Association of disease duration and PASI response rates at week 12 in patients with moderate-to-severe plaque psoriasis receiving biologics in the real-world psoriasis study of health outcomes (PSoHO).

PURPOSE: Currently, in the treatment of moderate-to-severe psoriasis (PsO) there is a lack of evidence demonstrating optimal biologic treatment response with respect to disease duration. The aim of this post-hoc analysis, using real world data from the Psoriasis Study of Health Outcomes (PSoHO), is to provide evidence if early intervention with biologics is associated with better treatment outcomes and if there is any difference among drug classes or individual biologics. MATERIALS AND METHODS: For this post-hoc analysis patients were categorised into two subgroups according to shorter (≤2 years) or longer (>2 years) disease duration. Analysis was performed on anti-interleukin (IL)-17A cohort vs other biologics cohort, anti-IL-17A vs other drug classes, and pairwise comparisons of ixekizumab vs individual biologics, provided that the statistical models converged. Analysis investigated the association of disease duration with the proportion of patients achieving 100% improvement in Psoriasis Area Severity Index score (PASI 100) at week 12. Adjusted comparative analyses, reported as odds ratio (OR), were performed using Frequentist Model Averaging (FMA) for each cohort or treatments within each subcategory of the subgroups. RESULTS: At week 12, anti-IL-17A and other biologics cohorts displayed minimal differences in numerical response rate for PASI 100 with respect to disease duration. The anti-IL-17A cohort showed a higher numerical PASI 100 response rate compared to the other biologic cohort irrespective of disease duration (≤2 years: 36.7% vs 21.8%; >2 years: 35.8% vs 21.9%). CONCLUSION: Overall, the results do not clearly indicate that treating patients early is critical in achieving optimal patient outcomes. Furthermore, patients treated with ixekizumab show numerically higher response rates relative to other individual biologics irrespective of disease duration.

Quality by design approach for development and characterization of gabapentin-loaded solid lipid nanoparticles for intranasal delivery: In vitro, ex vivo, and histopathological evaluation.

Objectives: "Quality by Design" (QbD) is a novel approach to product development that involves understanding the product and process, as well as the relationship between critical quality attributes (CQA) and critical process parameters (CPP). This study aimed to optimize the gabapentin-loaded solid lipid nanoparticle formulation (GP-SLN) using a QbD approach and evaluate in vitro and ex vivo performance. Materials and Methods: The GP-SLN formulation was created using the microemulsion method by combining Gelucire 48/16, Tween 80, and Plurol Oleique CC 497. The Box-Behnken experimental design was adopted to investigate the effects of independent factors on dependent factors. The GP-SLN formulation was assessed based on particle size and distribution, zeta potential, morphology, entrapment efficiency, release kinetics, permeation parameters, stability, and nasal toxicity. Results: The nanoparticles had a cubical shape with a particle size of 185.3±45.6 nm, a zeta potential of -24±3.53 mV, and an entrapment efficiency of 82.57±4.02%. The particle size and zeta potential of the GP-SLNs remained consistent for 3 months and followed Weibull kinetics with a significantly higher ex vivo permeability (1.7 fold) than a gabapentin solution (GP-SOL). Histopathology studies showed that intranasal administration of the GP-SLN formulation had no harmful effects. Conclusion: The current study reports the successful development of a GP-SLN formulation using QbD. A sustained release of GP was achieved and its nasal permeability was increased. Solid lipid nanoparticles with optimum particle size and high entrapment efficiency may offer a promising approach for the intranasal delivery of drugs.

Comparing Achievement of National Psoriasis Foundation Treatment Targets among Patients with Plaque Psoriasis Treated with Ixekizumab versus Other Biologics in Clinical and Real-World Studies.

