Antimicrobial Resistance of Urinary Tract Isolates in Acute Uncomplicated Cystitis Among College-Aged Women: Choosing a First-Line Therapy

Objective and Participants The authors of this retrospective case study focused on antimicrobial susceptibility of urinary tract isolates in cases of acute uncomplicated cystitis in college-aged women, aged 18 to 24 years, diagnosed at a major south-central university student health center. Methods The authors obtained pertinent data from patient medical and laboratory records, including, diagnoses, urine culture, and susceptibility results. Results Of 179 isolates, 161 (90%) were Escherichia coli (E. Coli) isolates, of which 23% were resistant to trimethoprimsulfamethoxazole, < 1% were resistant to Ciprofloxacin, and < 1% were resistant to nitrofurantoin. Sixty-eight (42%) E. Coli isolates were multidrug resistant. There were 18 isolates cultured in the study group that were significant organisms other than E. coli. For all organisms in the study group, there was a combined resistance rate of 22% to trimethoprim-sulfamethoxazole, < 1.0% for Ciprofloxacin, and 7% for nitrofurantoin. Conclusions The findings suggest that both Ciprofloxacin and Nitrofurantoin are acceptable choices for empiric therapy of acute uncomplicated urinary tract infection in this study population, keeping in mind the potential for rising resistance rates to Ciprofloxacin in the community setting.     

Antibiotic resistance in urinary tract infections in college students

Abstract Objective: To determine resistance to antibiotics of Escherichia coli in uncomplicated urinary tract infections (uUTIs) in female college students. Participants: Symptomatic patients presenting to a student health service from September 2008 to December 2009. Methods: Clean catch midstream urine samples were tested for urinalysis (UA) and culture and sensitivity. Results: Of 168 students enrolled in the study, 138 had positive UA, and 94 of these grew >100,000 colonies/mL of E. coli. Ampicillin resistance was 31.9%, trimethoprim-sulfamethoxazole (TMP-SMX) resistance 16.0%, ciprofloxacin resistance 4.3%, amoxicillin/clavulanate resistance 3.2%, and nitrofurantoin resistance 1.1%. The sensitivity of UA was 95.4% and the positive predictive value was 87.0% (p ≤ .001). Specificity was 77.5% and negative predictive value 92.9%. Conclusions: In healthy college women with uUTI symptoms, TMP-SMX should not be universally used for empirical therapy, whereas use of ciprofloxacin, amoxicillin/clavulanate, and nitrofurantoin are appropriate.     

Uncomplicated E. coli urinary tract infection in college women: a follow-up study of E. coli sensitivities to commonly prescribed antibiotics

Treatment of uncomplicated urinary tract infections (UTIs) has changed in the past few years with researchers advocating empiric treatment for shorter periods of time without the use of cultures. Researchers report that antibiotic resistance of Escherichia coli (E. coli) to commonly prescribed antibiotics in uncomplicated UTIs has been increasing. Trimethoprim/sulfamethoxazole (TMP/SMX) is 1 of these antibiotics. Researchers also report that resistance patterns may differ depending on the geographic area of the United States. In this study, the authors present the results of a 7-month retrospective chart analysis of 98 E. coli sensitivities to commonly prescribed antibiotics in the treatment of uncomplicated UTIs at a college health service. They examined the more common antibiotic choices and analyzed their in vitro responses. Of these antibiotics, ciprofloxacin, nitrofurantoin, amoxicillin/clavulanate, and TMP/SMX had the highest sensitivity rates. The authors compared the results with a previous study that they performed at the same institution in 1993. The results of this study show a sensitivity rate of 86% for TMP/SMX. When compared with the previous result of 87%, this represented a 1% change. Because of this slight decrease in sensitivity and the increasing concern over resistance, the authors suggest that they will continue to reevaluate the resistance pattern in their population on a regular basis. This will help determine if there is a need for modifying choices of empiric therapy for UTIs.     

