Occurrence Of New Episodes Research Articles

Incidence and Recurrence of Urinary Tract Infections Caused by Uropathogenic Escherichia coli: A Retrospective Cohort Study.

Urinary tract infections (UTIs) are among the most common bacterial infections, with uropathogenic Escherichia coli (UPEC) as the main etiologic agent of uncomplicated UTIs (uUTIs). The prevalence of uUTis caused by organisms with antimicrobial resistance (AMR) is increasing worldwide, complexifying the disease management and increasing the risk of complications. In efforts to develop new strategies for uUTI prevention, it is imperative to understand factors associated with the occurrence of new episodes. This retrospective cohort study aimed to assess the incidence of uUTIs caused by UPEC (UPEC-uUTIs) or unknown etiology (untested uUTIs) in adults aged ≥18 years receiving care in a San Francisco healthcare system. During 2014-2019, 1087 UPEC-uUTI and 4106 untested uUTI cases were documented, of which 324 (29.8%; 95% confidence interval: 27.1%-32.6%) and 1030 (25.1%; 95% confidence interval: 23.8%-26.4%) were followed by ≥1 new episode of uUTI within 12 months. In the UPEC-uUTI cohort, male gender, diagnosis of diabetes mellitus, and prior uUTI were risk factors for new episodes of uUTI. At the time of first UPEC-uUTI diagnosis, antimicrobial prescriptions were retrieved for 41.1% of cases. When tested, AMR was most frequently reported for trimethoprim/sulfamethoxazole or trimethoprim/sulfamethoxazole prescribed with other antimicrobials. Our study provides important information on the incidence and risk of repeated episodes of uUTIs, as well as on AMR related to them.

Prevalence of toothache and associated factors in children and adolescents: a systematic review and meta-analysis.

This systematic review aimed to determine the pooled prevalence of toothache in children and adolescents and to verify its association with sociodemographic characteristics and dental caries experience. Six main and three grey literature databases were searched in February 2021. Observational studies that assessed the prevalence of toothache and associated factors were included. The methodological quality of the studies was evaluated following the guidelines by Fowkes and Fulton. Proportion and association meta-analyses were performed in MedCalc and Revman software, respectively. The certainty of the evidence was determined with the GRADE approach. Seventy-one studies met the inclusion criteria. Thirty-two presented high methodological quality and a low risk of bias. The overall pooled prevalence of toothache in children and adolescents was 36.2% (95%CI: 33.0-39.42; I2: 99.72%; P < 0.001). Females (OR: 1.17; 95%CI: 1.08-1.26; I2: 91%; P < 0.001) and children and adolescents whose caregivers had ≤ 8years of schooling (OR: 1.42; 95%CI: 1.30-1.56; I2: 77%; P < 0.001) presented the higher chance of reporting toothache. Dental caries experience increased the chance of reporting toothache in 3.49 times (95%CI: 2.70-4.51; I2: 92%; P < 0.001). The certainty of the evidence was very low. The overall pooled prevalence of toothache was considered high. Sociodemographic characteristics (sex and caregivers' educational level) and previous dental caries experience were significantly associated with toothache reports. Toothache is still a recurrent issue in many countries. Thus, it is essential to understand its possible associated factors to reduce the occurrence of new episodes.

Efficacy of vitamin D in children with pneumonia: a randomized control trial study

Background and Objectives: Pneumonia is the inflammation of parenchyma of lungs. It strictly represents any inflammatory condition that involves the lungs along with the visceral pleura, airways, alveoli, connective tissues and vascular structures. The objective of the study was to see the efficacy of vitamin D in children with pneumonia.Material and Methods: A randomized control study was conducted in Department of Pediatric Medicine, Mayo Hospital, Lahore, Pakistan. One hundred patients with pneumonia received vitamin D along with appropriate antibiotics and one hundred were treated with antibiotics but without vitamin D. The patients were discharged after the fast breathing and chest in drawing settled. The duration of hospital stay was noted. They were followed up for next 90 days after discharge from hospital and any new episode of pneumonia was noted and recorded.Results: The mean number of days to recovery were similar between the group receiving vitamin D (5.7 ± 2.7 days) and the group not receiving vitamin D (6.1 ± 2.8days), (p=0.28). While comparing repeat episode of pneumonia within next three months, the repeat episode of pneumonia was significantly lower in the intervention group (2%) than the group without supplementation (9%; p = 0.002) within 30 days of supplementation of vitamin D.Conclusion: Vitamin D supplementation in a single dose to the children diagnosed as pneumonia significantly reduces the occurrence of new episodes of pneumonia within one month of discharge.Janaki Medical College Journal of Medical Sciences (2015) Vol. 3 (1):5-13

T2238C ANP gene variant and risk of recurrent acute coronary syndromes in an Italian cohort of ischemic heart disease patients.

