Changes in the incidence and epidemiology of neonatal group B Streptococcal disease over the last two decades in Crete, Greece

Group B streptococcus (GBS) remains a leading cause of neonatal disease. However, GBS rates and prevention strategies vary considerably worldwide. Herein, we investigated the burden and epidemiological trends of neonatal GBS infections in our area (Greece) over the last two decades. We conducted a multicenter retrospective study that includes all cases of culture-proven GBS disease in infants <90 days old in the last 22 years. Neonatal GBS incidence was 0.17/1000 live births (95%CI: 0.11-0.21). A significant increase was noted during the second decade (0.23 vs 0.10/1000, P<0.05). Late onset disease (LOD) significantly increased during the second decade (0.08 vs 0.02, P<0.05). Infants in the LOD group had a higher risk of meningitis (RR 1.8, 95%CI: 1.23-2.71). Long-term neurological sequelae were reported in 42.8% of meningitis cases. The mortality rate was 8%. The incidence of neonatal GBS disease in our area is among the lowest reported, but an increase was noted the last decade mainly due a rise in the LOD. The burden of LOD, the mortality and long-term disability are still substantial, thus effective prevention strategies − including maternal vaccination for neonatal GBS − are needed

Medical Treatment of Nocturia in Men with Lower Urinary Tract Symptoms : Systematic Review by the European Association of Urology Guidelines Panel for Male Lower Urinary Tract Symptoms

Context: The treatment of nocturia is a key challenge due to the multi-factorial pathophysiology of the symptom and the disparate outcome measures used in research. Objective: To assess and compare available therapy options for nocturia, in terms of symptom severity and quality of life. Evidence acquisition: Medical databases (Embase, Medline, Cochrane Systematic Reviews, Cochrane Central) were searched with no date restriction. Comparative studies were included which studied adult men with nocturia as the primary presentation and lower urinary tract symptoms including nocturia or nocturnal polyuria. Outcomes were symptom severity, quality of life, and harms. Evidence synthesis: We identified 44 articles. Antidiuretic therapy using dose titration was more effective than placebo in relation to nocturnal voiding frequency and duration of undisturbed sleep; baseline serum sodium is a key selection criterion. Screening for hyponatremia (<130 mmol/l) must be undertaken at baseline, after initiation or dose titration, and during treatment. Medications to treat lower urinary tract dysfunction (alpha-1 adrenergic antagonists, 5-alpha reductase inhibitors, phosphodiesterase type 5inhibitor, antimuscarinics, beta-3 agonist, and phytotherapy) were generally not significantly better than placebo in short-term use. Benefits with combination therapies were not consistently observed. Other medications (diuretics, agents to promote sleep, nonsteroidal anti-inflammatories) were sometimes associated with response or quality of life improvement. The recommendations of the Guideline Panel are presented. Conclusions: Issues of trial designmake therapy of nocturia a challenging topic. The range of contributory factors relevant in nocturia makes it desirable to identify predictors of response to guide therapy. Consistent responses were reported for titrated antidiuretic therapy. For other therapies, responses were less certain, and potentially of limited clinical benefit. Patient summary: This review provides an overview of the current drug treatments of nocturia, which is the need to wake at night to pass urine. The symptom can be caused by several different medical conditions, and measuring its severity and impact varies in separate research studies. No single treatment deals with the symptom in all contexts, and careful assessment is essential to make suitable treatment selection. (C) 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.Peer reviewe

Management of Urinary Retention in Patients with Benign Prostatic Obstruction : A Systematic Review and Meta-analysis

