Association of interleukin-17F (rs763780) single nucleotide polymorphism with multiple sclerosis and optic neuritis.

IL-17F single nucleotide polymorphism (SNP) can affect IL-17F expression and activity and this can lead to the increased susceptibility to several autoimmune diseases. The aim was to investigate the association of IL-17F (rs763780) SNP with the development of multiple sclerosis (MS) in a cohort of Egyptian patients and to evaluate the effect of this polymorphism on the disease course. IL-17F (rs763780) gene polymorphisms was typed by TaqMan genotyping assay for 231 Egyptians divided into 102 MS patients and 129 healthy controls with matched age and sex. The IL-17F rs763780 C containing genotypes (CT+CC) and C allele have statistically significant increased frequency in MS patients when compared with controls (p = 0.005 and 0.004 respectively) especially in females' patients (p = 0.005 and 0.006 respectively). The heterozygous CT genotype was associated with the presence of optic neuritis (p = 0.038). The multivariable regression analysis revealed significant associations between smoking, the higher frequency of attacks and the prediction of higher EDSS score (p = 0.032, 0.049 respectively). It can be concluded that the IL-17F rs763780 C containing genotypes (CT and CC) and C allele may be risk factors for the development of MS in the studied Egyptian cohort by a gender-dependent mechanism that contributes to tendency for predisposition in females and optic neuritis is more common in patients carrying the CT heterozygous genotype.

Immunomodulatory and anti-cancer potential of cloves (Syzygium aromaticum) bud extract and its phytogenic silver nanoparticles.

Clove plant (Syzygium aromaticum) is one of the Myrtaceae family. It's a common flavor in food and the traditional medicine. The study's objective was to ascertain whether the clove bud aqueous extract (CAE) and CAE + nanosilver have any biological effects on immune cells and HT-29 colon cancer cell line. Nanosilver was produced through green synthesis approach using CAE. Produced nanosilver was characterized via electron microscope (scanning, SEM) and ultraviolet-visible spectroscopy. CAE and CAE + nanosilver were examined for their active biomolecules using FTIR analysis, p53 contents using real-time PCR, apoptosis and cell cycle arrest power on HT-29 cancer cell line via flow cytometerty and immunomodulatory potential utilizing MTT assay. Results cleared that a spherical nanosilver with a diameter range of 53 nm was formed by CAE. There were several active biomolecules in CAE and CAE + nanosilver. CAE and CAE + nanosilver increased the p53 protein expression and apoptotic cell number in HT-29 colon cancer cells. CAE and CAE + nanosilver could arrest HT-29 cells at the phase G2/M. CAE and CAE + nanosilver stimulated quiescent and PHA-pre-treated splenic cells at higher concentrations, and CAE suppressed quiescent splenic cell when diluted. In conclusion, the safe edible Syzygium aromaticum plant can be utilized to make anti-tumor agent, essentially for colon tumor. As Syzygium aromaticum plant could stimulate immune cells, it can be used as immune-stimulatory agent that can help fight tumor and tumor development.

Effect of Inclusion of Degraded and Non-Degraded Date Pits in Broilers' Diet on their Intestinal Microbiota and Growth Performance.

The current study aims to assess the effect of non-degraded date pits (NDDP) and degraded date pits (DDP) in broilers' diets on gut microbiota and growth performance. The degradation of date pits (DP) occurred via the cellulolytic fungus Trichoderma reesei by a solid-state degradation procedure. One-day-old Brazilian broilers were allocated into six dietary groups: (1) maize-soy diet, (2) maize-soy diet with oxytetracycline (20%, 50 g 100 kg-1), (3) maize-soy diet with 5% NDDP, (4) maize-soy diet with 10% NDDP, (5) maize-soy diet with 5% DDP, and (6) maize-soy diet with 10% DDP. At the end of the trial, the total count of bacteria was significantly (p < 0.05) less in broilers fed 10% DDP diet (treatment 6) compared with the control group (treatment 1). In addition, DDP and oxytetracycline control diets have a similar diminishing effect on total bacterial counts and the populations of Salmonella, Campylobacter, Shigella spp., and Escherichia coli. Over 35 days of trial, weight gains were similar among the six dietary groups. Our results showed that DDP and control diets have a similar effect on growth performance. The feed conversion ratio (FCR) was poorer in broilers fed NDDP diets than other treatments. The European Production Efficiency Index (EPEI) was greater with 5% and 10% DDP than those fed NDDP at the same levels, with no significant variance from the control and antibiotic-supplemented diet (treatment 2). Overall, it can be suggested that maintaining 10% of DDP can partly replace dietary maize while also serves as a gut health enhancer and thus a growth promoter in the diet for broilers.