The role of C2238/atrial natriuretic peptide (ANP) minor allele, at the T2238C ANP gene variant, as a predisposing risk factor for acute cardiovascular events, has been previously reported. We aimed at evaluating, by a retrospective approach, the long-term impact of C2238/ANP-minor allele carrier status toward the risk of recurrent acute coronary syndromes (re-ACS) in an Italian cohort of ischemic heart disease patients. A total of 379 patients (males = 80.5%; mean age = 62.5 ± 9.2 years) presenting with ACS were retrospectively analyzed. Mean follow-up was 5.1 ± 3.5 years (range 1-26 years). Occurrence of new episodes of unstable angina, non-ST-segment elevation myocardial infarction and STE myocardial infarction over the years was recorded and compared between subjects not carrying and carrying C2238/ANP-minor allele. At univariate analysis, C2238/ANP-minor allele carrier status and treatment with beta-blocker, aspirin and statin were associated with risk of re-ACS. Multivariate analysis confirmed that hypercholesterolemia (P < 0.0001) and C2238/ANP-minor allele carrier status (P < 0.05) were both significantly and independently associated with increased risk of re-ACS. Both treatments with beta-blocker and with statin were significantly associated with reduced risk of re-ACS (P = 0.01 and P < 0.01, respectively). Age above 55 years was associated with recurrence of ACS in C2238/ANP-minor allele carriers (hazard ratio 1.427, 95% confidence interval 1.066-1.911, P = 0.017). Kaplan-Meier curves confirmed highest risk of new events occurrence in C2238/ANP-minor allele carriers (P = 0.035). The present results demonstrate that C2238/ANP-minor allele carrier status is an independent risk factor for ACS recurrence in an Italian cohort of ischemic heart disease patients over the long term, and they support the role of C2238/ANP-minor allele as a negative prognostic factor in coronary artery disease patients.

Probiotics for the treatment of upper and lower respiratory‐tract infections in children: systematic review based on randomized clinical trials

ObjectivesEvaluate the effect of probiotics on the symptoms, duration of disease, and the occurrence of new episodes of upper and lower respiratory infections in healthy children. SourcesIn order to identify eligible randomized controlled trials, two reviewers accessed four electronic databases [Medline/PubMed, Scopus (Elsevier), Web of Science, and Cochrane (Cochrane VHL)], as well as ClinicalTrials.gov until January of 2015. Descriptors were determined by using the Medical Subject Headings tool, following the same search protocol. Summary of the findingsStudies showed to be heterogeneous regarding strains of probiotics, the mode of administration, the time of use, and outcomes. The present review identified 11 peer‐reviewed, randomized clinical trials, which analyzed a total of 2,417 children up to 10 incomplete years of age. In the analysis of the studies, reduction in new episodes of disease was a favorable outcome for the use of probiotics in the treatment of respiratory infections in children. It is noteworthy that most of these studies were conducted in developed countries, with basic sanitation, health care, and strict, well‐established and well‐organized guidelines on the use of probiotics. Adverse effects were rarely reported, demonstrating probiotics to be safe. ConclusionsDespite the encouraging results reducing new episodes of respiratory infections, the authors emphasize the need for further research, especially in developing countries, where rates of respiratory infections in children are higher when compared to the high per capita‐income countries identified in this review.

Probiotics for the treatment of upper and lower respiratory-tract infections in children: systematic review based on randomized clinical trials

ObjectivesEvaluate the effect of probiotics on the symptoms, duration of disease, and the occurrence of new episodes of upper and lower respiratory infections in healthy children. SourcesIn order to identify eligible randomized controlled trials, two reviewers accessed four electronic databases [MEDLINE/PubMed, Scopus (Elsevier), Web of Science, and Cochrane (Cochrane VHL)], as well as ClinicalTrials.gov until January 2015. Descriptors were determined by using the Medical Subject Headings tool, following the same search protocol. Summary of the findingsStudies showed to be heterogeneous regarding strains of probiotics, the mode of administration, the time of use, and outcomes. The present review identified 11 peer-reviewed, randomized clinical trials, which analyzed a total of 2417 children up to 10 incomplete years of age. In the analysis of the studies, reduction in new episodes of disease was a favorable outcome for the use of probiotics in the treatment of respiratory infections in children. It is noteworthy that most of these studies were conducted in developed countries, with basic sanitation, health care, and strict, well-established and well-organized guidelines on the use of probiotics. Adverse effects were rarely reported, demonstrating probiotics to be safe. ConclusionsDespite the encouraging results – reducing new episodes of respiratory infections – the authors emphasize the need for further research, especially in developing countries, where rates of respiratory infections in children are higher when compared to the high per capita-income countries identified in this review.