INTRODUCTION: The National Psoriasis Foundation (NPF) recommends evaluating patient response to treatment at week 12, with a target response of ≤ 1% body surface area (BSA) affected by plaque psoriasis and an acceptable response of BSA ≤ 3% or ≥ 75% improvement. This post hoc analysis compared the achievement of NPF target and acceptable responses for ixekizumab (IXE) versus other biologics. METHODS: Outcomes were evaluated at week 12 for patients with moderate-to-severe plaque psoriasis from four head-to-head randomized clinical trials (RCTs; UNCOVER-2, UNCOVER-3, IXORA-R, and IXORA-S) and one real-world prospective observational study (Psoriasis Study of Health Outcomes; PSoHO). RCT patients were treated with IXE or etanercept (ETN; UNCOVER-2/3), guselkumab (GUS; IXORA-R), or ustekinumab (UST; IXORA-S). PSoHO patients were treated with anti-interleukin (IL)-17A biologics (IXE, secukinumab, SEC) and other approved biologics for the treatment of plaque psoriasis. Patients with missing outcomes were imputed as non-responder imputation. For RCT data, statistical comparisons between treatment groups were performed using Fisher's exact test with no multiplicity adjustments. For real-world data, adjusted comparative analyses were performed using frequentist model averaging (FMA) and reported as odds ratio (OR). RESULTS: Across the four head-to-head clinical trials analyzed, significantly higher proportions of patients achieved target and acceptable responses at week 12 with IXE versus ETN, GUS, or UST. Likewise, the proportion of PSoHO patients achieving target and acceptable response at week 12 was higher with IXE compared with other individual biologics. Adjusted comparative analyses showed that IXE had significantly greater odds of target and acceptable response at week 12 versus SEC, GUS, risankizumab (RIS), adalimumab (ADA), UST, and tildrakizumab (TILD) and numerically greater odds of target and acceptable response at week 12 versus brodalumab (BROD). CONCLUSION: Across both clinical studies and real-world settings, more patients treated with IXE achieved NPF target and acceptable responses at week 12 compared with those treated with other biologics. TRIAL REGISTRATION: UNCOVER-2 (NCT01597245); UNCOVER-3 (NCT01646177); IXORA-R (NCT03573323); IXORA-S (NCT02561806); PSoHO (EUPAS24207).

Impact of climate change and land cover dynamics on nitrate transport to surface waters.

The study investigated the impact of climate and land cover change on water quality. The novel contribution of the study was to investigate the individual and combined impacts of climate and land cover change on water quality with high spatial and temporal resolution in a basin in Turkey. The global circulation model MPI-ESM-MR was dynamically downscaled to 10-km resolution under the RCP8.5 emission scenario. The Soil and Water Assessment Tool (SWAT) was used to model stream flow and nitrate loads. The land cover model outputs that were produced by the Land Change Modeler (LCM) were used for these simulation studies. Results revealed that decreasing precipitation intensity driven by climate change could significantly reduce nitrate transport to surface waters. In the 2075-2100 period, nitrate-nitrogen (NO3-N) loads transported to surface water decreased by more than 75%. Furthermore, the transition predominantly from forestry to pastoral farming systems increased loads by about 6%. The study results indicated that fine-resolution land use and climate data lead to better model performance. Environmental managers can also benefit greatly from the LCM-based forecast of land use changes and the SWAT model's attribution of changes in water quality to land use changes.

Risk factors for post-acute sequelae of COVID-19 in hospitalized patients: An observational study based on a survey in a tertiary care center in Türkiye.

Introduction: Long COVID is a multisystem disease with various symptoms and risk factors. We aim to investigate the post-acute sequelae of COVID-19 and related risk factors in a tertiary care center. Materials and Methods: In this observational study, based on a survey of 1.977 COVID-19 patients hospitalized from April 2020 to January 2021, a retrospective assessment was carried out on 1.050 individuals who were reachable via telephone to determine their eligibility for meeting the inclusion criteria. Results: The data of 256 patients who reported at least one persistent symptom were analyzed. Long COVID prevalence was 24.3%. Among 256 patients (median age 52.8; 52.7% female; 56.63% had at least one comorbidity), dyspnea, fatigue, arthralgia-myalgia, cough, and back pain were the most common post-acute sequelae of COVID-19 (42.4%; 28.29%; 16.33%; 13.15% and 7.17%, respectively). The risk factors for the persistence of dyspnea included having lung diseases such as chronic obstructive pulmonary disease, a history of intensive care support, the requirement for long-term oxygen therapy, and a history of cytokine storm (p= 0.024, p= 0.026, p< 0.001, p= 0.036, p= 0.005, respectively). The correlation between lung involvement with post-discharge cough (p= 0.041) and dizziness (p= 0.038) was significant. No correlation between the symptoms with the severity of acute infection, age, and gender was found. When a multivariate regression analysis was conducted on the most common long COVID-related symptoms, several independent risk factors were identified. These included having lung disease for dyspnea (OR 5.81, 95% CI 1.08-31.07, p= 0.04); length of hospital stay for myalgia (OR 1.034, 95% CI 1.004-1.065, p= 0.024); and pulmonary involvement of over 50% during COVID-19 infection for cough (OR 3.793, 95% CI 1.184-12.147, p= 0.025). Conclusion: COVID-19 survivors will require significant healthcare services due to their prolonged symptoms. We hope that our findings will guide the management of these patients in clinical settings towards best practices.

