Características de las infecciones urinarias en pacientes con vejiga neurógena según el sistema de vaciado vesical utilizado en comparación con pacientes sin vejiga neurógena

IntroductionTo analyze the prevalence and etiology of urinary tract infection in patients with neurogenic bladder depending on the bladder emptying system used as compared to a population with no neurological impairment. To assess perception of urinary tract infection by patients with neurogenic bladder.Materials and methodsAn epidemiological and prospective study was conducted on 283 patients, in whom a total of 283 urethral cultures were performed. Of these, 106 came from patients with neurological damage, 28 from a control group with no neurological impairment, 74 from patients admitted to the intensive care unit (ICU) of our hospital, and 75 from patients who attended the emergency room for symptoms of acute urinary tract infection. The sensitivity and specificity of patient perception as indicative of urinary tract infection was analyzed using ROC curves.ResultsPositive urethral cultures were found in 66% of patients with neurological damage and 25% of control patients. Within the neurological group, patients with the highest rates of positive urethral cultures were those with myelomeningocele (MMC) (81.5%) and spinal cord injuries (71.7%), with a statistically significant difference (p=0.01). The microorganism most commonly found in all subgroups was Escherichia coli, followed by Enterococcus faecalis and Pseudomonas aeruginosa in the neurological subgroup, Enterococcus faecalis and Proteus mirabilis in the control subgroup, and Klebsiella pneumoniae and Staphylococcus agalactiae in the emergency room subgroup. In the ICU subgroup, the most commonly found microorganism was Enterococcus faecalis, followed by Escherichia coli and Pseudomonas aeruginosa.Sensitivity for perception by neurological patients as an indication of the presence of urinary tract infection was 97.2%, as compared to 80% in the control group. Specificity was low in both groups.ConclusionsE. coli was the microorganism found in positive urethral cultures from all subgroups, except in the ICU group. The groups with the highest urinary tract infection rates were patients with MMC and spinal cord injuries. Sensitivity and specificity (as measured using ROC curves) for perception by neurological patients as an indication of the presence of urinary tract infection was higher in neurological patients than in the non-neurological control group (p=0.0004, area: 0.643).     

Current status and outcomes of coronary revascularization 1999 to 2002: 148,396 surgical and percutaneous procedures

BACKGROUND: Current practice, trends, and early outcomes in patients undergoing surgical and percutaneous coronary interventions (PCI) are changing and subject to speculation. METHODS: 148,396 consecutive patients in 69 HCA, Inc hospitals who underwent either PCI or coronary artery bypass grafting (CABG) were tracked in the HCA Casemix Database from 1999 through the first quarter of 2002. Comorbid conditions, procedures, complications, and outcome variables were defined through International Classification of Diseases, Ninth Revision coding. Odds ratios (OR) for death and other procedure-related complications were estimated using logistic regression adjusting for age, sex, and 31 other patient clinical and procedural characteristics. RESULTS: Now 65.4% of all coronary revascularization is by PCI with a 6.8% annual rate of increase whereas CABG volume is declining by 1.9% per year. However the majority of these changes occurred between 1999 and 2000 with only small changes in the last 3 years. Coronary artery bypass grafting is still utilized primarily for multivessel disease (3.38 bypasses per patient) whereas PCI is predominately (83%) still limited to single-vessel intervention. Unadjusted mortality rates over the full 13-quarter period were 1.25% for PCI and 2.63% for CABG (p < 0.001), with PCI rates remaining constant and CABG mortality declining. Twenty-three percent of CABG is performed off pump with a lower mortality than conventional on-pump CABG (2.37% versus 2.69%, p < 0.001). Percutaneous coronary intervention patients have lower mortality (OR 0.51), and fewer acute renal failure (OR 0.39), neurologic (OR 0.12), and cardiac (OR 0.16) complications than CABG patients (p < 0.001). CONCLUSIONS: Interventions for coronary artery disease continue to rise primarily due to an increase in PCI. The volume of PCI continues to increase relative to CABG. Although adverse outcomes are higher after CABG, the proportion of multivessel disease treated is greater. The difference in adverse outcomes between CABG and PCI remains small and continues to decline.     

Metabolic syndrome is directly associated with gamma glutamyl transpeptidase elevation in Japanese women