Antibiotic Resistance in Urinary Tract Infections in College Students

Abstract

Objective: To determine resistance to antibiotics of Escherichia coli in uncomplicated urinary tract infections (uUTIs) in female college students. Participants: Symptomatic patients presenting to a student health service from September 2008 to December 2009. Methods: Clean catch midstream urine samples were tested for urinalysis (UA) and culture and sensitivity. Results: Of 168 students enrolled in the study, 138 had positive UA, and 94 of these grew >100,000 colonies/mL of E. coli. Ampicillin resistance was 31.9%, trimethoprim-sulfamethoxazole (TMP-SMX) resistance 16.0%, ciprofloxacin resistance 4.3%, amoxicillin/clavulanate resistance 3.2%, and nitrofurantoin resistance 1.1%. The sensitivity of UA was 95.4% and the positive predictive value was 87.0% (p ≤ .001). Specificity was 77.5% and negative predictive value 92.9%. Conclusions: In healthy college women with uUTI symptoms, TMP-SMX should not be universally used for empirical therapy, whereas use of ciprofloxacin, amoxicillin/clavulanate, and nitrofurantoin are appropriate.     

The Relationship Between Urinary Tract Infections and the Collegiate Academic Calendar

Abstract

College students believe that they are more likely to be ill during examination periods than at other times in the academic year. We in the health service hypothesized that urinary tract infections are not affected by the demands of the academic calendar.

During a 4-year study, the university health service obtained urine culture data prospectively from 456 patients who had a total of 508 episodes of urinary tract infections. Each year, the number of urinary tract infections decreased during both midterm and final examination periods, but rebounded to higher-than-average levels in the second week following the midterm examination period, as well as during the second week of the second (spring) semester, immediately after the mid-winter recess. Mean duration of symptoms was 34 hours (range, from 12 to 60).

Urinary tract infections were less common during examination periods, when students were preoccupied with academic responsibilities, but such infections increased in frequency in the period immediately after examinations, when sexual intimacy was resumed or when sexual intercourse with a new partner began. Urinary tract infections in college women, the study indicated, are primarily related to sexual intercourse, and susceptibility is only indirectly affected by the demands of the academic calendar.     

The relationship between urinary tract infections and the collegiate academic calendar

College students believe that they are more likely to be ill during examination periods than at other times in the academic year. We in the health service hypothesized that urinary tract infections are not affected by the demands of the academic calendar. During a 4-year study, the university health service obtained urine culture data prospectively from 456 patients who had a total of 508 episodes of urinary tract infections. Each year, the number of urinary tract infections decreased during both midterm and final examination periods, but rebounded to higher-than-average levels in the second week following the midterm examination period, as well as during the second week of the second (spring) semester, immediately after the mid-winter recess. Mean duration of symptoms was 34 hours (range, from 12 to 60). Urinary tract infections were less common during examination periods, when students were preoccupied with academic responsibilities, but such infections increased in frequency in the period immediately after examinations, when sexual intimacy was resumed or when sexual intercourse with a new partner began. Urinary tract infections in college women, the study indicated, are primarily related to sexual intercourse, and susceptibility is only indirectly affected by the demands of the academic calendar.     

Transurethral resection of the prostate achieves favorable outcomes in stroke patients with symptomatic benign prostate hyperplasia

Objectives: To evaluate the surgical outcomes of stroke patients with symptomatic benign prostatic hyperplasia (BPH) who underwent transurethral resection of the prostate (TURP) and compare the clinical outcomes between patients with stroke and those without stroke receiving this procedure.

Methods: This retrospective cohort study analyzed claims data collected during the period of 1997–2012 from Taiwan National Health Insurance Research Database. We enrolled 6625 patients who had persistent lower urinary tract symptoms and underwent TURP for BPH. They were categorized into a stroke (n?=?577) and nonstroke (n?=?6048) group. Patient characteristics, postoperative clinical outcomes, medication records, and medical expenses were compared.