Electrocardiographic measurements in children with pre-dialysis chronic kidney disease and undergoing kidney replacement therapy.

Cardiovascular diseases are the main causes of morbidity in children with chronic kidney disease (CKD). Electrocardiography (ECG) can provide important information about cardiac functions and parameters associated with sudden cardiac death. This study aims to evaluate the potentially dangerous changes in CKD and kidney replacement therapies by ECG and to determine the value of ECG in predicting cardiovascular outcome compared with echocardiography. 101 patients with CKD were divided into subgroups according to treatment modalities as pre-dialysis CKD, hemodialysis (HD), peritoneal dialysis (PD) and kidney transplantation (KTx). Differences in anthropometric measurements, laboratory results, blood pressures, ECG monitoring were compared within groups as well as with 40 healthy controls. Available echocardiographic findings were noted. In the patients, HD group had highest frequency of hypertension. ECG revealed prolonged QTc as more frequent (16.8% vs 0%, p = 0.006) and higher QTcD (56.7 ± 6.5 vs 39.9 ± 5.1 ms, p = 0.001) in the patients compared to controls, especially in dialysis patients, whereas lowest values were in KTx subgroup. Left ventricular (LV) hypertrophy (LVH) was more frequent (47.1%) in HD compared to other CKD subgroups in ECG (p = 0.052). Echocardiography also showed LV mass index as highest in HD and lowest in KTx (121.4 ± 55.7 vs 63.7 ± 18.3 g/m2, p = 0.000), with numerically highest LVH in HD (58.3%, p = 0.063).  Conclusion: ECG can be used to detect cardiovascular problems in patients with CKD, especially in HD. As ECG results were in line with echocardiography, patients with ECG abnormalities suggestive of LVH should be referred for echocardiographic assessment. What is Known: • Cardiovascular diseases such as coronary artery disease, congestive heart failure, arrhythmias and sudden cardiac death are major causes of morbidity and mortality in chronic kidney disease. • Electrocardiography has significant advantages in demonstrating cardiac functions in children because it is readily available, non-invasive and often non-experts can interpret the results. What is New: • The heart rate is higher, QTc is longer and QTcD is higher in dialysis patients and the prolonged QTc is more frequent in patients with underlying glomerular diseases. • Left ventricular hypertrophy is more common in HD patients and those with hypertension, hypercalcemia, anemia or glomerular etiology. The cardiovascular risky conditions are less frequent in the patients with kidney transplantation.

Graph neural network based unsupervised influential sample selection for brain multigraph population fusion.

Graph neural networks (GNNs) have witnessed remarkable proliferation due to the increasing number of applications where data is represented as graphs. GNN-based multigraph population fusion methods for estimating population representative connectional brain templates (CBT) have recently led to improvements, especially in network neuroscience. However, prior studies do not consider how an individual training brain multigraph influences the quality of GNN training for brain multigraph population fusion. To address this issue, we propose two major sample selection methods to quantify the influence of a training brain multigraph on the brain multigraph population fusion task using GNNs, in a fully unsupervised manner: (1) GraphGradIn, in which we use gradients w.r.t GNN weights to trace changes in the centeredness loss of connectional brain template during the training phase; (2) GraphTestIn, in which we exclude a training brain multigraph of interest during the refinement process in the test phase to infer its influence on the CBT centeredness loss. Next, we select the most influential multigraphs to build the training set for brain multigraph population fusion into a CBT. We conducted extensive experiments on brain multigraph datasets to show that using a dataset of influential training samples improves the learned connectional brain template in terms of centeredness, discriminativeness, and topological soundness. Finally, we demonstrate the use of our methods by discovering the connectional fingerprints of healthy and neurologically disordered brain multigraph populations including Alzheimer's disease and Autism spectrum disorder patients. Our source code is available at https://github.com/basiralab/GraphGradIn.