Effect of Trichoderma reesei Degraded Date Pits on Antioxidant Enzyme Activities and Biochemical Responses of Broiler Chickens.

The long-term use of antimicrobials as growth promoters in poultry feed leads to antimicrobial resistance in pathogens. Thus, alternatives to antibiotics are essential for reasons associated with both safety and cost-effectiveness. Underutilized plant sources need to be developed to replace antibiotics in broiler feed. Several feed resources have been introduced so far, but they have yet to be applied widely. Date pits are a major by-product of the date industry (6-8%) and have the potential antioxidant to replace antibiotics. In this study, fresh date pits were degraded using the mold Trichoderma reesei under solid-state degradation (SSD), resulting in degraded date pits (DDP). A total of 180 Brazilian "Cobb 500" broiler chicks were divided into six feed treatments in triplicate groups. The treatments were corn-soy basal diet (positive control; C+), corn-soy + 20% oxytetracycline at 0.05% (negative control; C-), corn-soy + 10% DDP, corn-soy + 0.2% mannan-oligosaccharides (MOS), corn-soy + 0.1% mannose, and corn-soy + 0.2% mannose. The antioxidant and biochemical effects of DDP, MOS, and mannose were determined in the blood serum, liver, and intestine of broilers at age 21 and 42 days. The results indicated that the contents of antioxidants such as flavonoids and phenolics, as well as the MOS content in DDP, were increased by the degradation process. Additionally, mannose, glucose, arabinose, rhamnose, and glucuronic acid were significantly increased in DDP after degradation. The activity of antioxidant enzymes (GPx-glutathione peroxidase, catalase, and SOD-superoxide dismutase) in the serum, liver, and intestine of broilers fed with diets containing 10% DDP and 0.2% MOS was increased significantly compared to the control group. Malondialdehyde activity was decreased, whereas the mean corpuscular hemoglobin level and the iron content were significantly upregulated in the broilers fed with 10% DDP, 0.1% mannose, and 0.2% MOS diets compared with the control. Thus, DDP can be used to improve the antioxidant status and has a prebiotic-like effect in broiler chicken performance.

Intestinal Development and Histomorphometry of Broiler Chickens Fed Trichoderma reesei Degraded Date Seed Diets.

A study was conducted to investigate the impact of degraded date pits (DDP) on the development and morphology of the intestine in broilers. Trichoderma reesei was used to produce the DDP using a solid-state degradation method. One hundred and eighty broilers were divided into six treatments in triplicate groups of 10 chicks each. The dietary treatments were: positive control with corn-soy basal diet, negative control with corn-soy basal diet + 20% oxytetracycline at 0.05%, corn-soy basal diet + 10% DDP, corn-soy basal diet + 0.2% mannan-oligosaccharides (MOS), corn-soy basal diet + 0.2% mannose and corn-soy basal diet + 0.1% mannose for 6 weeks. The results indicate that a 10% DDP diet increased the activities of the pancreatic enzymes, the villus length, and the villus/crypt ratio, and decreased the crypt depth of the intestine. In conclusion, when compared to oxytetracycline and MOS, DDP can be used as a replacement for antibiotic growth promoters for broilers while improving gut development and intestinal health.

Anti-HBc screening in Egyptian blood donors reduces the risk of hepatitis B virus transmission.