AIM: This study aimed to determine whether metabolic syndrome is directly or indirectly, through fatty liver, associated with elevated gamma-glutamyl transpeptidase (GGT) levels in Japanese women. METHODS: From 4 366 women who received their annual health check-up, 4211 women were selected for analysis. All 4211 women were negative for both hepatitis B surface antigen and antibody to hepatitis C virus. Clinical and biochemical variables were examined by using univariate and multivariate analysis. RESULTS: A raised GGT level (&gt;68 IU/L) was seen in 258 (6.1%) of the 4 211 women. In univariate analysis, all variables examined (age, body mass index, blood pressure, hemoglobin concentration, fasting blood glucose, glycosylated hemoglobin A1c, cholesterol, triglyceride, and uric acid) were associated with the elevated GGT level, whereas in multivariate analysis, four variables (age ≥ 50 yr, hemoglobin ≥14 g/dL, triglyceride ≥150 mg/dL, and presence of diabetes) were significantly and independently associated with raised GGT level. Clinical variables predicting the presence of ultrasonographic evidence of fatty liver were also examined by multivariate analysis; four variables were associated with the presence of fatty liver: BMI = 25 kg/m^2, hemoglobin ≥14 g/dL, triglyceride ≥150 mg/dL, and uric add ≥7 mg/dL. There was no significant association between the raised GGT level and the presence of fatty liver. Hypertriglyceridemia was significantly and independently associated with both the raised GGT level and the presence of fatty liver. CONCLUSION: Metabolic syndrome seemed to be directly, not indirectly through fatty liver, associated with the raised GGT level in ]apanese women.     

Internalizing and externalizing symptoms and attributional style in youth with diabetes.

The psychiatric functioning of 28 youths with insulin-dependent diabetes mellitus was examined. Measures of psychological functioning were related to age at onset, duration of diabetes, and metabolic control, as assessed by HgbAlC. Children diagnosed with insulin-dependent diabetes mellitus at a later age were considered by teachers to have more behavioral problems. Children who had better metabolic control tended to hold themselves responsible for negative events. It is worthwhile to develop interventions to teach diabetic children a realistic balance between taking appropriate responsibility for controllable negative events without taking undue blame for uncontrollable negative events associated with the disease.     

Impact of adolescent mental disorders and physical illnesses on quality of life 17 years later

OBJECTIVE: To investigate associations of mental disorders and physical illnesses during adolescence with quality of life (QOL) 17 years later. DESIGN: The Children in the Community Study, a prospective longitudinal investigation. SETTING: Upstate New York. PARTICIPANTS: A community-based sample of mothers and their offspring were interviewed. MAIN OUTCOME MEASURES: Axis I disorders and Axis II personality disorders and physical illnesses were assessed by self-report and mother report in 1985-1986. Outcome indicators of QOL were assessed in 2001-2004. RESULTS: Compared with participants without adolescent illness or disorder, those with a history of physical illness reported poorer physical health (mean difference [MD], -4.8); those with a history of an Axis I disorder reported poorer physical health (MD, -8.0) and more problematic social relationships (MD, -4.5); and those with a history of personality disorder reported poorer physical health (MD, -8.2), more problematic social relationships (MD, -5.0), lower psychological well-being (MD, -3.6), and more adversity within their environmental context (MD, -4.6) in adulthood. Comorbid physical illness and mental disorder were associated with all 5 QOL domains (MD, -3.1 to -11.9). After adjusting for all demographic variables and comorbidity, associations remained between physical illness and poor physical health (effect size [ES], -0.33); an Axis I disorder and problematic social relationships (ES, -0.37); and personality disorder and problematic social relationships (ES, -0.36), low psychological well-being (ES, -0.23), impaired role function (ES, -0.24), and an adverse environmental context (ES, -0.50). CONCLUSIONS: Mental disorders may have more adverse long-term associations with QOL than do physical illnesses. Adolescent personality disorders may have a more adverse impact on adult QOL than do adolescent Axis I disorders.     

Balance between somatostatin and D2 receptor expression drives TSH-secreting adenoma response to somatostatin analogues and dopastatins

Context First‐line therapy for thyrotropin‐secreting pituitary adenomas (TSHomas) is neurosurgery, while medical treatment rests mainly on somatostatin analogues. Clinically available sst₂‐preferring analogues, octreotide and lanreotide, induce normalization of hormone levels in approximately 90% of patients and tumour shrinkage in 45%. Objective We evaluated somatostatin 1, 2, 3 and 5 and dopamine D2 receptor expression in tumour samples from three TSHomas, and the relationships between receptor expression, in vitro antiproliferative response and clinical data, including octreotide test and three months of therapy with octreotide long‐acting repeatable (LAR). TSHoma cell proliferation was tested in vitro using octreotide, cabergoline and two chimeric compounds, BIM‐23A760 and BIM‐23A387. Results All patients showed significant TSH lowering to acute octreotide test, but a hormonal response to long‐term treatment was observed in only two patients, showing a high sst₅/sst₂ ratio. Patient 2, characterized by high expression of sst₂ and sst₁ and a relative lower expression of sst₅, experienced tachyphylaxis after prolonged octreotide treatment. In vitro, the somatostatin/dopamine receptor agonist BIM‐23A760 caused the highest antiproliferative effect among those tested. Combined treatment with octreotide and cabergoline displayed an additive effect of magnitude comparable to that of the other chimeric compound (BIM‐23A387). Octreotide resistance was confirmed in cells isolated from the nonresponder patient, although it could be overcome by treatment with the chimeric compounds. Conclusions A high sst₅/sst₂ ratio might be predictive of a positive outcome to long‐term treatment with somatostatin analogues in TSHomas. Moreover, combined somatostatin and D₂ receptor targeting might be considered as a potential tool to improve the response rate in octreotide‐resistant tumours.