Comparative effectiveness of biologics for patients with moderate-to-severe psoriasis and special area involvement: week 12 results from the observational Psoriasis Study of Health Outcomes (PSoHO).

Introduction: Psoriasis localized at the scalp, face, nails, genitalia, palms, and soles can exacerbate the disease burden. Real-world studies comparing the effectiveness of treatments for these special areas are limited. Methods: Psoriasis Study of Health Outcomes (PSoHO) is an international, prospective, non-interventional, study comparing the effectiveness of anti-interleukin (IL)-17A biologics (ixekizumab and secukinumab) compared to other approved biologics and the pairwise comparative effectiveness of ixekizumab relative to five other individual biologics for patients with moderate-to-severe psoriasis. To determine special area involvement, physicians answered binary questions at baseline and week 12. The proportion of patients who achieved special area clearance at week 12 was assessed. Missing outcome data were imputed as non-response. Comparative treatment analyses were conducted using frequentist model averaging. Results: Of the 1,978 patients included, 83.4% had at least one special area involved at baseline with the scalp (66.7%) as the most frequently affected part, followed by nails (37.9%), face/neck (36.9%), genitalia (25.6%), and palms and/or soles (22.2%). Patients with scalp, nail, or genital, but not palmoplantar or face/neck psoriasis, had significantly higher odds of achieving clearance at week 12 in the anti-IL-17A cohort compared to the other biologics cohort. Patients with scalp psoriasis had a 10-20% higher response rate and significantly greater odds (1.8-2.3) of achieving clearance at week 12 with ixekizumab compared to included biologics. Conclusion: Biologics demonstrate a high level of clearance of special areas at week 12 in a real-world setting. Patients with scalp, nail, or genital involvement have significantly higher odds of clearance at week 12 with anti-IL-17A biologics compared to other biologics.

Factors Predicting Quality of Life Impairment in Adult Patients with Atopic Dermatitis: Results from a Patient Survey and Machine Learning Analysis.

INTRODUCTION: Atopic dermatitis (AD) is a chronic, inflammatory skin disorder that impairs patients' quality of life (QoL). Physician assessment of AD disease severity is determined by clinical scales and assessment of affected body surface area (BSA), which might not mirror patients' perceived disease burden. METHODS: Using data from an international cross-sectional web-based survey of patients with AD and a machine learning approach, we sought to identify disease attributes with the highest impact on QoL for patients with AD. Adults with dermatologist-confirmed AD participated in the survey between July-September 2019. Eight machine learning models were applied to the data with dichotomised Dermatology Life Quality Index (DLQI) as the response variable to identify factors most predictive of AD-related QoL burden. Variables tested were demographics, affected BSA and affected body areas, flare characteristics, activity impairment, hospitalisation and AD therapies. Three machine learning models, logistic regression model, random forest and neural network, were selected on the basis of predictive performance. Each variable's contribution was computed via importance values from 0 to 100. For relevant predictive factors, further descriptive analyses were conducted to characterise those findings. RESULTS: In total, 2314 patients completed the survey with mean age 39.2 years (standard deviation 12.6) and average disease duration of 19 years. Measured by affected BSA, 13.3% of patients had moderate-to-severe disease. However, 44% of patients reported a DLQI > 10, indicative of a very large to extremely large impact on QoL. Activity impairment was the most important factor predicting high QoL burden (DLQI > 10) across models. Hospitalisation during the past year and flare type were also highly ranked. Current BSA involvement was not a strong predictor of AD-related QoL impairment. CONCLUSIONS: Activity impairment was the single most important factor for AD-related QoL impairment while current extent of AD did not predict higher disease burden. These results support the importance of considering patients' perspectives when determining the severity of AD.