Isolated Anterior Talofibular Ligament Broström Repair for Chronic Lateral Ankle Instability

Background: Lateral ankle sprains may result in pain and disability in the short term, decreased sport activity and early retirement from sports in the mid term, and secondary injuries and development of early osteoarthritis to the ankle in the long term. Hypothesis: This combined approach to chronic lateral instability and intra-articular lesions of the ankle is safe and in the long term maintains mechanical stability, functional ability, and a good level of sport activity. Study Design: Case series; Level of evidence, 4. Methods: We present the long-term outcomes of 42 athletes who underwent ankle arthroscopy and anterior talofibular Broström repair for management of chronic lateral ankle instability. We assessed in all patients preoperative and postoperative anterior drawer test and side-to-side differences, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Kaikkonen grading scales. Patients were asked about return to sport and level of activity. Patients were also assessed for development of degenerative changes to the ankle, and preoperative versus postoperative findings were compared. Results: Thirty-eight patients were reviewed at an average of 8.7 years (range, 5-13 years) after surgery; 4 patients were lost to follow-up. At the last follow-up, patients were significantly improved for ankle laxity, AOFAS scores, and Kaikkonen scales. The mean AOFAS score improved from 51 (range, 32-71) to 90 (range, 67-100), and the mean Kaikkonen score improved from 45 (range, 30-70) to 90 (range, 65-100). According to outcome criteria set preoperatively, there were 8 failures by the AOFAS score and 9 by the Kaikkonen score. Twenty-two (58%) patients practiced sport at the preinjury level, 6 (16%) had changed to lower levels but were still active in less demanding sports (cycling and tennis), and 10 (26%) had abandoned active sport participation although they still were physically active. Six of these patients did not feel safe with their ankle because of the occurrence of new episodes of ankle instability. Of the 27 patients who had no evidence of degenerative changes preoperatively, 8 patients (30%) had radiographic signs of degenerative changes (5 grade I and 3 grade II) of the ankle; 4 of the 11 patients (11%) with preexisting grade I changes remained unchanged, and 7 patients (18%) had progressed to grade II. No correlation was found between osteoarthritis and status of sport activity (P = .72). Conclusion: Combined Broström repair and ankle arthroscopy are safe and allow most patients to return to preinjury daily and sport activities.

The impact of decision latitude, psychological load and social support at work on the development of neck, shoulder and low back symptoms among female human service organization workers

The aim of the present study was to investigate longitudinal relations between decision latitude, psychological workload and social support and musculoskeletal neck, shoulder and low back symptoms. In this longitudinal two-wave cohort study a questionnaire survey was conducted among female human service organization workers ( n = 1690). The analyses were based on respondents who were considered free from the respective symptoms at baseline measurements, resulting in study samples of n = 741 for neck symptoms, n = 670 for shoulder symptoms, and n = 640 for low back symptoms. In general support was found for the job demand–control–(support) model. High strain work (high psychological load coupled with low decision latitude) in combination with low social support (‘iso-strain’) was related to increased risks of developing symptoms (occurrence of new episode) in all the body regions studied (neck, shoulder and low back). Relevance to industry The results indicate that, in order to minimize the occurrence of musculoskeletal symptoms, it is important to ensure that employees have adequate levels of decision latitude, to keep the workload at optimal levels, and to provide supervisor support and structures that facilitate coworker support.

Efeitos da eritropoetina recombinante humana em recém-nascidos pré-termo com doenças infecciosas

To study the effects of recombinant human erythropoietin (rHuEpo) in preterm newborns (PTNs) with serious infectious diseases. A not randomized case-control study was carried out in 34 preterm newborns with diagnosis of serious infectious pathologies, gestational age up to 35 weeks, birth weight less than 1500 g and clinical stability. Newborns selected for treatment with rHuEpo received 400 U/kg erythropoietin ss, subcutaneously twice a week. Oral iron supplementation was initiated when the levels of serum ferritin were lower than 60 mcg/l. The study was continued for six weeks or until the patient was discharged from the hospital. Erythropoiesis, granulopoiesis, thrombocytopoiesis, the need for transfusions and the occurrence of new episodes of infectious disease were analyzed. In the treated group there was a significant increase in the number of reticulocytes, although there was no statistically significant difference between the groups with regard to the number or volume of transfusions. There was no significant difference in neutrophils and platelet values. The use of rHuEpo, 800 U/kg/week, in PTNs with infectious diseases was effective in inducing erythropoiesis, without significant changes in the number of neutrophils or platelets. This strategy, and the accurate control of the blood collected for laboratory exams, may be beneficial for prevention of the anemia in PTNs with serious infectious diseases.