Occult hepatitis B virus (HBV) in blood donors is considered as a potential risk for transmission of HBV infection. The aim of this study was to determine the prevalence of anti-hepatitis B core antibody (anti-HBC) positivity in Egyptian blood donations as well as to estimate the frequency of HBV-DNA in anti-HBc-positive donations. The study included 760 Egyptian healthy blood donors, representing 26 different Egyptian governorates screened according to routine practice for the presence of hepatitis B surface antigen (HBsAg), hepatitis C virus (HCV) antibodies (Abs), HIV-1/2 Abs and Treponema Abs. The accepted blood units for donation were tested for the presence of total anti-HBc Abs by two tests. Positive units for anti-HBc were further tested for HBV-DNA by polymerase chain reaction. According to routine screening, a total of 48/760 units (6.3%) were rejected [38 (5%) HCV-Ab-positive units, 9 (1.18%) HbsAg-positive units and 1 (0.13%) Treponema-Ab-positive unit]. Among the accepted blood units for donation, prevalence of anti-HBc was 78/712 units (10.96%). HBV-DNA was detected in 9/78 (11.54%) of the anti-HBc-positive units, and thus, occult HBV infection was detected in 9/712 (1.26%) of the accepted blood donations. Implementing anti-HBc test to the routine assay for the forthcoming two decades would certainly eliminate possible HBV-infected units. Rejection of these units will be beneficial to decrease the risk of HBV transmission with its potential consequences particularly in immunocompromised recipients.

A review of some fish nutrition methodologies.

Several classical warm blooded animal (poultry, sheep, cows, etc.) methods for dietary nutrients evaluation (digestibility, metabolizablity, and energy budget) are applied to fish, even though fish live in a different environment in addition to being cold blooded animals. These applications have caused significant errors that have made these methods non-additive and meaningless, as is explained in the text. In other words, dietary digestion and absorption could not adequately be measured due to the aquatic environment fish live in. Therefore, net nutrient deposition and/or growth are the only accurate measurement left to evaluate dietary nutrients intake in fish. In order to understand and predict dietary nutrient intake-growth response relationship, several mathematical models; (1) the simple linear equation, (2) the logarithmic equation, and (3) the quadratic equation are generally used. These models however, do not describe a full range of growth and have no biological meaning as explained in the text. On the other hand, a model called the saturation kinetic model. It has biological basis (the law of mass action and the enzyme kinetic) and it describes the full range of growth curve. Additionally, it has four parameters that summarize the growth curve and could also be used in comparing diets or nutrients effect on fish growth and/or net nutrient deposition. The saturation kinetic model is proposed to be adequate for dietary nutrient evaluation for fish. The theoretical derivation of this model is illustrated in the text.

A comparative analysis of patients with early-onset vs late-onset nosocomial pneumonia in the ICU setting.