The association between burnout of healthcare employees and quality of work-life in Northwestern Turkey.

Aim: The present study aimed to determine the factors that affect the working life quality (WLQ) of healthcare employees and to examine the association between burnout levels and WLQ. Subject and methods: This cross-sectional study was conducted with 332 healthcare employees working in Kirklareli, Northwestern Turkey. The data were collected with the e-survey, which included the Personal Information Form, Working Life Quality Questionnaire (WLQQ), and Maslach Burnout Inventory-General Form (MBI-GF). Results: A total of 54.2% of the participants, who had a mean age of 34.45±8.82, were midwives/nurses and 14.5% were physicians. It was determined that 71.1% of the participants had increased workloads, 81.6% were working outside their job descriptions during the pandemic period, and 57.8% wanted to quit their job. In the multivariate linear regression analysis, according to the adjusted models, a positive and significant association was determined between the WLQQ general dimension scores and having professional seniority of ≥10 years, and a negative association was detected with working in a secondary healthcare institution, increased workload, working outside the job description, and the desire to quit the job (p < 0.05). A positive association was detected between the WLQQ general dimension scores and the competence sub-dimension of the MBI-GF, and a significant and negative association was detected between burnout and desensitization (p < 0.05). Conclusion: WLQ scores increased as the burnout and desensitization decreased and the competence increased among the healthcare employees. In order to raise the WLQ, initiatives must be planned to improve the working conditions of healthcare employees and reduce psychosocial risks.

Bilateral Femur and Humerus Avascular Necrosis Associated With Corticosteroids: A Rare Case Presentation.

Avascular necrosis of the bone is a pathology characterized by compromised blood circulation, leading to necrosis due to insufficient vascular nourishment. Within the realm of orthopedics and traumatology, instances of avascular necrosis are steadily increasing. Notably, the escalating use of corticosteroids in managing inflammatory diseases and acute respiratory distress syndrome associated with the COVID-19 pandemic has resulted in a surge of outpatient referrals concerning cases of glucocorticoid-associated avascular necrosis. This study aims to elucidate the management of avascular necrosis following oral corticosteroid use in a young and otherwise healthy male patient, impacting both humeral and femoral heads bilaterally. A 26-year-old adult male, devoid of chronic health conditions, received a diagnosis of bilateral avascular necrosis in humeral and femoral heads within two years following a one-month course of oral corticosteroids. The patient underwent a comprehensive treatment regimen, encompassing hyperbaric oxygen therapy, oral antiplatelet therapy, a tailored physical therapy and rehabilitation program, and bilateral core decompression surgery for both hip joints. During the three-year follow-up, the patient exhibited a favorable response to treatment, demonstrating a complete and painless range of motion in both shoulder and hip joints. This case serves to underscore a crucial point: femoral head avascular necrosis may not invariably manifest as the initial bone affected, and a substantial time lapse may transpire between corticosteroid use and the onset of clinical symptoms. We emphasize the critical importance of not dismissing complaints pertaining to other bones in patients with a confirmed diagnosis and stress the significance of prompt detection in avascular necrosis. Furthermore, this study highlights the necessity for heightened vigilance in instances of orthopedic grievances among individuals with a history of corticosteroid use, particularly those related to the pandemic and inflammatory diseases, to facilitate early diagnosis and intervention for avascular necrosis.

Real-World Treatment Patterns and Treatment Benefits among Adult Patients with Atopic Dermatitis: Results from the Atopic Dermatitis Patient Satisfaction and Unmet Need Survey.

Atopic dermatitis is a chronic inflammatory skin disorder associated with a heterogeneous presentation and considerable disease burden. Exploring atopic dermatitis treatment patterns and patient benefits could improve disease management and patients' quality of life. This study aimed to describe current and previous atopic dermatitis treatment patterns and patient benefits from those treatments to inform disease management. Data were collected in 10 countries. Adults (n = 1,988) with confirmed moderate-to-severe atopic dermatitis completed a web-based cross-sectional survey. Most patients (86.6%) had body surface area involvement <10%, and therapies used were topical (69.7%), systemic (28.1%), and biologics (2.3%). Most flares were managed by topical monotherapies (73.4%), even in patients with body surface area involvement ≥10%. Treatment expectations were met only partially, or not at all, in 75% of patients. Those with body surface area involvement ≥10% reported lower treatment satisfaction. Overall, this study highlights the unmet medical needs in atopic dermatitis management.

