturer at Kagoshima University Graduate School of Medical. He specializes in Diabetes and certified by the Japan Diabetes Society, and also specializes in Internal Medicine certified by the Japanese Society of Internal Medicine. He received his PhD in 2000 at Kobe University Graduate School of Medicine. He studied as a Postdoctoral fellow at the Department of Neuroscience of the University of Florida, USA. His current field of interest is diabetes treatment and body weight regulation. He has many publications in medical journals including Diabetes Care, Diabetologia, Endocrinology and Gastroenterology.
Objective: Hyperuricemia often causes kidney dysfunction which increases serum urate, forming a vicious cycle in the kidney. In this study, urate-lowering therapy was demonstrated in type 2 diabetes patients with hyperuricemia to evaluate the effect on diabetic nephropathy. Methods: Type 2 diabetes patients with hyperuricemia (n=34) were treated by urate-lowering drugs. Serum urate levels, estimated glomerular filtration rate (eGFR), blood pressure, HbA1c, and urinary albumin-excretion rate (UAER) were measured for 52 weeks. The parameters at the end point when serum urate decreased to below 6.0 mg/dL and at 52 weeks were compared to the initial levels at week 0. Results: Serum urate level decreased to the end point in all patients and was maintained at under 6.0 mg/dL throughout the observation period. eGFR significantly increased at the end point and also at 52 weeks. Overall UAER did not change after 52 weeks; however, the treatment decreased UAER significantly in patients with no microalbuminuria. There was a negative relationship between the change of serum urate levels and the change of eGFR, and a negative relationship between the baseline UAER and the change of UAER when patients with macroalbuminuria were excluded. There were no changes in HbA1c levels and blood pressure before and after the treatment. Conclusion: There were significant improvements in kidney function by lowering serum urate levels to under 6.0 mg/dL and the effect was maintained for at least 52 weeks. This treatment may be one strategy to slow the progression of nephropathy in type 2 diabetic patients with hyperuricemia.
Ahmed Omer Yousif is currently working as a Foundation 2 Doctor in Nottingham Queens Medical Centre, UK. He graduated from the University of Liverpool in 2016, after which he worked in Pilgrim Hospital, Boston in East Lincolnshire for one year. There he started his research in Urology and under the guidance of Dr. Shaukat Memon (Consultant Urologist) performed a research audit into urethral strictures. He has since presented a poster in the international conference of Psychiatry 2017 and has been involved in various teaching projects.
Background: Urethral strictures contribute to 17,000 admissions and 12,000 operations yearly with an estimated cost over 10 million in the UK. Current management techniques all involve general anesthetic thus leading to prolonged hospital stay and an increase in NHS resources. A new technique allowing urethral strictures to be managed as an outpatient basis using an instrument called an S curve dilator has been developed. Aim: The primary objective is to assess whether utilizing the S-curve dilator technique was more economical than other techniques employed and secondary objective is to assess the aetiology behind urethral strictures and therefore allow steps to reduce them. Methodology: This was a retrospective study that looked at all the urethral strictures that were treated using S–curve dilators between 23/06/2015 till 03/08/2016. All the S-curve dilator technique operations were performed by one trained consultant over that time period. The study was set in a 400–bed district general hospital covering a population of 731,500 where this technique has recently been utilized since 2015. Results: The national average cost of treating urethral strictures using the S curve dilators is £363 as compared to £1559 as an elective procedure using other procedures requiring general anesthetic. The most common aetiology underlying urethral strictures is iatrogenic damage following trans-urethral resection of the prostate (TURP) operations. Conclusion: The new S Cook dilators allow urethral strictures to be managed as an outpatient procedure, thus; reducing theatre waiting lists, reduced inpatient stay and reduced cost (3 times cheaper). Furthermore, it offers advantages over blind procedures in that there are no false passages and there is reduced risk of damage and failure. Urethral strictures most commonly occur following TURP operations which could be related to urinary catheters being left in too long prior to the operation. Recommendations: Continue using S-curve dilators and train more urologists/ nurses to do them; ensure catheters are not left for too long whilst awaiting TURP operations and; perform a qualitative study regarding patient satisfaction and experience with urethral stricture operations using S-curve dilators. Limitations: The main limitation was the small sample size and the lack of literature on S Cook dilators.