STUDY OBJECTIVE: To compare the clinical outcomes of critically ill patients developing early-onset nosocomial pneumonia (NP; ie, within 96 h of ICU admission) and late-onset NP (ie, occurring after 96 h of ICU admission). DESIGN: Prospective cohort study. SETTING: A medical ICU and a surgical ICU from a university-affiliated urban teaching hospital. PATIENTS: Between July 1997 and November 1998, 3, 668 patients were prospectively evaluated. INTERVENTION: Prospective patient surveillance and data collection. RESULTS: Four hundred twenty patients (11.5%) developed NP. Early-onset NP was observed in 235 patients (56.0%), whereas 185 patients (44.0%) developed late-onset NP. Among patients with early onset NP, 114 patients (48. 5%) spent at least 24 h in the hospital prior to ICU admission, compared to 57 patients (30.8%) with late-onset NP (p = 0.001). One hundred eighty-three patients (77.9%) with early-onset NP received antibiotics prior to the development of NP, as compared to 162 patients (87.6%) with late-onset NP (p = 0.010). The most common pathogens associated with early-onset NP were Pseudomonas aeruginosa (25.1%), oxacillin-sensitive Staphylococcus aureus (OSSA; 17.9%), oxacillin-resistant S aureus (ORSA; 17.9%), and Enterobacter species (10.2%). P aeruginosa (38.4%), ORSA (21.1%), Stenotrophomonas maltophilia (11.4%), OSSA (10.8%), and Enterobacter species (10.3%) were the most common pathogens associated with late-onset NP. The ICU length of stay was significantly longer for patients with early-onset NP (10.3 +/- 8.3 days; p < 0.001) and late-onset NP (21. 0 +/- 13.7 days; p < 0.001), as compared to patients without NP (3.5 +/- 3.2 days). Hospital mortality was significantly greater for patients with early-onset NP (37.9%; p = 0.001) and late-onset NP (41.1%; p = 0.001) compared to patients without NP (13.1%). CONCLUSIONS: Both early-onset and late-onset NP are associated with increased hospital mortality rates and prolonged lengths of stay. The pathogens associated with NP were similar for both groups. This may be due, in part, to the prior hospitalization and use of antibiotics in many patients developing early-onset NP. These data suggest that P aeruginosa and ORSA can be important pathogens associated with early-onset NP in the ICU setting. Additionally, clinicians should be aware of the common microorganisms associated with both early-onset NP and late-onset NP in their hospitals in order to avoid the administration of inadequate antimicrobial treatment.

The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting.

STUDY OBJECTIVE: To evaluate the relationship between the adequacy of antimicrobial treatment for bloodstream infections and clinical outcomes among patients requiring ICU admission. DESIGN: Prospective cohort study. SETTING: A medical ICU (19 beds) and a surgical ICU (18 beds) from a university-affiliated urban teaching hospital. PATIENTS: Between July 1997 and July 1999, 492 patients were prospectively evaluated. INTERVENTION: Prospective patient surveillance and data collection. RESULTS: One hundred forty-seven patients (29.9%) received inadequate antimicrobial treatment for their bloodstream infections. The hospital mortality rate of patients with a bloodstream infection receiving inadequate antimicrobial treatment (61.9%) was statistically greater than the hospital mortality rate of patients with a bloodstream infection who received adequate antimicrobial treatment (28.4%; relative risk, 2. 18; 95% confidence interval [CI], 1.77 to 2.69; p < 0.001). Multiple logistic regression analysis identified the administration of inadequate antimicrobial treatment as an independent determinant of hospital mortality (adjusted odds ratio [AOR], 6.86; 95% CI, 5.09 to 9.24; p < 0.001). The most commonly identified bloodstream pathogens and their associated rates of inadequate antimicrobial treatment included vancomycin-resistant enterococci (n = 17; 100%), Candida species (n = 41; 95.1%), oxacillin-resistant Staphylococcus aureus (n = 46; 32.6%), coagulase-negative staphylococci (n = 96; 21.9%), and Pseudomonas aeruginosa (n = 22; 10.0%). A statistically significant relationship was found between the rates of inadequate antimicrobial treatment for individual microorganisms and their associated rates of hospital mortality (Spearman correlation coefficient = 0.8287; p = 0.006). Multiple logistic regression analysis also demonstrated that a bloodstream infection attributed to Candida species (AOR, 51.86; 95% CI, 24.57 to 109.49; p < 0.001), prior administration of antibiotics during the same hospitalization (AOR, 2.08; 95% CI, 1.58 to 2.74; p = 0.008), decreasing serum albumin concentrations (1-g/dL decrements) (AOR, 1.37; 95% CI, 1.21 to 1.56; p = 0.014), and increasing central catheter duration (1-day increments) (AOR, 1.03; 95% CI, 1.02 to 1.04; p = 0.008) were independently associated with the administration of inadequate antimicrobial treatment. CONCLUSIONS: The administration of inadequate antimicrobial treatment to critically ill patients with bloodstream infections is associated with a greater hospital mortality compared with adequate antimicrobial treatment of bloodstream infections. These data suggest that clinical efforts should be aimed at reducing the administration of inadequate antimicrobial treatment to hospitalized patients with bloodstream infections, especially individuals infected with antibiotic-resistant bacteria and Candida species.

