Case-control time course study of urinary leukocyte and bacterial counts in patients with acute urinary tract infections responsive and not responsive to antibacterial therapy.

BACKGROUND: Urinary tract infections (UTIs) are usually diagnosed by urine particle detection and urine bacterial culturing, but an empiric treatment is often prescribed before the microbiological results are known. The aim of this study was to assess whether quantification of bacteriuria and leukocyturia could predict the outcome of empiric antibiotic therapy. METHODS: By using a Sysmex UF-100 analyser, we performed a case-control study in which bact channel counts (BCCs) and leukocyte (WBC) quantification were compared in urine samples obtained from responsive patients (RPs) and non-responsive patients (NRPs) at diagnosis (t0) and 24h (t24) after the start of empiric antibacterial treatment. RESULTS: BCCs decreased significantly from t0 (median: 30,000 E6/L) to t24 (median: 700 E6/L; p<0.001) in RPs but not in NRPs (median at t0 31,000 E6/L, and 23,000 E6/L at t24; p>0.05). Similarly, WBC counts were reduced in RPs at t24 relative to the initial values (p<0.001) but not in NRPs. A reduction of 70% in the BCC count or 60% in the WBC count of paired samples was useful for discriminating between RPs and NRPs. CONCLUSIONS: Our results suggest that quantitative time course analysis of urine BCCs and WBCs can be used to predict the success of first-line empiric treatment for UTIs.

Performance of automated platelet quantification using different analysers in comparison with an immunological reference method in thrombocytopenic patients.

BACKGROUND: Rapidly available and accurate platelet counts play an important role in the evaluation of haemorrhagic status and in assessing the need for platelet transfusions. We, therefore, evaluated platelet counting performance of haematology analysers using optical, impedance and immunological methods in thrombocytopenic patients. MATERIALS AND METHODS: We considered 99 patients with a platelet (plt) count under 50 x 10(9) plt/L. We compared the platelet counts obtained using ADVIA 2120 (optical method), Cell-Dyn Sapphire (optical, impedance and immunological methods with CD61) and a reference, double staining (CD41+CD61) immunological method. RESULTS: The platelet counts of all the considered methods showed good correlation with those of the reference method, despite an overestimation in platelet quantification. The degree of inaccuracy was greater for platelet counts under 20 x10(9) plt/L. CONCLUSIONS: Clinicians who use platelet thresholds below 20 x10(9) plt/L for making clinical decisions must be aware of the limitations in precision and accuracy of cell counters at this level of platelet count. Inaccurate counts of low platelet numbers could create problems if attempts are made to reduce the threshold below 20 x 10(9) plt/L.

[Thrombophilia risk factors evaluation in a group of Italian patients with deep venous thrombosis]. / Valutazione del rischio trombofilico in una coorte di pazienti con trombosi venosa profonda.

UNLABELLED: Venous thrombosis usually results from coexistence of multiple genetic and acquired risk factors with a trigger condition. In this study the authors report their experience in a cohort of Italian patients with previous venous thrombosis. MATERIAL AND METHODS: We considered 292 consecutive patients. Each patient was studied by using a panel of functional and genetic tests to detect some of the most relevant thrombophilia risk factors. RESULTS: The single most frequent thrombophilia risk factor was activated C protein resistance due to FV Leiden. Tests for anti phospholipids auto antibodies showed reactivity in 62 subjects. CONCLUSION: The great majority (80%) of patients showed almost one thrombophilia risk factor. Presence of multiple risk factors was demonstrated in 128 (44%) patients.

Effects of the phytoestrogen genistein on hot flushes, endometrium, and vaginal epithelium in postmenopausal women: a 1-year randomized, double-blind, placebo-controlled study.

