Urinary bacteriologic study prior to endoscopic urologic surgery

ObjectiveThe objectives of this study are to know the incidence of preoperative bacteriuria in patients undergoing endoscopic urologic surgery, to analyze the most frequent microorganisms appearing in the cultures and their resistance to antibiotics in order to select the most appropriate prophylactic one for our population, and to determine the risk factors related to postoperative bacteriuria or sepsis of urologic originMaterial and Methods449 patients undergoing endoscopic urologic surgery were included in the study. Urinary samples were collected for culture prior to prophylactic antibiotic administration and again a week after bladder catheter removal once the antibiotic treatment was finished. Variables related to an increase in infectious complications were analyzed. Special attention was paid to postoperatory incidences, mainly those of infectious natureResultsPreoperative bacteriuria was found in 66 out of 428 patients (15.4%). It was found to be related to age, sex, previous infection episodes, diabetes mellitus, indwelling catheter and to the pathology for which operation was indicated. The most frequently found microorganism was Escherichia Coli. Resistance to prophylactic antibiotic was found in 37.9% of patients with preoperatory bacteriuria. Postoperatory bacteriuria, observed in 22.0% of the patients was exclusively related to preoperatory bacteriuria. 2.9% of patients showed sepsis of urinary origin criteria during hospital staying, and it was found to be exclusively related to length of surgery and neither to preoperatory bacteriuria nor to indwelling catheter time or the “inappropriate” prophylactic antibiotic use in these casesConclusionsA good part of patients who underwent endoscopic surgery showed preoperatory bacteriuria, responsible for postoperative bacteriuria in less than 25% of the cases. The length of surgery seemed to be the only related cause whit sepsis of urinary origin     

Apoptosis in normal and diseased oral tissues

Apoptotic cell death plays an important role in maintenance of the normal physiological state and in the pathogenesis of diseases in the body. Over the last three decades the molecular mechanisms of apoptosis have been unravelled leading to development of novel therapeutic approaches. This paper aims to present current knowledge of the role of apoptosis in normal oral tissues and in the development of oral diseases.     

Evaluation of the pattern of treatment, level of anticoagulation control, and outcome of treatment with warfarin in patients with non-valvar atrial fibrillation: a record linkage study in a large British population

Objective: To evaluate how well patients with non-valvar atrial fibrillation (NVAF) were maintained within the recommended international normalised ratio (INR) target of 2.0–3.0 and to explore the relation between achieved INR control and clinical outcomes.

Design: Record linkage study of routine activity records and INR measurements.

Setting: Cardiff and the Vale of Glamorgan, South Wales, UK.

Participants: 2223 patients with NVAF, no history of heart valve replacement, and with at least five INR measurements.

Main outcome measures: Mortality, ischaemic stroke, all thromboembolic events, bleeding events, hospitalisation, and patterns of INR monitoring.

Results: Patients treated with warfarin were outside the INR target range 32.1% of the time, with 15.4% INR values > 3.0 and 16.7% INR values < 2.0. However, the quartile with worst control spent 71.6% of their time out of target range compared with only 16.3% out of range in the best controlled quartile. The median period between INR tests was 16 days. Time spent outside the target range decreased as the duration of INR monitoring increased, from 52% in the first three months of monitoring to 30% after two years. A multivariate logistic regression model showed that a 10% increase in time out of range was associated with an increased risk of mortality (odds ratio (OR) 1.29, p < 0.001) and of an ischaemic stroke (OR 1.10, p = 0.006) and other thromboembolic events (OR 1.12, p < 0.001). The rate of hospitalisation was higher when INR was outside the target range.

Conclusions: Suboptimal anticoagulation was associated with poor clinical outcomes, even in a well controlled population. However, good control was difficult to achieve and maintain. New measures are needed to improve maintenance anticoagulation in patients with NVAF.

     

Estimated cost of inpatient admissions and outpatient appointments for a population with epilepsy: a record linkage study

Purpose: This study describes the hospital costs for a population with epilepsy in 1 year (1999). The study was conducted in a defined geographic United Kingdom population of 424,000. METHODS: A register of patients with epilepsy was constructed by using a variety of data sources that had undergone a process of record linkage. Hospital admissions were coded by using Healthcare Resource Group (HRG) and costed by using published National Health Service reference costs. A population of 3,892 people with epilepsy was recorded. RESULTS: The cost of inpatient care for these patients with epilepsy was pound 2,537,386 ($4,135,939), an excess of pound 1,598,909 ($2,606,222) compared with the population as a whole. Of this, pound 320,182 ($521,897) was associated with a primary diagnosis of epilepsy, and pound 679,757 ($1,108,004) was associated with secondary diagnoses. Outpatient expenditure was pound 732,823 ($1,194,501). CONCLUSIONS: This study demonstrates that people with epilepsy use excess resources and that this is not explained solely by either the direct or indirect effects of their epilepsy. These data may help in understanding of the complex issues surrounding the health economics of epilepsy.     

Usefulness of troponin I for predicting systolic dysfunction in acute coronary syndromes. Results of a prospective and quantitative study

The relationship between troponin I and systolic function (quantitative contrast ventriculography) was evaluated in 137 consecutive patients with a first acute coronary syndrome (60 with and 77 without ST elevation). In general, a larger troponin I peak value was related with a more depressed ejection fraction and poorer regional systolic function (p < 0.0001). Nevertheless, this correlation was weaker than expected, especially in those cases without ST-segment elevation, suggesting that other factors apart from systolic dysfunction must be taken into account in order to explain the worse prognosis of those patients with increased serum levels of this marker of myocardial damage.     

Current situation in Spain of aerosol insect sprays registered for household use by the environmental health authorities

BACKGROUND: The recent transposition of the Biocides Directive by means of Royal Decree 1054/2002 involves a substantial change in different Environmental Health-related aspects. To assess the impact of these changes, an analysis of the current situation is provided, based on which the consequences of the implementation of this Directive in Spain may be assessed, in addition to setting out the main aspects which must be analyzed with a view to a Biocides Registry being put into place in accordance with the aforementioned Royal Decree. METHODS: The analysis was made based on the data included in the Spanish Ministry of Health and Consumer Affairs related to aerosol insect sprays registered for Household Use. Aerosols were chosen as a result of their being the type most numerous on the market for household use. RESULTS: The formulation of these aerosols includes 25 insecticides, 1 disinfectant and 2 synergizers. A majority of the 298 aerosol insect sprays include some pyretroid in their composition, by itself or combined with some other insecticide, disinfectant and/or synergizing compound. Most of these biocides are a mixture of active substances. CONCLUSIONS: Based on the analysis made, the need of setting out new procedures for assessing the effectiveness of the formulas prepared for the use in question (design of standardized testing protocols, assessment of effectiveness on the different pest species, the effect of the mixture of active ingredients, safety timeframes, ...), in addition to the aspects related to toxicology; ecotoxicology or physicochemical characteristics.