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PubMed2004

[Male urethral stenosis: review of complications].

OBJECTIVES: To evaluate a historical series of urethral stenosis retrospectively. To study the urinary, genital and systemic complications. To study risk factors for the development of such complications and, based on them, identify groups of patients more susceptible to complications with the aim to establish prophylactic, therapeutic or follow-up actions. METHODS: We studied 175 male patients with urethral stenosis, which constitute the historical series of male urethral stenosis treated in the Hospital General Universitario in Alicante from 1977 to 1987 (11 years). Statistical treatment: clinical protocol for data collection. Codification of variables. Descriptive statistics for all variables. Percentage description of qualitative variables. Data processing by the basic SPSS + statistical software and the Harvard Graphics graphical software ran in an IBM PS/2 computer. The level of statistical significance for comparisons between variables was established in p < 0.05. RESULTS: 155/175 patients presented complications (88.57%). The number of complications overall was 795. Complication sites in order of frequency were: 628 (78.99%) urinary tract, 111 (13.96%) genital system, 44 (5.53%) systemic and 12 (1.50%) abdominal wall hernias. The most frequent complications were: acute urinary retention 100 patients, bladder obstructive uropathy 84, urinary tract infection 63, ejaculation disorders 50, stenosis recurrence 47, and 30 with various degrees of renal failure. Most complications were reversible after resolution of the stenosis, although 3 patients had non reversible deterioration of their renal function and 4 unilateral postobstructive renal atrophy 3 patients died as a consequence of such complications (two cases of septicemia and one postoperative pulmonary embolism. Prophylaxis is the best treatment for these complications, eradicating urinary tract infection if present, and treating stenosis itself. Nevertheless, the treatment of complications required 132 medical treatments, 16 suprapubic bladder punctions, 94 surgical treatments, 5 extracorporeal shock wave lithotripsies, 2 mechanical lithotripsies, and 1 hemodialysis in a patient with end stage renal disease (single kidney with ureteritis secondary to tuberculosis). Risk factors for the development of complications are among others: age > 70 years (retired), history of sexually transmitted diseases, urinary tract infection, previous urethral surgery for recurrent stenosis, and post void residual urine. CONCLUSIONS: Complications of urethral stenosis are very frequent in this series. Currently, in comparison with past times, these complications can be prevented, since its diagnostic is very simple by ultrasound. Many of these complications are reversible if obstruction and infection are corrected. Based on these results we have identified several groups of patients with higher risk of complications. Global studies of this issue are necessary, both national and international.

Adolescent↗
PubMed1988

Ofloxacin: its pharmacology, pharmacokinetics, and potential for clinical application.

Ofloxacin is a 4-quinolone antibiotic with rapid bactericidal activity against a wide variety of organisms. Its proposed mechanism of activity is interference with DNA gyrase, an enzyme essential for the replication of bacterial DNA. In vitro activity of ofloxacin includes a variety of aerobic and anaerobic bacteria. Enteric gram-negative bacilli and cocci are generally sensitive to ofloxacin; nonaeruginosa strains of Pseudomonas are less so. Numerous bacterial pathogens of the gastrointestinal tract are also sensitive to the drug. Although its MIC values for gram-positive aerobic organisms are generally higher, ofloxacin's bactericidal activity against these organisms is considered by some to be adequate, and superior to that of most other fluoroquinolones. Ofloxacin is well absorbed after oral administration. Wide tissue and body fluid distribution is demonstrated. Urinary excretion is thought to be the primary route of elimination, with 80% of the dose recovered in the urine within 24 hours. The serum half-life ranges between 2.9 and 9 hours in a dose-dependent manner. Only modest accumulation is reported after multiple-dose administration. Clinical trials using daily dosages of 100-800 mg/day in single or divided doses have been reported in the treatment of a variety of conditions such as skin and soft tissue infections, tonsillitis, sexually transmitted disease, respiratory tract infections, cystitis, and complicated and uncomplicated urinary tract infections. English reports of these trials, however, are generally limited to abstract form, making evaluation of trial design difficult. Side effects most frequently encountered include gastrointestinal and central nervous system reactions.