The occurrence of ventilator-associated pneumonia in a community hospital: risk factors and clinical outcomes.

STUDY OBJECTIVES: To prospectively identify the occurrence of ventilator-associated pneumonia (VAP) in a community hospital, and to determine the risk factors for VAP and the influence of VAP on patient outcomes in a nonteaching institution. DESIGN: Prospective cohort study. SETTING: A medical ICU and a surgical ICU in a 500-bed private community nonteaching hospital: Missouri Baptist Hospital. PATIENTS: Between March 1998 and December 1999, all patients receiving mechanical ventilation who were admitted to the ICU setting were prospectively evaluated. INTERVENTION: Prospective patient surveillance and data collection. RESULTS: During a 22-month period, 3,171 patients were admitted to the medical and surgical ICUs. Eight hundred eighty patients (27.8%) received mechanical ventilation. VAP developed in 132 patients (15.0%) receiving mechanical ventilation. Three hundred one patients (34.2%) who received mechanical ventilation died during hospitalization. Logistic regression analysis demonstrated that tracheostomy (adjusted odds ratio [AOR], 6.71; 95% confidence interval [CI], 3.91 to 11.50; p < 0.001), multiple central venous line insertions (AOR, 4.20; 95% CI, 2.72 to 6.48; p < 0.001), reintubation (AOR, 2.88; 95% CI, 1.78 to 4.66; p < 0.001), and the use of antacids (AOR, 2.81; 95% CI, 1.19 to 6.64; p = 0.019) were independently associated with the development of VAP. The hospital mortality of patients with VAP was significantly greater than the mortality of patients without VAP (45.5% vs 32.2%, respectively; p = 0.004). The occurrence of bacteremia, compromised immune system, higher APACHE (acute physiology and chronic health evaluation) II scores, and older age were identified as independent predictors of hospital mortality. CONCLUSIONS: These data suggest that VAP is a common nosocomial infection in the community hospital setting. The risk factors for the development of VAP and risk factors for hospital mortality in a community hospital are similar to those identified from university-affiliated hospitals. These risk factors can potentially be employed to develop local strategies for the prevention of VAP. CLINICAL IMPLICATIONS: ICU clinicians should be aware of the risk factors associated with the development of VAP and the impact of VAP on clinical outcomes. More importantly, they should cooperate in the development of local multidisciplinary strategies aimed at the prevention of VAP and other nosocomial infections.

Using protocols to improve the outcomes of mechanically ventilated patients. Focus on weaning and sedation.

The use of nonphysician-directed protocols and guidelines for the management of sedation and weaning has been shown to reduce the duration of mechanical ventilation for patients with acute respiratory failure when compared with conventional physician-directed practices. Practitioners in ICUs frequently are needed to perform multiple tasks and to evaluate numerous elements of clinical information in the care of the critically ill. In this complex environment, protocols and guidelines are one strategy for ensuring that specific tasks are carried out in a timely manner. Simple-to-employ methods for facilitating changes and improvements in the care of hospitalized patients recently have been proposed. These methods emphasize the importance of developing a culture of cooperation within the ICU so protocols and guidelines can be implemented successfully. Such a culture should embrace changes in medical practices in the ICU if they are associated with improved clinical outcomes. The results of studies evaluating the use of protocols and guidelines have important implications for general critical care practices, because many ICUs do not have physicians who are constantly at the patient's bedside. The need for effective communication from the bedside caregiver (e.g., nurse, respiratory therapist, pharmacist, technician) to the physician, so that treatment orders can be changed appropriately, usually results in some delay in the implementation of treatment changes. Protocols are one method for potentially reducing those delays and ensuring that medical care is administered in a more standardized and efficient manner.

Does schistosomiasis play a role in the high sero prevalence of HCV antibody among Egyptians?