The Value of Indirect Comparisons of Systemic Biologics for Psoriasis: Interpretation of Efficacy Findings.

INTRODUCTION: It can be challenging for dermatologists to keep abreast of the growing evidence from published indirect comparisons (ICs) of treatments for psoriasis. The objective of this analysis was to summarise comparative clinical efficacy and safety findings from ICs of systemic biologics for the treatment of moderate-to-severe psoriasis and to identify factors potentially affecting efficacy outcomes and their possible implications for clinical decision making. METHODS: An umbrella review of short- and long-term efficacy and safety findings from 26 ICs visually compared 90% improvement in Psoriasis Area Severity Index (PASI90) treatment rankings and three safety outcome rankings side by side. Pearson's correlation coefficients measured the strength of the association between each pair of ICs on the basis of identified factors that could potentially affect efficacy findings. RESULTS: Some consistency in short-term PASI90 efficacy rankings was observed for certain drugs, although rankings for most drugs varied by IC. Factors potentially affecting efficacy outcomes included the use of different methodologies for head-to-head comparison and statistical analyses, and variation in drugs and classes included treatment dosing and duration, outcome definitions and effect measures reported between ICs. Considerable variation in these factors was found across all 26 ICs. Comparative safety information of value to physicians was limited. CONCLUSIONS: Substantial differences were identified between ICs in factors that could potentially affect efficacy outcomes. Treatment rankings must be interpreted alongside actual differences in IC outcomes to allow conclusions on clinical relevance. Drugs within a class cannot be considered of equal efficacy: therapies should be considered individually rather than by class.

Plain language title: Interpreting indirect comparison efficacy findings in psoriasisPsoriasis is a chronic, often life-long, inflammatory skin disease with a high disease burden and considerable quality of life impairment, particularly in moderate-to-severe psoriasis.We, an international group of researchers, aimed to highlight the importance of fully understanding indirect comparisons (ICs) used to compare the efficacy and safety of multiple treatments for moderate-to-severe plaque psoriasis outside of head-to-head clinical trials, to effectively use their findings in clinical practice.We visually compared side-by-side efficacy and safety results and rankings from 26 ICs of systemic biologics for psoriasis and described our findings. We also identified factors with the potential to affect the efficacy outcomes of these ICs (Fig. 2) and looked for similarities and differences between the 26 ICs in terms of these factors. Finally, given what we found, we considered how the results of these ICs should be interpreted to support physicians in choosing the treatments best suited to the needs of their patients with psoriasis.Treatment ranking results from ICs (based on, for example, efficacy or safety outcomes) need to be interpreted together with information on actual numerical differences between treatment effects to inform the physician's decisions. When selecting the most efficacious treatment, drugs within a class cannot be considered equal, and therapies should be considered individually rather than by class. Substantial differences were identified between ICs with respect to factors that could potentially affect efficacy outcomes, highlighting the need to fully understand each individual analysis before making decisions based on its findings. Comparative safety information was limited.

Protective Policy Index (PPI) global dataset of origins and stringency of COVID 19 mitigation policies.

We have developed and made accessible for multidisciplinary audience a unique global dataset of the behavior of political actors during the COVID-19 pandemic as measured by their policy-making efforts to protect their publics. The dataset presents consistently coded cross-national data at subnational and national levels on the daily level of stringency of public health policies by level of government overall and within specific policy categories, and reports branches of government that adopted these policies. The data on these public mandates of protective behaviors is collected from media announcements and government publications. The dataset allows comparisons of governments' policy efforts and timing across the world and can serve as a source of information on policy determinants of pandemic outcomes-both societal and possibly medical.

Methicillin-resistant Staphylococcus aureus (MRSA) in an Austrian urological department: 10 years experience covering 95.161 patients.