Results: Compared with the stroke group patients, those in the nonstroke group were younger, had fewer comorbidities, and more favorable postoperative clinical outcomes. Nevertheless, TURP achieved favorable outcomes in stroke patients with symptomatic BPH. In the stroke group, the rate of urinary tract infection (UTI) decreased from 34.7% during 1 year preoperatively to 29.8% during 1 year postoperatively (p?=?.05). The rate of urinary retention (UR) also decreased from 55.5% during 1 year preoperatively to 22.5% during 1 year postoperatively (p?=?.05). TURP reduced the overall medical expenses of patients with stroke. Annual patient medical expense during 1 year preoperatively, 1 year postoperatively, 2 years postoperatively, and 3 years postoperatively was NT$659,000, NT$646,000, NT$560,000, and NT$599,000, respectively.

Conclusions: In patients with stroke, TURP reduces the risks of UTI and UR and annual total medical expense.     

The Association Between Mental Health and Acute Infectious Illness Among a National Sample of 18- to 24-Year-Old College Students

Poor mental health is associated with physical illness, but this association is poorly characterized among college students. Objective and Participants: Using American College Health Association-National College Health Assessment data, the authors characterized poor mental health (depression, anxiety, negative affect) and examined the relationship between poor mental health and acute infectious illnesses (bronchitis, ear infection, sinusitis, strep throat) among 47,202 US college students. Methods: The authors used frequency and cross-tabulation analyses to characterize mental health and determine univariate associations among variables. They used binary logistic regression to determine the association between poor mental health and acute infectious illness, controlling for research-derived covariates. Results: The prevalence of acute infectious illness ranged from 8% to 29%. The prevalence of anxiety and depression ranged from 12% to 20%, respectively. Depression, anxiety, and exhaustion were associated with acute infectious illness across all dependent measures, with odds ratios ranging from .56 to .91. Conclusions: Poor mental health is associated with acute infectious illness among college students.     

Postcoital Contraception: Student Choices and Effectiveness

Abstract

A five-semester study was undertaken to obtain information about the selections patients make when given a choice of postcoital contraceptives and the effectiveness of those choices. Three postcoital contraceptive (PCC) regimens were used: a copper intrauterine device (IUD), high-dose estrogen (HDE), and an estrogen/progestin combination (E/P). Four hundred eighty-two patients requested PCC. Two percent selected an IUD, 9% HDE, and 89% chose E/P. There were 8 pregnancies–7 in the E/P group and 1 in the HDE group. It is concluded that PCC is an effective second chance to prevent unintended pregnancy. When given a choice, most patients will select E/P. During this same time span, 931 other students requested pregnancy tests. Forty-four percent (416) of those tests were positive, and 62% (254) of those with positive tests had a voluntary interruption of pregnancy (VIP).

“Yogurt–An Autodigesting Source of Lactose,” JOSEPH C. KOLARS, MICHAEL D. LEVITT, MOSTAFA AOUJI, DENNIS A. SAVAIANO. Large quantities of yogurt are consumed by some lactase-deficient population groups. We used breath hydrogen measurements to determine whether lactase-deficient subjects absorbed lactose in yogurt better than lactose in milk. Ingestion of 18 g of lactose in yogurt resulted in only about one third as much hydrogen excretion as a similar load of lactose in milk or water, indicating a much better absorption of lactose in yogurt. Ingestion of yogurt also resulted in fewer reports of diarrhea or flatulence than did a similar quantity of lactose ingested in milk or a water solution. The enhanced absorption of lactose in yogurt appeared to result from the yogurt organisms. This autodigesting feature makes yogurt a well-tolerated source of milk for lactase-deficient persons and may explain the widespread consumption of yogurt by lactase-deficient population groups. (New England Journal of Medicine 1984;310:1–3)     

Are urge incontinence and aging risk factors of erectile dysfunction in patients with male lower urinary tract symptoms?

