Fosfomycin in a single dose versus a 7-day course of amoxicillin-clavulanate for the treatment of asymptomatic bacteriuria during pregnancy.

The purpose of this paper was to compare the efficacy of a single dose of 3 g of fosfomycin to that of a 7-day regimen of amoxicillin-clavulanate in the treatment of asymptomatic bacteriuria during pregnancy. A randomised, prospective, interventional, analytical, longitudinal study was undertaken, in which the efficacy of two antibiotic regimens (one short and the other long) in the treatment of pregnant women with asymptomatic bacteriuria is compared. One hundred and nine patients were randomly assigned to two groups: 56 were treated with amoxicillin-clavulanate and 53 with fosfomycin. The two groups were similar in terms of co-morbidity, treatments received during pregnancy, obstetric, gynaecological and surgical history and laboratory data. The efficacy of the two regimens was similar and the eradication rate was over 80% in both groups (P = 0.720) (relative risk [RR] 1.195, 95% confidence interval [CI]: 0.451-3.165). The number of reinfections was greater in the amoxicillin-clavulanate group (P = 0.045). The secondary effects were lower in the fosfomycin group (P = 0.008). There were no significant differences in the number of persistences (P = 0.39), development of symptomatic urinary infections (P = 0.319) or recurrences (P = 0.96). Treatment with a single dose of fosfomycin is as effective as the standard course of treatment with amoxicillin-clavulanate and may be preferable due to its simpler administration and the smaller number of reinfections.

[Validity of clinical tests to confirm or exclude the diagnosis of acute myocardial infarction]. / Validez de las pruebas diagnósticas para confirmar o descartar un infarto agudo de miocardio.

BACKGROUND: To know the clinical usefulness of the diagnostic tests habitually used to diagnose an acute myocardial infarction (MI), in a group of patients in which this diagnosis is clinically highly suspected. PATIENTS AND METHODS: A cross sectional study was designed. The sample (n = 114) was randomized and selected by term and specific of days from the patients attending the Emergency Service at Elda General Hospital (Alicante, Spain) in a year period. The method we used was is a validity study, making 2 x 2 tables. The clinical outcome was the gold standard and was cross matched with some of the clinical criteria habitually used to diagnose acute myocardial infarction: thoracic pain character, irradiation, ECG findings and CK-MB levels. RESULTS: Clinical suspicion of MI was confirmed in only 27.8% (IC--95%: 19.3-36.3). The best validity indexes of clinical usefulness to confirm the MI diagnosis were obtained from ECG findings (CP+ = infinity) and CK-MB (CP+ = 24.2 at the end of the observational period and CP = 17.9 at the beginning). The best negative clinical validity indexes were CK values obtained at the end of the observational period (CP- = 0.07) and the ECT findings obtained at the end of the observational period (CP- = 0.10). CONCLUSION: Clinical carefulness is essential to avoid a diagnostic mistakes in MI patients, since the symptoms we used as a diagnostic guide do not offer good validity indexes. Changes in ECG or CK-MB levels could confirm the MI diagnosis but normal findings in both tests did not discard this diagnosis. We should keep the possibility of a mistake till the end of the observational period.

[Validity of clinical tests to confirm or to exclude the diagnosis of acute appendicitis]. / Validez de las pruebas diagnósticas para confirmar o descartar una apendicitis aguda.

AIMS: The clinical usefulness of the diagnostic tests (usually employed to diagnose an acute appendicitis in a group of patients in which this diagnosis is clinically highly suspected). PATIENTS AND METHODS: A cross sectional study was designed. The sample (n = 116) was randomly selected by term and specific days from the patients attending the Emergency Service at Elda General Hospital in a year period. The method used was is a validity study making 2 x 2 tables. We have cross matched the habitual routine tests with: a) the clinical outcome if the patient was not surgically treated, or b) the result of the biopsy for those operated. Being these the gold standard. The validity indexes studied were sensibility (S), specificity (E). The 95% confidence index of the CF were calculated. RESULTS: Acute appendicitis clinical suspicion was confirmed in 29.4% (IC 95%: 20.8-38). The best validity indexes were: a) kind of pain (S = 81.3; E = 33.8); b) peritoneal inflammatory signs (S = 78.5%, E = 45.9%); c) presence of leucocytosis in blood exam (S = 100%, E = 54.5%), and d) a greater difference in axillary-rectum temperature (S = 13.6%, E = 96.6%). Only leucocytosis reached 0 for PP- and CP-; the blood leucocytosis (PP+ = 47.8%, CP+ = 2.20) and the axillary-rectum temperature (PP+ = 60%, CP+ = 4.0) dissociation were the test with most valuable indexes. CONCLUSIONS: Clinical suspicion of acute appendicitis in a group of patients having a great probability of suffering it over estimates this diagnosis. The symptoms or signs routinely used in the diagnosis did not reach high validity indexes in these patients. They are a poor help to stress or reject the diagnosis of acute appendicitis. To be careful is the main tool the doctors have. Blood leucocytosis is the test that has the best agreement indexes of clinical usefulness and it has the best countence with the gold standard.