A prospective study of the effects of sexual or physical abuse on back pain

A prospective investigation of the effects of abuse on future pain and disability was conducted in order to understand better the possible causal role of abuse. Participants were 422 females from a previous population study (Pain 73 (1997) 47–53) who either reported no spinal pain ( n=194) or some spinal pain ( n=228) at the baseline. A standardized questionnaire was used to assess self-reported physical and sexual abuse during childhood and as an adult. One year later, a follow-up questionnaire was used to evaluate pain and physical function outcomes. Results for the No Pain Group showed that only self-reported physical abuse at baseline was associated with an increased occurrence of new episodes of back pain (odds ratio=2.65). Both sexual and physical abuse were linked to as much as four-fold increase in the occurrence of a new episode of functional problems at follow-up. However, for the Pain Group, no significant differences were found between those reporting and not reporting abuse at baseline and either pain or disability at follow-up. This unique prospective study with individuals from the general population underscores the probable importance of abuse in the etiology of a pain or disability problem. Nevertheless, since no clear relationship between abuse and pain was shown for those already reporting pain at baseline, the role of abuse in the development of persistent pain is still not comprehensible. There is a need for investigations with prospective designs employing patients as well as nonpatients as subject.

Clinical and endoscopic aspects in the evolution of patients with bleeding peptic ulcer--a cohort study.

Bleeding ulcers are a major problem in public health and represent approximately half of all the cases of upper gastrointestinal hemorrhage in the United States. This study aims to determine the prognostic value of factors such as clinical history, laboratory and endoscopic findings in the occurrence of new episodes of bleeding in patients who have upper gastrointestinal hemorrhage caused by gastric or duodenal peptic ulcer. A cohort study with 94 patients was designed to investigate prognostic factors to the occurrence of new episodes of bleeding. From the 94 patients studied, 88 did not present a new bleeding episode in the 7 days following hospital admission. The incidence of rebleeding was significantly higher in those patients with hemoglobin < 6 g/dL at the admission (P = 0.03, RR = 6.2). The localization of the ulcers in bulb was positively associated to rebleeding (P = 0.003). The rebleeding group needed a greater number of units transfunded (P = 0.03) and the time of hospitalization was longer than the time of the hemostasia group (P = 0.0349). The identification of patients with risk of death by bleeding peptic ulcer remains as a challenge, once few factors are capable of predicting the severity of the evolution. The identification of such factors will allow the choice of the better therapeutic conduct improving the diagnosis and decreasing the rate of rebleeding and the mortality.

The role of physical and psychological factors in occupational low back pain: a prospective cohort study

OBJECTIVETo examine risk factors for onset of low back pain (LBP) in healthcare workers.METHODSNursing students, during their 3 year training period, and 1 year after training were studied in a...

Risk factors for back pain incidence in industry: a prospective study

The objective of this study was to examine the relationship between physical and psychological risk factors on the one hand, and the occurrence of new episodes of back pain on the other hand. A prospective study was conducted with 12 months follow-up by means of self-administered questionnaires. The study took place in the Cargo Department of a major Dutch airline company. The subjects for this study were 270 workers involved in heavy physical work. Only workers without back pain at baseline were included. Self-reported back pain and sick leave due to back pain during the follow-up period were measured. Of the 238 workers included in the analysis, 73 (31%) developed a new episode of back pain during the follow-up period, and 27 (11%) subjects reported sick leave due to back pain. Multiple logistic regression analysis showed that the history of back pain was the best predictor for the occurrence of a new episode of back pain during follow-up (OR 9.8; 95% CI 2.8–34.4 for subjects who had back pain more than twice in the past year). Low job satisfaction was also associated with an increased risk for the occurrence of back pain during follow-up (OR 1.2; 95% CI 1.01–1.4). Riding a forklift truck appeared to be a protective factor for the occurrence of back pain (OR 0.7; 95% CI 0.5–0.99). In this study the best predictors for the occurrence of back pain were the history of back complaints and low job satisfaction. Although it needs to be confirmed by future intervention studies, the results indicate that increasing job satisfaction may be a successful (co-)intervention for the prevention of back pain at the workplace.

Employment and physical work activities as predictors of future low back pain.