Introduction: Several studies have indicated that erectile dysfunction (ED) patients also suffer from lower urinary tract symptoms (LUTS). We investigated a group of men with LUTS and assessed their sexual function with the aim of being able to predict ED risk factors and introduce ED treatments earlier for this patient group.

Methods: International Prostate Symptom Score (IPSS), Overactive Bladder Symptoms Score (OABSS) and Sexual Health Inventory for Men (SHIM) score were obtained from 236 men with LUTS at their first out-patients visit. Clinical parameters such as body mass index, prostate volume, residual urine volume and prostate specific antigen were also evaluated. The relationship between the SHIM score and other clinical data was analyzed.

Results: According to the SHIM score, ED in men with LUTS was severe 15%, moderate 19%, moderate to mild 28%, mild 17%, normal 7% and data was incomplete in 14%. Based on the results of a multivariate analysis, aging (p?p?=?0.024) were significantly correlated to severe and moderate ED. Furthermore, among OAB symptoms score items, urge urinary incontinence was a risk factor for severe and moderate ED (p?=?0.005).

Conclusion: Aging and OAB (notably urinary urge incontinence) are risk factors for severe and moderate ED in men with LUTS.     

The role of sex steroid hormones in benign prostatic hyperplasia

Introduction: The etiology of benign prostatic hyperplasia (BPH) remains a mystery to scientists; estrogen/androgen imbalance in aged men has been implicated.

Methods: Thirty (30) apparently healthy men and newly diagnosed BPH patients were recruited from the Ghana Police Hospital. Lower urinary tract syndrome (LUTS) and prostate volume were assessed via the prostate symptom score sheet (IPSS) and abdominopelvic scan, respectively. Laboratory assays for total prostate specific antigen (tPSA) and hormones [androstenedione (AED), testosterone (T), dihydrotestosterone (DHT), androstanedioladiol (3α-adiol), androstanediol (3β-diol), estrone (E1) and estradiol (E2)] were performed via ELISA techniques. Non-parametric analyses were employed. p?Results: AED was significantly higher in controls compared to the BPH patients. AKRIC2 (3α-diol/DHT) was significantly higher in the BPH group (p?p=?0.029). Age correlated negatively with T, while a negative correlation was observed between TIPSS and 3β-diol and AKRIC1. Also, prostate volume correlated negatively with fT.tPSA correlated positively with E2 and aromatase activity (E2/T) and negatively with fT. On multiple linear regression, DHT and 3β-diol remained independent predictors for TIPSS and fT for tPSA.

Conclusion: Estrogens and androstanediols seem to play a role in BPH development.     

Methicillin-Resistant Staphylococcus aureus on Campus: A New Challenge to College Health

As new drugs to control bacterial pathogens are developed, the organisms evolve to survive. Staphylococcus aureus, a common organism, has steadily developed resistance to antibiotics. For more than 40 years, resistant S. aureus presented a formidable problem to hospitalized patients; in the past decade, however, it has begun to appear outside the clinical setting—often in young people without significant medical conditions. Early diagnosis, appropriate control measures, and proper antibiotic choice can limit the spread and severity of infection.     

The College Student Psychiatric Emergency: II Diagnosis and Disposition

Abstract

Student psychiatric emergencies are a cause of great concern on college campuses, and they merit further study. The authors elucidate some of the characteristics of 1,156 visits to a hospital psychiatric emergency department made by 933 students over an eight-year period. The diagnoses given to students in emergencies were found to be equally divided among psychosis, neurosis, personality disorder, and “other.” Only about 30% of the students' visits to the psychiatric emergency department resulted in admission to the hospital; the implications, for college mental health programs, of having 70% of psychiatric emergencies returned to campus is discussed.