Anti-Bacterial Agents↗
PubMed2002

Independent representations of limb axis length and orientation in spinocerebellar response components.

Dorsal spinocerebellar tract (DSCT) neurons transmit sensory signals to the cerebellum that encode global hindlimb parameters, such as the hindlimb end-point position and its direction of movement. Here we use a population analysis approach to examine further the characteristics of DSCT neuronal responses during continuous movements of the hind foot. We used a robot to move the hind paw of anesthetized cats through the trajectories of a step or a figure-8 footpath in a parasagittal plane. Extracellular recordings from 82 cells converted to cycle histograms provided the basis for a principal-component analysis to determine the common features of the DSCT movement responses. Five principal components (PCs) accounted for about 80% of the total variance in the waveforms across units. The first two PCs accounted for about 60% of the variance and they were highly robust across samples. We examined the relationship between the responses and limb kinematic parameters by correlating the PC waveforms with waveforms of the joint angle and limb axis trajectories using multivariate linear regression models. Each PC waveform could be at least partly explained by a linear relationship to joint-angle trajectories, but except for the first PC, they required multiple angles. However, the limb axis parameters more closely related to both the first and second PC waveforms. In fact, linear regression models with limb axis length and orientation trajectories as predictors explained 94% of the variance in both PCs, and each was related to a particular linear combination of position and velocity. The first PC correlated with the limb axis orientation and orientation velocity trajectories, whereas second PC with the length and length velocity trajectories. These combinations were found to correspond to the dynamics of muscle spindle responses. The first two PCs were also most representative of the data set since about half the DSCT responses could be at least 85% accounted for by weighted linear combinations of these two PCs. Higher-order PCs were unrelated to limb axis trajectories and accounted instead for different dynamic components of the responses. The findings imply that an explicit and independent representation of the limb axis length and orientation may be present at the lowest levels of sensory processing in the spinal cord.

Anesthesia↗
PubMed1988

Quinolones: a new class of antimicrobial agents with wide potential uses.

Quinolone antibiotics provide potentially important therapy for many infections that heretofore required extensive hospitalization. Improper use of these agents rapidly can lead to resistance and thereby remove them from the physician's arsenal of antimicrobial compounds. It also is possible that with more extensive use, these drugs will demonstrate adverse reactions that to date are unknown. Attention to how the agents are used can simultaneously avoid the problems of resistance and toxicity.

Anti-Infective Agents↗
PubMed1997

Large dorsal horn neurons which receive inputs from numerous substance P-like immunoreactive axon terminals in the laminae I and II of the chicken spinal cord.

Large neurons outlined with numerous substance P (SP)-like immunoreactive (LI) boutons were detected immunocytochemically in the dorsal horn of the chicken spinal cord at the light microscopic level. The cervical enlargement was mainly used for observations. By electron microscopy, asymmetrical synapses were observed between the SP-LI axon terminals and the soma and dendrites of the large neurons. Cell bodies of the large neurons were mostly localized in the lamina I and the region lateral to the lamina I. Some of the cell bodies were also located in the lamina II. Their dendrites extended in the lamina I, in the region lateral to the lamina I, and deeply in the lamina II. In the lamina II, dendrites of these neurons formed synapses with SP-containing central terminals in synaptic glomeruli known to originate from primary afferents. The findings suggest that these large neurons receive nociceptive information directly from primary afferents. In the light of previous investigations, these neurons are considered to be pain-transmitting long ascending tract neurons.

Animals↗
PubMed1999

Antibiotic dispensing by drug retailers in Kathmandu, Nepal.