OBJECTIVE: To evaluate in a 12-month, prospective, randomized, double-blind, placebo-controlled study whether pure administration of the phytoestrogen genistein (54 mg/d) might reduce the number and severity of hot flushes in postmenopausal women with no adverse effect on the endometrium. DESIGN: A total of 389 participants met the main study criteria and were randomly assigned to receive the phytoestrogen genistein (n=198) or placebo (n=191). About 40% of participants in both groups did not suffer from hot flushes, and the evaluation was performed in a subgroup of 247 participants (genistein, n=125; placebo, n=122). Reductions from baseline in the frequency and severity of hot flushes were the principal criteria of efficacy. Endometrial thickness was evaluated by ultrasonography. The maturation value was also used to determine hormonal action on the vaginal cells. RESULTS: There were no significant differences in age, time since menopause, body mass index, and vasomotor symptoms between groups at baseline (4.4 +/- 0.33 hot flushes per day in the genistein group and 4.2 +/- 0.35 hot flushes per day in the control group). The effect was already evident in the first month and reached its peak after 12 months of genistein therapy (-56.4% reduction in the mean number of hot flushes). Furthermore, there was a significant difference between the two groups at each evaluation time (1, 3, 6, and 12 months). No significant difference was found in mean endometrial thickness and maturation value score between the two groups, either at baseline or after 12 months. CONCLUSIONS: The phytoestrogen genistein has been shown to be effective on vasomotor symptoms without an adverse effect on endometrium.

From the donor's arm to blood product: a study on bacterial contamination of apheresis platelet concentrates.

BACKGROUND: Transfusion-associated bacterial infections are a quite frequent collateral effect of administration of platelet concentrates (PC). We carried out a microbiological surveillance of bacterial contamination of apheresis platelet concentrates by studying microbial flora on donors' arms before and after skin disinfection, through blood cultures with the diversion volume and with the PC. MATERIALS AND METHODS: Platelet aphereses were carried out using two Haemonetics MCS+ instruments. Cutaneous swabs were examined by the direct plate technique and blood cultures were performed using Bact/ALERT aerobic bottles. In the 5 years from January 2001 to December 2005 we tested 481 PC. RESULTS: Cutaneous swabs showed significant bacterial growth in 89% of cases before skin disinfection and in 44% after. None of the blood cultures performed on diversion blood was positive, one (0.2%) PC was positive on the fifth day after collection and the presence of a Staphylococcus epidermidis strain was demonstrated. CONCLUSIONS: Our results suggest that the skin disinfection protocol adopted in our structure is not fully satisfactory. The cultures performed on the PC showed a low prevalence of contamination, and the only positive sample was contaminated by a common skin contaminant (S. epidermidis). The culture became positive on the fifth day after collection, but on the second day the PC had been transfused to a patient, without any adverse reaction. In our experience a culture method using Bact/ALERT aerobic bottles was not able to prevent transfusion of the only contaminated PC identified in this study.

Gestrinone versus danazol as preoperative treatment for hysteroscopic surgery: a prospective, randomized evaluation.

OBJECTIVE: To compare danazol and gestrinone treatment as preoperative endometrial preparation for operative hysteroscopy. DESIGN: Prospective, randomized clinical study. SETTING: University department of gynecological, obstetrical sciences and reproductive medicine. PATIENT(S): One hundred thirty-five patients with endouterine pathologies (endometrial polyps, submucous myoma, septate uterus). INTERVENTION(S): Patients pretreated with gestrinone (n = 68) and with danazol (n = 67) underwent operative hysteroscopy. MAIN OUTCOME MEASURE(S): Endometrial response to the medical pretreatment, side effects, procedure time, intraoperative bleeding, infusion volume, patient satisfaction. RESULT(S): Side effects were infrequent in both groups, though the patients' personal satisfaction was in favor of gestrinone. The rate of endometrial response was higher for the gestrinone group (97.1% vs. 83.6%). Operative time (mean +/- SD) was 12 +/- 1.8 and 15.2 +/- 1.9 minutes for the gestrinone and danazol groups, respectively. The gestrinone group showed a lower incidence of moderate bleeding (3% vs. 22.4%) and a lower infusion volume (2,100 +/- 200 mL vs. 2,400 +/- 250 mL). Regarding cervical dilatation time, no significant difference was found between the two groups (1.6 +/- 0.3 minutes vs. 1.5 +/- 0.4 minutes). CONCLUSION(S): Both treatments are good ways to prepare the endometrium for operative hysteroscopy. However, the data suggest that gestrinone pretreatment is preferable to danazol.