“Prevention of Acute Mountain Sickness by Dexamethasone,” T. Scott Johnson, et al. Acute mountain sickness is a syndrome that occurs when unacclimatized persons ascend rapidly to high altitudes. It is postulated that cerebral edema causes its symptoms. Since dexamethasone is useful in treating some forms of cerebral edema, we investigated its role in the prevention of acute mountain sickness. Using a double-blind crossover design, we exposed eight young men to a simulated altitude of 4570 m (15,000 ft) on two occasions. By random assignment, each subject received dexamethasone (4 mg every 6 hours) or placebo for 48 hours before and throughout the 42-hour exposure. The presence of symptoms of acute mountain sickness was established by two methods: a questionnaire and an interview by a physician. Dexamethasone significantly reduced the symptoms of acute mountain sickness. During dexamethasone treatment, the cerebral-symptom score (mean ± S.E.) decreased from 1.09 ± 0.18 to 0.26 ± 0.08, and the respiratory-symptom score decreased from 0.64 ± 0.09 to 0.31 ± 0.06 (both, P < 0.05). As judged by the interviewing physician, the symptom score decreased from 1.10 ± 0.11 to 0.28 ± 0.07 (P = 0.01). We conclude that dexamethasone may be effective in preventing the symptoms of acute mountain sickness. (New England Journal of Medicine 1984;310:683–6.)     

A systematic review of the association between lower urinary tract symptoms and falls,injuries, and fractures in community-dwelling older men

Background: Lower urinary tract symptoms (LUTS) have been associated with falls in studies either exclusively or predominantly of women. It is, therefore, less clear if LUTS are risk factors for falls in men.

Methods: We conducted a systematic review of the literature on the association between LUTS and falls, injuries, and fractures in community-dwelling older men. Medline, Embase, and Cinahl were searched for any type of observational study that has been published in a peer-reviewed journal in English language. Studies were excluded if they did not report male-specific data or targeted specific patient populations. Results were summarized qualitatively.

Results: Three prospective cohort studies and six cross-sectional studies were identified. Incontinence, urgency, nocturia, and frequency were consistently shown to have weak to moderate association with falls (the point estimates of odds ratio and relative risk ranged from 1.31 to 1.67) in studies with low risk of bias for confounding. Only frequency was shown to be associated with fractures.

Conclusions: Urinary incontinence and lower urinary tract storage symptoms are associated with falls in community-dwelling older men. The circumstances of falls in men with LUTS need to be investigated to generate hypotheses about what types of interventions may be effective in reducing falls.     

Prevalence of low testosterone and its relationship to body mass index in older men with lower urinary tract symptoms associated with benign prostatic hyperplasia

Abstract

Purpose: We examined the prevalence of low testosterone (LT) and its relationship with body mass index (BMI) in men with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), who were enrolled in a clinical trial of drug therapy, the Medical Therapy of Prostatic Symptoms (MTOPS) Study.

Materials and methods: MTOPS enrolled 3047 men, and of these, 1896 had total testosterone (TT) measured at baseline. LT was defined as a single measurement of TT of <300?ng/dL.

Results: The overall prevalence of LT was 25.7%. Prevalence increased with increasing BMI; 14.7% among men who were normal weight (BMI <25?kg/m²) and 24.2% and 39.3% among overweight (BMI 25 to <30?kg/m²), and obese (baseline BMI ≥30?kg/m²) men, respectively.

Conclusions: LT was observed in about one in four MTOPS study participants with baseline TT measurements. The prevalence of LT increased markedly with increasing BMI. Our findings suggest a high prevalence of LT in obese men with LUTS/BPH. Physicians should be alert to the possibility of symptoms of hypogonadism in this population.     

Differences in dietary patterns among college students according to body mass index

OBJECTIVE AND PARTICIPANTS: The authors surveyed 557 undergraduate students aged 18-56 years to assess weight status, health behaviors, and dietary variety. METHODS: They used body mass index (BMI) to divide students into 4 weight categories: underweight (BMI < 19 kg/m2), healthy weight (19 kg/m2 to 24.99 kg/m2), over-weight (25 kg/m2 to 29.99 kg/m2), and obese (> 30 kg/m2). RESULTS: Approximately 33% of respondents were overweight or obese, and 8% were underweight. Among the weight categories, the authors observed significant differences in diet (eg, cheese, pork, lamb, veal and game, fish, green leafy vegetables, other vegetables, and the cumulative total of all meats). Overall, 33% of the students consumed 1 fruit in 3 days. The authors found no differences among the weight categories related to eating fatty, sugary snacks. CONCLUSIONS: College administrators should create health promotion and skill-building programs to improve students' diet variety.     