PURPOSE: So far, few data is available on Methicillin-resistant Staphylococcus aureus (MRSA) infections in urology. To obtain a better insight into MRSA infections, we studied prevalence, colonization and infection site and clinical implications of MRSA in a urological department over a 10-year period. METHODS: A retrospective study of all patients diagnosed with MRSA for the first time over a 10-year period was set-up. RESULTS: Between 2000 and 2009, a total of 95.161 in- and outpatients were seen at our department. The prevalence of patients with newly diagnosed MRSA was low, that is, <0.1 % per year (mean 0.07%, 0.02-0.1 %). In total, 62 MRSA cases were identified over a 10-year period. MRSA incidence was 10 times higher in inpatients (0.2 %) than in outpatients (0.02 %). Asymptomatic MRSA colonization was present in 25/62 patients (40.3 %), the remaining 59.7 % (37/62) showed clinical symptoms: MRSA positive swabs from open wounds were seen in 10/62 patients (16.1 %). Urinary tract infections were seen in 26/10 patients (41.9 %), while life-threatening MRSA sepsis occurred in one patient only over a decade. CONCLUSIONS: In summary, we observed very low rates of MRSA colonization and infection. Still, complications like delayed wound healing, development of abscess and even sepsis may occur.

The natural history of the overactive bladder syndrome in females: a long-term analysis of a health screening project.

AIM: To analyze the natural history of the overactive bladder (OAB) syndrome in women over a period of 6.5 years. METHOD: Women participating in a health screening survey in the area of Vienna in 1998/1999 underwent a detailed health investigation and completed the Bristol Female Lower Urinary Tract Symptom (BFLUTS) Questionnaire. In 2005 all women who were still living in the area of Vienna, were contacted by mail to complete the BFLUTS questionnaire again. RESULTS: A total of 386 women with a mean age of 54 years (range: 21-81 years) entered this study and were all followed for a mean of 6.5 years. At baseline, the prevalence of OAB was 19.4% (n = 75/386) and increased to 27.2% (105/386) 6.5 years later resulting in an average annual progression rate of 1.2%. The incidence was 19.3% (n = 60/311; average annual rate: 2.9%), a remission was seen in 40% (n = 30/75; average annual rate: 6.2%), stable disease in 41.3% (n = 31/75; average annual rate: 6.4%), a progression was noticed in 6.7% (n = 5/75; average annual rate: 1.0%) and an improvement in 12% (n = 9/75; average annual rate: 1.8%). Women with a full remission were 49.9 years (± 13 years), those with stable disease 58.2 years (± 9.3 years), those with improvement 57.4 years (± 10.4 years), those with deterioration 61.8 years (± 12.8 years) and those with de novo OAB 57.3 years (± 12.3 years). CONCLUSION: OAB is a dynamic disease with long-lasting stable disease courses as well as remissions and progressions.

Impact of overactive bladder symptoms on sexuality in both sexes.

OBJECTIVES: To define the epidemiological impact of the overactive bladder syndrome (OAB) on sexual life. We therefore analyzed this issue in a large cohort of individuals participating in a health screening project. PATIENTS AND METHODS: A total of 2,365 men and women completed the Bristol Female Lower Urinary Tract Symptoms Questionnaire (BFLUTS). OAB was defined according to the International Continence Society (ICS). The impact of OAB on sexual life was assessed by a single question: 'In general, how do your micturition problems affect your sexual life'. RESULTS: A total of 1.199 men and 1.166 women with were analyzed. The overall prevalence of OAB was 13.9% (n = 329): 9.7% had OAB(dry) and 4.2% OAB(wet). A total of 17.6% (n = 58) of individuals with OAB reported a negative impact of OAB on sexual life as compared to 4.7% of those without OAB (p < 0.001). One of 4 with OAB(wet) reported a negative impact on sexual life (25%) as compared to 14.4% in those with OAB(dry) (p < 0.005). CONCLUSION: Sexual dysfunction is frequently reported in individuals with OAB. Individuals with OAB(wet) are experiencing a more profound impact on sexuality. Therefore, patients with OAB should be assessed regarding sexual dysfunction by the urologist.