UNLABELLED: OBJECTIVES To assess over-the-counter antimicrobial dispensing by drug retailers in Kathmandu, Nepal, for rationality, safety, and compliance with existing government regulations. METHODS: Standardized cases of dysuria in a young adult male and acute watery diarrhoea in a child were presented by a mock patient to retailers at 100 randomly selected pharmacies. Questions asked by retailers and advice and medications given at their initiative were recorded. RESULTS: All retailers engaged in diagnostic and therapeutic behaviour beyond their scope of training or legal mandate. Historical information obtained by retailers was inadequate to determine the nature or severity of disease or appropriateness of antimicrobial therapy. 97% (95% CI = 91.5-99.4%) of retailers dispensed unnecessary antimicrobials in diarrhoea, while only 44% (95% CI = 34.1-54.3%) recommended oral rehydration therapy and only 3% (95% CI = 0.6-8.5%) suggested evaluation by a physician. 38% (95% CI = 28.5-48.2%) gave antimicrobials in dysuria, yet only 4% (95% CI = 1.1-9.9%) adequately covered cystitis. None covered upper urinary tract or sexually transmitted infections, conditions which could not be ruled out based on the interviews, and only 7% (95% CI = 2.9-13. 9%) referred for a medical history and physical examination necessary to guide therapy. CONCLUSIONS: Although legislation in Nepal mandates a medical prescription for purchase of antibiotics, unauthorized dispensing is clearly problematic. Drug retailers in our study did not demonstrate adequate understanding of the disease processes in question to justify their use of these drugs. Risks of such indiscretion include harm to individual patients as well as spread of antimicrobial resistance. More intensive efforts to educate drug retailers on their role in dispensing, along with increased enforcement of existing regulations, must be pursued.

Adult↗
PubMed2005

Toward understanding the risk of secondary airborne infection: emission of respirable pathogens.

Certain respiratory tract infections are transmitted through air. Coughing and sneezing by an infected person can emit pathogen-containing particles with diameters less than 10 microm that can reach the alveolar region. Based on our analysis of the sparse literature on respiratory aerosols, we estimated that emitted particles quickly decrease in diameter due to water loss to one-half the initial values, and that in one cough the volume in particles with initial diameters less than 20 microm is 60 x 10(-8) mL. The pathogen emission rate from a source case depends on the frequency of expiratory events, the respirable particle volume, and the pathogen concentration in respiratory fluid. Viable airborne pathogens are removed by exhaust ventilation, particle settling, die-off, and air disinfection methods; each removal mechanism can be assigned a first-order rate constant. The pathogen concentration in well-mixed room air depends on the emission rate, the size distribution of respirable particles carrying pathogens, and the removal rate constants. The particle settling rate and the alveolar deposition fraction depend on particle size. Given these inputs plus a susceptible person's breathing rate and exposure duration to room air, an expected alveolar dosemicrois estimated. If the infectious dose is one organism, as appears to be true for tuberculosis, infection risk is estimated by the expression: R = 1-exp(-micro). Using published tuberculosis data concerning cough frequency, bacilli concentration in respiratory fluid, and die-off rate, we illustrate the model via a plausible scenario for a person visiting the room of a pulmonary tuberculosis case. We suggest that patients termed "superspreaders" or "dangerous disseminators" are those infrequently encountered persons with high values of cough and/or sneeze frequency, elevated pathogen concentration in respiratory fluid, and/or increased respirable aerosol volume per expiratory event such that their pathogen emission rate is much higher than average.

Aerosols↗
PubMed1997

Levofloxacin and trovafloxacin: the next generation of fluoroquinolones?