[The validity of the separate determination of total cholesterol in the primary prevention of coronary risk]. / Validez de la determinación aislada del colesterol total en la prevención primaria del riesgo coronario.

BACKGROUND: The aim of this study was to validate total cholesterol (TC) determination in the primary prevention of coronary risk and evaluate the prevalence of low HDL cholesterol (HDL-C) levels at the different TC cut-off points to thereby determine the TC level at which HDL-C determination is of interest. METHODS: The atherogenic index was used as the reference method in TC evaluation with the values of low HDL-C levels being evaluated at the following TC cut-off points: 160, 180, 200, 220, 240, 250, and 300 mg/dl (4.44; 4.66; 5.18; 5.70; 6.22; 6.48; 7.77 mmol/l). According to the results of the Framingham study the atherogenic index or the existence of low HDL-C levels were considered as abnormal. The sample included 4,162 workers from the province of Alicante (Spain) selected by consecutive sampling and opportunistic search in January and February, 1993. Validity was calculated with confidence interval of 95%. RESULTS: The atherogenic index was high in 43.7% of the sample, ranging from 6% in the population with TC lower than 160 mg/dl (4.14 mmol/l) to 76.4% in those oscillating between 250-299 mg/dl (6.48-7.76 mmol/l). Low HDL-C levels were detected in 20.1% with a prevalence ranging from 38.8% in those with a TC of less than 160 mg/dl (4.14 mmol/l) to 11.9% in those with TC > or = 250 mg/dl (> or = 6.48 mmol/l). The cut-off points for low TC had high sensitivity (S) and low specificity (SP) (160 mg/dl [4.14 mmol/l]: S = 91.1%, SP = 11.5%; 180 mg/dl [4.66 mmol/l]: S = 95.2%, SP = 30.2%). The highest TC points presented very low S and very high SP (250 mg/dl [6.48 mmol/l]: S = 46.3%, SP = 87.7%; 300 mg/dl [6.48 mmol/l]: S = 7.4%, SP = 97%). CONCLUSIONS: The HDL-cholesterol should be determined in people with a total cholesterol of less than 200 mg/dl (5.18 mmol/l) since, in this group there is an important percentage of individuals with an altered atherogenic index and low HDL-C levels.

Incidence and risk factors associated with urinary tract infection in diabetic patients with and without asymptomatic bacteriuria.

In order to compare the incidence of symptomatic urinary tract infection (UTI) in diabetic patients with and without asymptomatic bacteriuria (ASB), and to identify other risk factors for these infections, 289 females and 168 males were studied over a 12-month period. Symptomatic UTI occurred in 69.2% of patients with ASB (67.6% female and 76.5% male) versus 9.8% without ASB (14.9% female and 2.6% male). ASB and urinary incontinence were associated with symptomatic UTI in both women and men. Other risk factors included previous antimicrobial treatment and macrovascular complications in women and obesity and prostatic syndrome in men. The presence of ASB was found to be the major risk factor for developing symptomatic urinary tract infection. Further prospective randomized clinical trials of diabetic patients with risk factors for UTI who are receiving or not receiving treatment may be considered.

[Asymptomatic bacteriuria in patients with diabetes mellitus. To treat or not to treat?]. / Bacteriuria asintomática en pacientes con diabetes mellitus. Tratar o no tratar?

Women with diabetes mellitus suffer symptomatic bacteriuria and symptomatic urinary infections more often than non-diabetic women. Prevalence is similar, however, in males with and without diabetes. There is a controversy on the impact of asymptomatic bacteriuria on the development of complications in diabetic patients. Current evidence is reviewed concerning the need for detection and treatment of asymptomatic bacteriuria in these patients.