Differences in Dietary Patterns Among College Students According to Body Mass Index

Objective and Participants: The authors surveyed 557 undergraduate students aged 18-56 years to assess weight status, health behaviors, and dietary variety. Methods: They used body mass index (BMI) to divide students into 4 weight categories: underweight (BMI < 19 kg/m²), healthy weight (19 kg/m² to 24.99 kg/m²), over-weight (25 kg/m² to 29.99 kg/m²), and obese (> 30 kg/m²). Results: Approximately 33% of respondents were overweight or obese, and 8% were underweight. Among the weight categories, the authors observed significant differences in diet (eg, cheese, pork, lamb, veal and game, fish, green leafy vegetables, other vegetables, and the cumulative total of all meats). Overall, 33% of the students consumed 1 fruit in 3 days. The authors found no differences among the weight categories related to eating fatty, sugary snacks. Conclusions: College administrators should create health promotion and skill-building programs to improve students' diet variety.     

Juggling resistance and compliance: The case of Israeli ultra-orthodox media

In an attempt to examine how resistant discourses are constructed in a highly conservative society, this article presents four discursive forms of resistance used by an Israeli ultra-orthodox Jewish magazine juggling between compliance and resistance in its attempt to subvert hegemonic rabbinical authority. These resistance forms are: cushioning, discursive hybrids, explicit provocation and trivializing. Based on a qualitative content analysis of 229 articles published in the weekly magazine Mishpacha (Family), the study seeks to contribute to the existing literature on resistance in and around organizations by exposing the complex and heterogeneous nature of discursive resistance in authoritarian-religious environments. Furthermore, the paper offers a glimpse into the ways that a social group within a religious society resists authority though without shattering its ideological basis.     

Efficacy and safety of orally disintegrating tamsulosin tablets in Taiwanese patients with benign prostatic hyperplasia

Objectives: Tamsulosin is an alpha-1 adrenoceptor antagonist applied in treating lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). This study aimed to evaluate safety, efficacy and acceptance of newly formulated orally disintegrating tamsulosin tablets in Taiwanese patients with LUTS/BPH. Methods: This single center, non-comparative, observational study enrolled 45 male patients over age 50 years. All patients received 0.2?mg tamsulosin orally disintegrating tablets daily and were evaluated at weeks 0, 4, 8, 12 of the 12-week treatment period. Tamsulosin efficacy was evaluated by International Prostate Symptom Score (I-PSS) with 7 questions on urinary symptoms and one disease-specific quality-of-life question, with scores ranging from 0 (no symptoms) to 35 (highly symptomatic). Maximum flow rate (ml/s), voided volume (ml), flow time (s), and mean flow rate (ml/s) were measured. Danish prostatic symptom sexual function scale rated severity and associated concerns of erection quality, ejaculatory function and pain/discomfort were also assessed. Results: Patients’ mean ± SD age was 62.47?±?7.77 (range: 50–89) and mean ± SD I-PSS was 13.98?±?5.50. Statistically significant changes from baseline were found in post-test I-PSS and quality of life (both P < 0.001). Mean ± SD I-PSS decreased from 14.30?±?9.34 to 6.73?±?0.88 at patients’ final visit. Statistically significant increases in mean maximum flow rate and mean flow rate were found over 12-week study period (P < 0.05). No adverse events were reported. No significant differences were found in pulse, SBP/DBP or sexual function. Conclusion: Orally disintegrating tamsulosin tablets demonstrate acceptable safety and efficacy for acceptance and well tolerance by Taiwanese LUTS/BPH patients.