The pharmacology, spectrum of activity, pharmacokinetics, clinical efficacy, and adverse effects of levofloxacin, recently approved by FDA, and trovafloxacin, currently undergoing clinical trials, are reviewed. Compared with quinolones in current use, levofloxacin is more potent against gram-negative bacteria and exhibits better antipseudomonal activity as well as greater oral bioavailability. Trovafloxacin is more potent than existing quinolones against gram-positive bacteria. Both agents exert their antibacterial effects by inhibiting bacterial DNA synthesis. Compared with other quinolones, levofloxacin and trovafloxacin both demonstrate superior activity against the Bacteroides fragilis group, Chlamydia spp., Mycoplasma pneumoniae, and Mycobacterium spp. The half-life (t1/2) of levofloxacin is nearly eight hours. Levofloxacin can therefore be administered once daily for mild to moderate infections and twice daily for more serious infections. The recommended daily dose is 500 mg. Trovafloxacin has a t1/2 of 12 hours, which allows for single daily doses, and is extensively metabolized. Levofloxacin has demonstrated clinical efficacy in the treatment of community-acquired respiratory-tract infections, genitourinary infections, skin and skin-structure infections, acute bacterial sinusitis, and infections of the head and neck. Trovafloxacin may have a role in treating skin and skin-structure or soft-tissue infections respiratory-tract infections, sexually transmitted diseases, and meningitis. Both agents are well tolerated, with central-nervous-system and gastrointestinal adverse effects reported most frequently. Concomitant administration of antacids or compounds containing meal cations decreases absorption of these quinolones. Levofloxacin and trovafloxacin have favorable antimicrobial and pharmacokinetic profiles, offering the advantages of once-daily doses as well as superior potency and spectrum of activity compared with currently available quinolones.

Animals↗
PubMed2002

Contextual influences on reproductive health service use in Uttar Pradesh, India.

This study examines the determinants of the use of four types of reproductive health-care services in Uttar Pradesh, India: contraceptive services, antenatal care, delivery in a medical institution, and services dealing with reproductive tract and sexually transmitted infections. The analysis uses a multilevel modeling strategy to assess the presence of household- and community-level variation in service use. The influence of community-level characteristics and reproductive health-care service attributes on service use is examined. The results highlight strong community-level influences on service use, although the type of community effect varies by service type. The role of some individual and household factors in determining a person's use of services is mediated by the characteristics of the community in which the individual lives. The results demonstrate the need to look beyond individual factors when examining health-care-seeking behavior, and illustrate that there is no singular "community" effect on service use.

Adolescent↗
PubMed1985

Amoxicillin-potassium clavulanate: a novel beta-lactamase inhibitor.

Potassium clavulanate is a novel beta-lactamase inhibitor, which, in combination, expands the spectrum of amoxicillin to include many amoxicillin-resistant organisms. Potassium clavulanate is excreted 30-50 percent unchanged renally and its plasma time-course parallels that of amoxicillin. Several studies suggest that an increased incidence of gastrointestinal side effects may occur with this combination. In the current oral formulation, its greatest utility may be in pediatric infections due to beta-lactamase-producing Haemophilus influenzae and B. cattarhalis. In adults, the combination has not been adequately studied against other effective antibiotics.

Amoxicillin↗
PubMedDate not supplied

Schistosomal epididymitis.

Epididymitis is a frequent inflammatory process. It is related to sexually transmitted diseases, urinary tract infections by E. coli, or scrotal trauma. We describe the case of a Caucasian 32-year old man, who presented scrotal pain for 3 months, with difficult management with medication. Testis was normal; however, the left epididymis was extremely painful and hardened. Following the unsuccessful use of analgesic and anti-inflammatory medication, a left epididymectomy was performed, with resolution of the pain. The pathological examination showed the presence of chronic inflammatory process associated with eggs of the parasite Schistosoma mansoni in the resected epididymis. Patient evolved without pain in the post-operative period and was medicated with a single dose of oxamniquine after etiologic confirmation.

Adult↗
PubMed1999

Urological needs assessment for primary care practice: implications for undergraduate medical education.

PURPOSE: The majority of graduating medical students will become primary care physicians. We discuss what urological topics primary care physicians need to know, proficiency in urological skills of primary care physicians and undergraduate urological curriculum recommendations that would serve the needs of primary care physicians. MATERIALS AND METHODS: A written survey instrument was mailed to all 452 family practice residency directors in the United States. Subjects rated how well family practice physicians need to know urological topics and how proficient they must be in urological skills. RESULTS: A total of 329 responses were received (response rate 73%). Respondents indicated that they need to know urinary tract infection, sexually transmitted disease, epididymitis, benign prostatic hyperplasia diagnosis, hematuria and erectile dysfunction diagnosis very well. They indicated a greater need to know diagnostics than staging or management of prostate, bladder, renal or testis cancer (p <0.05). Among diagnostics respondents indicated that generalists should be highly proficient in urinalysis interpretation. Proficiency was ranked greater for interpretations of semen analysis than excretory urogram, abdominal computerized tomography or magnetic resonance imaging, or renal ultrasound (p <0.05). Proficiency in catheter insertion and circumcision was ranked highly, and vasectomy was ranked moderately. CONCLUSIONS: Primary care physicians need to know and be proficient in many urological topics and skills. They need to know diagnostics better than staging and management information, and urological infectious topics better than urological cancers. They need to be proficient in physical examination, urinalysis interpretation, catheter insertion, circumcision and vasectomy. Undergraduate medical education should reflect these needs.

