ABSTRACT
Objetivo. Determinar la validez de criterio y el valor predictivo del síntoma disuria para el diagnóstico de infección del tracto urinario (ITU). Diseño. Estudio transversal para evaluación de un síntoma. Emplazamiento. Seis consultas de atención primaria (4 de zona urbana y 2 rurales) del Área 11 de Salud de Madrid. Participantes. Se incluyeron 232 pacientes mayores de 14 años que acudieron a consulta durante 6 meses consecutivos (116 consultaron por disuria y 116 asintomáticos para el síntoma disuria). A todos se les solicitó sedimento y urocultivo. Mediciones y resultados. Se estableció diagnóstico de ITU con urocultivo positivo o sedimento con leucocituria y bacteriuria. Se estudio la sensibilidad (S), especificidad (E), el valor predictivo positivo (VPP), el valor predictivo negativo (VPN), el cociente de probabilidades positivo (CPP) y el cociente de probabilidades negativo (CPN) de la disuria para el diagnóstico de ITU. La edad media fue de 54 años (rango, 19-82), siendo un 73 por ciento mujeres. No había diferencias significativas de edad y sexo entre casos y no casos (p > 0,1). La disuria mostró una S del 96 por ciento (IC del 95 por ciento, 86-98 por ciento), una E del 69 por ciento (IC del 95 por ciento, 61-76 por ciento) y un CPP de 3,1 (IC del 95 por ciento, 2,7-3,5) para el diagnóstico de ITU. En el subgrupo de mujeres la S fue del 95 por ciento (IC del 95 por ciento, 84-99 por ciento) y la E del 67 por ciento (IC del 95 por ciento, 58-75 por ciento). Se calculó para este síntoma un VPP del 30 por ciento (IC del 95 por ciento, 22-40 por ciento) y un VPN del 99 por ciento (IC del 95 por ciento, 95-100 por ciento). Conclusiones. Es poco probable el diagnóstico de ITU sin el síntoma disuria. La mayoría de los pacientes con ITU presentan disuria; sin embargo, este síntoma aislado no nos permite establecer el diagnostico de infección urinaria (AU)
Subject(s)
Male , Female , Humans , Urinary Tract Infections , Urination Disorders , Reproducibility of Results , Case-Control Studies , Cross-Sectional Studies , Predictive Value of TestsABSTRACT
OBJECTIVE: To assess the validity of criterion and predictive value of dysuria for the diagnosis of UTI. DESIGN: Cross-sectional study to assess a symptom. SETTING: Six general medicine clinics (four urban clinics and two rural clinics) in the 11th Health Area in Madrid. PATIENTS: The sample consists of 232 patients aged above fourteen who consulted during six consecutive months (116 of them reported having dysuria and 116 were asymptomatic). MEASUREMENTS AND MAIN RESULTS: The diagnosis of urinary tract infections (UTI) was achieved through positive urine cultures or bacteriuria and leukocyturia in the centrifuged urine sediment. The sensitivity (S) of dysuria analysis for the diagnosis of UTI, its specificity (E), its predictive value (VP), and its probability coefficient (CP) were considered. Average age of the sample was 54 years old (range 19-82); 73% of the patients were female. No statistically significative difference of sex and age was found between cases and non-cases (p > 0.1). Dysuria showed a 96% of sensitivity (95% CI, 86-98%), a 69% of E (95% CI, 61-76%) and 3.1 of CPP (95% CI, 2.7-3.5) for UTI diagnosis. In the women subgroup there was 95% of sensitivity (95% CI, 84-99%) and 67% of E (95% CI, 58-75%). A positive predictive value of 30% (95% CI, 22-40) and a negative predictive value of 99% (95% CI, 95-100) were estimated for this symptom. CONCLUSIONS: The diagnosis of urinary tract infections is unlikely in the absence of dysuria, but to treat all dysuria patients as UTI entails a high rate of overtreatment.
Subject(s)
Urinary Tract Infections/complications , Urination Disorders/etiology , Case-Control Studies , Cross-Sectional Studies , Female , Humans , Male , Predictive Value of Tests , Reproducibility of Results , Urinary Tract Infections/diagnosis , Urinary Tract Infections/microbiologyABSTRACT
BACKGROUND: To study the efficacy and the tolerance of the zidovudine (ZDV) in monotherapy for the treatment of a cohort of patients with HIV infection, most of them injection-drug users (IDU). METHODS: Retrospective study of a historic cohort of 350 patients, from January 1988 to December 1994. The clinic progression, the immunologic deterioriation and the survival after the ZDV administration were evaluated, like the toxicity of the drug. RESULTS: The estimated progression time to AIDS for the 25% of the cohort was 29 months for the initially asymptomatic patients and 22 months for the subjects who showed symptoms. After 26 months half of the patients showed CD4 cell counts less to 50% of the basals. The cumulative survival probability after a year was 99%, 97% and 85% for the groups A, B y C of the CDC classification, and 94%, 87% and 58% after two years for these groups. The predictive factors associated with the survival were the clinic and immunologic status, ESR, LDH, and beta 2-microglobulin levels at the beginning of the treatment. The 35% of the patients suffered adverse events, mainly hematologic effects, although they only forced to suspend the treatment in the 5% of the cases. The only predictive factor associated with the toxicity was a neutrophile count less than 1.500 cells/mm3 previous to the treatment (p < 0.001). CONCLUSION: The ZDV use in monotherapy in a cohort of patients majority IDU shows the same efficacy and safety as the treatment in other patients with HIV infection.
Subject(s)
Anti-HIV Agents/therapeutic use , HIV Infections/drug therapy , Zidovudine/therapeutic use , Adult , Cohort Studies , Female , HIV Infections/immunology , Humans , Male , Retrospective Studies , Survival Analysis , Treatment OutcomeABSTRACT
OBJECTIVE: To analyse medical care for terminal cancer patients (TCP) in a health district. DESIGN: A descriptive, crossover study. SETTING: primary care in an urban environment. PATIENTS: 227 patients who died of cancer between January 1994 and June 1995 and who came under the nine primary care teams (PCT) studied. MEASUREMENTS AND MAIN RESULTS: Information bases: mortality records and clinical histories from the PCT. VARIABLES STUDIED: age, sex, type of tumour, date of diagnosis of terminal illness, whether treated or not with morphine and (if so) the doses, place of death and the care activity engendered. Univariant analysis with standard means and deviations for the quantitative variables, frequencies for the qualitative ones and the Chi squared test for comparison. 64% were male. Most common neoplasias were, in order: lung, colon and stomach. 78 patients (49%) received morphine treatment, datum related to age. Average morphine dose was 80 mg in 24 hours. CONCLUSIONS: Patient treatment was inadequate because morphine, the lodestone of terminal cancer care, was insufficiently used. In contradiction with WHO recommendations, most patients died in hospital. Specific training programmes should be created for PC professionals with the aim of improving their handling of terminal cancer patients.