A population-based longitudinal study conducted in northwest England for a 12-month period involving adults aged 18-75 years. To determine physical factors related to employment that predict a new episode of low back pain. Most epidemiologic studies that have examined the relation between occupation and back pain have been cross-sectional or retrospective in design. Because workers who have experienced low back pain may have changed jobs or work activities, it is important to use longitudinal studies that define "exposures" before the onset of symptoms. From adults registered with two general practices in northwest England, 1412 people who were currently in employment and free of low back pain were identified. A lifetime occupational history was recorded for all participants, with details of activities performed in each occupation. Data on consultations for low back pain during the follow-up year were collected through computerized medical records, whereas those who had not consulted with low back pain were sent another questionnaire at the end of the 1-year follow-up. An increased risk of a new episode of low back pain was found in those whose jobs involved lifting/pulling/pushing objects of at least 25 lbs, or whose jobs involved prolonged periods of standing or walking. Risks were, in general, greater in women, for a first ever episode of back pain and for back pain that led to a general practice consultation. No clear relation between years of exposure to such factors and magnitude of risk was evident. Occupational activities, particularly in women, such as working with heavy weights or lengthy periods of standing or walking, were associated with the occurrence of low back pain. Short-term influences may be more important in the occurrence of new episodes rather than cumulative lifetime exposure, and emphasize that such morbidity may be avoidable.

Psychosocial factors in the workplace--do they predict new episodes of low back pain? Evidence from the South Manchester Back Pain Study.

A prospective, population-based cohort study of working adults. To determine whether work-related psychosocial factors and social status predict the occurrence of new episodes of low back pain and influence consultation behavior. Dissatisfaction with work and social status has been associated with low back pain in several studies; few of these studies have been prospective or population based. An initial postal survey was returned by 4,501 (59%) adults (18-75 years old) registered with two primary care practices. From this, a cohort of 1,412 people currently in employment and free of low back pain was identified, and baseline information on work-related psychosocial factors and psychologic distress was obtained. Social class was derived from current occupation using a standardized classification. New episodes of low back pain occurring in the next 12 months were identified by continuous monitoring of primary care consulters and by mailing a second questionnaire a year later to identify occurrences of low back pain for which no consultation was sought. The baseline cross-sectional survey showed modest but significant associations between low back pain and perceived inadequacy of income (risk ratio 1.3), dissatisfaction with work (risk ratio 1.4) and social class IV/V (risk ratio 1.2). In the follow-up year, the risk of reporting low back pain for which no consultation was sought doubled in those dissatisfied with their work. Both perceived inadequacy of income (odds ratio 3.6) and social class IV/V (odds ratio 4.8) were strongly associated with consulting with a new episode of low back pain during the follow-up year, an association more marked in women. The associations with work dissatisfaction and perceived adequacy of income were not explained by general psychologic distress or social status. People dissatisfied with work are more likely to report low back pain for which they do not consult a physician, whereas lower social status and perceived inadequacy of income are independent risks for working people to seek consultation because of low back pain.

Treatment of recurrent pericarditis with colchicine

Corticosteroid therapy, because of its frequent and severe side effects should be avoided if possible, and colchicine may be an effective substitute in steroid-dependent recurrent pericarditis. The aim of our study was to assess the usefulness of colchicine in recurrent pericarditis before initiating corticosteroid treatment. Nineteen consecutive patients (10 males, nine females, age 46 +/- 7 years) with recurrent pericarditis (two episodes or more) were included in this prospective open-label study. Before the study, the patients suffered a total of 57 episodes of pericarditis (mean = 3.0 +/- 0.5 episodes.patient-1) despite the use of non-steroidal anti-inflammatory drugs. The mean interval time between the episodes was 7.3 +/- 5.3 months. Colchicine was given at a loading dose of 3 mg and a maintenance dose of 1 mg daily (for 1 to 27 months (mean = 7.7). During the clinical follow-up, the efficacy was estimated by the occurrence of new episodes of pericarditis and by the need for corticosteroid treatment. No recurrence occurred in 14 out of the 19 patients (74%) during a follow-up of 37.4 +/- 6.5 months. In four out of the 19 patients (21%), five recurrences occurred, which resolved without corticosteroids. Follow-up at 23.8 +/- 12.7 months was free of further recurrence. Only one patient (5%) had several recurrences and required corticosteroids for chronic rheumatism. Tolerance was good except for two cases of diarrhoea, one case of hypothyroidism due to associated long-term antidiarrhoeal therapy (containing iodine), and one case of mild leucopenia.(ABSTRACT TRUNCATED AT 250 WORDS)