Clinical Competence↗
PubMed2002

Reproductive tract infections: prevalence and risk factors in rural Bangladesh.

OBJECTIVE: To determine the prevalence of and risk factors for reproductive tract infections among men and women in a rural community in Bangladesh. METHODS: In the Matlab area a systematic sample of married non-pregnant women aged 15-50 years was drawn from a comprehensive household registration system for married women. A systematic sample of married and unmarried men in the same age group was drawn from a census-derived demographic surveillance list. Private interviews were conducted with 804 women in a clinic, and cervical, vaginal, urinary and serological samples were collected. Urine and blood specimens were obtained from 969 men who were interviewed at home. FINDINGS: The prevalence of bacterial and viral reproductive tract infections was low to moderate. For example, fewer than 1% of the women had a cervical infection. No cases of human immunodeficiency virus (HIV) infection were found. However, among men there was a high level of reported risk behaviour and a low level of protection against infection. CONCLUSION: A low prevalence of reproductive tract infections, coupled with a high level of reported risk behaviour, indicated a need for primary programmes that would prevent an increase in the incidence of reproductive tract infections, sexually transmitted infections and HIV infection.

Adolescent↗
PubMed2003

Molecular mechanisms of fluoroquinolone resistance.

Fluoroquinolones have a broad spectrum of activity for complicated urinary tract infections, gastrointestinal infections, respiratory tract infections, sexually transmitted diseases, and chronic osteomyelitis. Since fluoroquinolones are excellent antibiotics for a number of clinical indications, their consumption has increased rapidly, both in human medicine and in food animals. Resistance to fluoroquinolones is chromosomal mediated, involving mutations either in the target genes including DNA gyrase (gyrA or gyrB) and topoisomerase IV (parC or parE), or in the regulatory factors controlling bacterial permeability or the efflux capacity of the bacteria. This review focuses on mechanisms of fluoroquinolone resistance, including known and proposed molecular mechanisms. This review also discuses the clinical impact of fluoroquinolone-resistant bacteria.

Animals↗
PubMed1992

The role of the fluoroquinolones.

Over the past decade, the quinolone antimicrobial class has enjoyed a renaissance with the emergence of the fluoroquinolone subclass. Norfloxacin, ciprofloxacin, ofloxacin, enoxacin, and lomefloxacin have the advantages of broad antimicrobial activity profiles including gram-positive and -negative aerobes, favorable pharmacokinetic profiles including substantial oral bioavailability and extensive tissue distribution, and in general, favorable safety profiles. As clinical experience accumulates, our understanding of their optimum roles will become more refined. In six instances, these agents may be preferred over currently available agents: complicated urinary tract infections, empiric therapy of suspected bacterial gastroenteritis, eradication of the Salmonella carrier state, respiratory exacerbations due to Pseudomonas aeruginosa in patients with cystic fibrosis, invasive external otitis, and chronic gram-negative bacillary osteomyelitis. The efficacy and convenience of these agents for the treatment of a broad range of infections have already resulted in their extensive use. Such use carries the risk of selection pressure for the development of resistance and the adverse consequences of increased cost over less expensive, equally effective alternatives. The use of the fluoroquinolones should focus on infections where there is demonstrated benefit of these agents over conventional agents or infections for which there are few or no alternatives.

Anti-Infective Agents↗