Many studies have demonstrated a very high prevalence of HCV antibodies among blood donors (BD) and chronic liver disease (CLD) patients in Egypt. This high prevalence might be attributed to cross reactivity between HCV antibodies and schistosome antibodies. We decided to study the association and cross serology between the presence of anti-HCV and Schistosomal infection among BD and CLD patients. Sera of blood donors and CLD patients were tested for anti-HCV by second generation ELISA. Antibodies to Schistosoma species were quantified by IHA test. Two tailed z score was used to detect significant difference. To test for cross reactivity between the two antibodies 20 BD and 20 CLD patients positive for both HCV-antibody and schistosome antibody were taken as controls. Another 20 samples also served as a control group; 10 of them seropositive for HCV only and 10 positive for IHA for schistosomiasis alone. All were subjected to: 1) RIBA-2 confirmatory test 2) Adsorption of schistosome antibodies using 100 microgram schistosome antigens per 100 microliters serum 3) Both HCV-ELISA-2 and RIBA-2 were checked after adsorption. The titre of schistosome antibodies in positive sera ranged from 1:128 to 1:1536. HCV seroprevalence was more pronounced among antischistosomal positive sera. This was seen in both BD and CLD patients where antischistosomal positive sera were at double risk to show positive HCV antibody. After adsorption of schistosome antibody, there was no change in reactivity of both ELISA-2 and RIBA-2. We conclude that HCV antibodies were significantly higher in schistosomal antibody positive Egyptians, there was no cross reactivity between the two antibodies and the high prevalence could be due to HCV transmission during anti-bilharzial parenteral therapy or due to depressed cell mediated immunity associated with schistosomal infection.

Prevalence of anti-HEV IgM among blood donors in Egypt.

Hepatitis E virus (HEV) is a common cause of acute viral hepatitis (AVH) in developing countries. In Egypt; where up to 80% of the inhabitants of rural villages have anti-HEV antibodies denoting past infection, most of these infections are asymptomatic with little evidence that the infection causes AVH. There are accumulating reports which suggest potential risk of HEV transmission by blood transfusion. However, detection of serological markers for HEV infection or HEV RNA in Egyptian blood banks is not routinely performed. 760 blood samples from apparently healthy donors at the National blood bank were tested for markers of acute HEV infection to estimate the seroprevalence of acute HEV infection, and potential risk of infection by blood transfusion. They included 124 females (16.82%) and 636 males (83.68%), with a mean age of 23.8 +/- 5.3 years and mean ALT value of 23.3 +/- 13.2 IU/ml. Samples were tested as pools of 10 subjects. Pools with highest reactivity were retested individually to determine the frequency of positive subjects. Out of the 760 samples, three (0.45%) samples were positive for anti-HEV IgM and two of them had HEV RNA as determined by RT-PCR. In conclusion, this study suggests that the tested blood donors have low prevalence of ongoing subclinical infection with HEV and that the potential risk of transfusion may be low.

Cadmium removal from human plasma by Cibacron Blue F3GA and thionein incorporated into polymeric microspheres.

Poly(2-hydroxyethylmethacrylate-ethyleneglycoldimethacrylate) [poly(HEMA-EGDMA)] microspheres carrying Cibacron Blue F3GA and/or thionein were prepared and used for the removal of cadmium ions Cd(II) from human plasma. The poly(HEMA-EGDMA) microspheres, in the size range of 150-200 microm in diameter, were produced by a modified suspension copolymerization of HEMA and EGDMA. The reactive triazinyl dye-ligand Cibacron Blue F3GA was then covalently incorporated into the microspheres. The maximum dye incorporation was 16.5 micromol/g. Then, thionein was bound onto the Cibacron Blue F3GA-incorporated microspheres under different conditions. The maximum amount of thionein bound was 14.3 mg/g. The maximum amounts of Cd(II) ions removed from human plasma by poly(HEMA-EGDMA)-Cibacron Blue F3GA and poly(HEMA-EGDMA)-Cibacron Blue F3GA-thionein were of 17.5 mg/g and 38.0 mg/g, respectively. Cd(II) ions could be repeatedly adsorbed and desorbed with both types of microspheres without significant loss in their adsorption capacity.

