Utilising alternative cystoscopic schedules to minimise cost and patient burden after trimodality therapy for muscle-invasive bladder cancer.

BACKGROUND: To assess urinary symptoms and urine cytology as screening tools for cystoscopic detection of local recurrence after bladder-preserving trimodality treatment (TMT). METHODS: Patients with muscle-invasive bladder cancer receiving definitive TMT follow-up three monthly for 2 years, six monthly for the next 3 years and then yearly, with a clinical review, urine cytology and cystoscopy at each visit (triple assessment, TA). Grade 2+ cystitis/haematuria absent/present was scored 0/1, and urine cytology reported negative/suspicious or positive was scored 0/1, respectively. The performance of these two parameters for predicting local recurrence in cystoscopic biopsy was tested. Other hypothetical surveillance schedules included cystoscopy on alternate visits (COAV), or suspected recurrence (COSR), six-monthly COSR and six-monthly TA. RESULTS: A total of 630 follow-up visits in 112 patients with 19 recurrences (7 muscle invasive, 12 non-muscle invasive) at a median follow-up of 19 months were analysed. The sensitivity and specificity of clinical symptoms were 47.4% and 92%, and for urine cytology 58% and 85%, respectively. The combination of clinical symptoms and cytology (COSR) was 95% sensitive and 78% specific for local recurrence but 100% sensitive for muscle-invasive recurrence. Both COAV and COSV schedules showed a high area under the curve (AUC) for detecting local recurrence (COAV = 0.84, COSR = 0.83), muscle-invasive recurrence (AUC = 0.848 each) and non-muscle-invasive recurrence (COAV = 0.82, COSR = 0.81); reducing the need for TAs by 64% and 67% respectively, and overall cost by 18% and 33%, respectively. CONCLUSION: Cystoscopy at suspected recurrence during follow-up is safe and the most cost-effective for detecting muscle-invasive local recurrences, while cystoscopy at alternate visits may be more optimal for detecting any local recurrence.

Prevalence and Antibiogram Assessment of Staphylococcus aureus in Beef at Municipal Abattoir and Butcher Shops in Addis Ababa, Ethiopia.

OBJECTIVE: A cross-sectional study was conducted from October 2013 to April 2014 to determine the prevalence and antibiotic resistance of Staphylococcus aureus from beef of Addis Ababa Abattoir and butcher shops in Addis Ababa. Seven hundred sixty-eight swab samples were taken from the abattoir and butcher carcasses using a systematic random sampling. One hundred twenty swab samples were also taken from hooks, cutting tables, and knives from the abattoir. Staphylococcus aureus positive isolates were taken for antibiotic susceptibility test. A questionnaire survey was conducted in the abattoir and butcher workers to assess the hygienic practice and possible risk factors regarding the contamination of meat. RESULTS: The prevalence of S. aureus in the abattoir, butcher, cutting table, hook, and knife was 9.4%, 19.8%, 15%, 15%, and 22.5%, respectively. The prevalence of S. aureus in the knife and butcher was found to be 2.8 (OR = 2.8, CI = 1.2-6.4) and 2.4 (OR = 2.4, CI = 1.6-3.6) times that of the abattoir results (p < 0.01). The antimicrobial susceptibility testing was also conducted on 133 isolates of S. aureus using the disc diffusion susceptibility method. Bacitracin, neomycin, and methicillin were found to be 100% resistant to S. aureus. To avoid the presence of pathogenic Staphylococcus isolates, preventive measures using good hygienic practices during slaughtering and handling of the beef carcasses are recommended.