A comparative study of the intravesical MTP and BCG treatment of transplantable bladder cancer.

We induced transitional cell cancer of the urinary bladder in Fischer rats by feeding them N-[4(5-nitro-2-furyl)-2-thiazolyl] formamide (FANFT). Tumors were subsequently transplanted orthotopically in the bladder submucosa of Fischer rats. This animal model was used to compare the therapeutic effects of maltose tetrapalmitate (MTP), and bacillus Calmette Guérin (BCG). The routes of administration compared were intravesical alone or intravesical and oral for MTP, and intravesical alone or intravesical and subcutaneous for BCG. The intravesical and oral MTP treatment was more effective than the intravesical and subcutaneous BCG as regards the tumor size, incidence of tumor metastasis and the immunologic status of the tumor bearing host.

The relationship of the International Prostate Symptom Score and objective parameters for diagnosing bladder outlet obstruction. Part I: when statistics fail.

PURPOSE: We evaluated the International Prostate Symptom Score and correlated it with objective means of determining bladder outlet obstruction. MATERIALS AND METHODS: Beginning in May 1996, 460 men 41 to 88 years old (mean age plus or minus standard deviation 60.4 +/- 9.4) were prospectively included in this study. Symptoms were evaluated using the International Prostate Symptom Score, and digital rectal examination, outpatient cystoscopy, prostate specific antigen determination and transrectal ultrasound were done. Urodynamic evaluation included uroflowmetry, filling cystometry and pressure flow study. RESULTS: Linear regression was done to correlate scores with measurable parameters. We noted no correlation of the total, obstructive symptoms or irritative symptoms score with objective parameters, including the average and maximum flow rate, post-void residual urine, prostate size and Schäfer grade. CONCLUSIONS: Prostatic symptom scores are qualitative. Using them to quantify the degree of obstruction or evaluate therapy is questionable.

Experience with a clinical guideline for the treatment of ventilator-associated pneumonia.

OBJECTIVE: To evaluate a clinical guideline for the treatment of ventilator-associated pneumonia. DESIGN: Prospective before-and-after study design. SETTING: A medical intensive care unit from a university-affiliated, urban teaching hospital. PATIENTS: Between April 1999 and January 2000, 102 patients were prospectively evaluated. INTERVENTIONS: Prospective patient surveillance, data collection, and implementation of an antimicrobial guideline for the treatment of ventilator-associated pneumonia. MEASUREMENTS AND MAIN RESULTS: The main outcome evaluated was the initial administration of adequate antimicrobial treatment as determined by respiratory tract cultures. Secondary outcomes evaluated included the duration of antimicrobial treatment for ventilator-associated pneumonia, hospital mortality, intensive care unit and hospital lengths of stay, and the occurrence of a second episode of ventilator-associated pneumonia. Fifty consecutive patients with ventilator-associated pneumonia were evaluated in the before period and 52 consecutive patients with ventilator-associated pneumonia were evaluated in the after period. Severity of illness using Acute Physiology and Chronic Health Evaluation II (25.8 +/- 5.7 vs. 25.4 +/- 8.1, p =.798) and the clinical pulmonary infection scores (6.6 +/- 1.0 vs. 6.9 +/- 1.2, p =.105) were similar for patients during the two treatment periods. The initial administration of adequate antimicrobial treatment was statistically greater during the after period compared with the before period (94.2% vs. 48.0%, p <.001). The duration of antimicrobial treatment was statistically shorter during the after period compared with the before period (8.6 +/- 5.1 days vs. 14.8 +/- 8.1 days, p <.001). A second episode of ventilator-associated pneumonia occurred statistically less often among patients in the after period (7.7% vs. 24.0%, p =.030). CONCLUSIONS: The application of a clinical guideline for the treatment of ventilator-associated pneumonia can increase the initial administration of adequate antimicrobial treatment and decrease the overall duration of antibiotic treatment. These findings suggest that similar types of guidelines employing local microbiological data can be used to improve overall antibiotic utilization for the treatment of ventilator-associated pneumonia.