Context: Practice patterns for the management of urinary retention (UR) secondary to benign prostatic obstruction (BPO; UR/BPO) vary widely and remain unstandardized. Objective: To review the evidence for managing patients with UR/BPO with pharmacological and nonpharmacological treatments included in the European Association of Urology guidelines on non-neurogenic male lower urinary tract symptoms. Evidence acquisition: Search was conducted up to April 22, 2018, using CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform. This systematic review included randomized controlled trials (RCTs) and prospective comparative studies. Methods as detailed in the Cochrane handbook were followed. Certainty of evidence (CoE) was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Evidence synthesis: Literature search identified 2074 citations. Twenty-one studies were included (qualitative synthesis). The evidence for managing patients with UR/BPO with pharmacological or nonpharmacological treatments is limited. CoE for most outcomes was low/very low. Only alpha 1-blockers (alfuzosin and tamsulosin) have been evaluated in more than one RCT. Pooled results indicated that a1-blockers provided significantly higher rates of successful trial without catheter compared with placebo [alfuzosin: 322/540 (60%) vs 156/400 (39%) (odds ratio {OR} 2.28, 95% confidence interval {CI} 1.55 to 3.36; participants = 940; studies = 7; I-2 = 41%; low CoE); tamsulosin: 75/158 (47%) vs 40/139 (29%) (OR 2.40, 95% CI 1.29 to 4.45; participants = 297; studies = 3; I-2 = 30%; low CoE)] with rare adverse events. Similar rates were achieved with tamsulosin or alfuzosin [51/87 (59%) vs 45/84 (54%) (OR 1.28, 95% CI 0.68 to 2.41;participants = 171; studies = 2; I-2 = 0%; very low CoE)]. Nonpharmacological treatments have been evaluated in RCTs/prospective comparative studies only sporadically. Conclusions: There is some evidence that usage of alpha 1-blockers (alfuzosin and tamsulosin) may improve resolution of UR/BPO. As most nonpharmacological treatments have not been evaluated in patients with UR/BPO, the evidence is inconclusive about their benefits and harms. Patient summary: There is some evidence that alfuzosin and tamsulosin may increase the rates of successful trial without catheter, but little or no evidence on various nonpharmacological treatment options for managing patients with urinary retention secondary to benign prostatic obstruction. (c) 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.Peer reviewe

What are the short-term benefits and potential harms of therapeutic modalities for the management of overactive bladder syndrome in women? : A review of evidence under the auspices of the European Association of Urology, Female Non-Neurogenic LUTS Guidelines Panel

Peer reviewe

Diagnostic Tests for Female Bladder Outlet Obstruction : A Systematic Review from the European Association of Urology Non-neurogenic Female LUTS Guidelines Panel

Acknowledgements Jae Hung Jung, Murat Gul, Ege Can Serefoglu (translation of foreign language articles) and Karin Plass for administrative support.Peer reviewedPostprin

Analysis of the genetic phylogeny of multifocal prostate cancer identifies multiple independent clonal expansions in neoplastic and morphologically normal prostate tissue.

Genome-wide DNA sequencing was used to decrypt the phylogeny of multiple samples from distinct areas of cancer and morphologically normal tissue taken from the prostates of three men. Mutations were present at high levels in morphologically normal tissue distant from the cancer, reflecting clonal expansions, and the underlying mutational processes at work in morphologically normal tissue were also at work in cancer. Our observations demonstrate the existence of ongoing abnormal mutational processes, consistent with field effects, underlying carcinogenesis. This mechanism gives rise to extensive branching evolution and cancer clone mixing, as exemplified by the coexistence of multiple cancer lineages harboring distinct ERG fusions within a single cancer nodule. Subsets of mutations were shared either by morphologically normal and malignant tissues or between different ERG lineages, indicating earlier or separate clonal cell expansions. Our observations inform on the origin of multifocal disease and have implications for prostate cancer therapy in individual cases

The role of focal therapy in the management of localised prostate cancer: a systematic review

CONTEXT: The incidence of localised prostate cancer is increasing worldwide. In light of recent evidence, current, radical, whole-gland treatments for organ-confined disease have being questioned with respect to their side effects, cancer control, and cost. Focal therapy may be an effective alternative strategy. OBJECTIVE: To systematically review the existing literature on baseline characteristics of the target population; preoperative evaluation to localise disease; and perioperative, functional, and disease control outcomes following focal therapy. EVIDENCE ACQUISITION: Medline (through PubMed), Embase, Web of Science, and Cochrane Review databases were searched from inception to 31 October 2012. In addition, registered but not yet published trials were retrieved. Studies evaluating tissue-preserving therapies in men with biopsy-proven prostate cancer in the primary or salvage setting were included. EVIDENCE SYNTHESIS: A total of 2350 cases were treated to date across 30 studies. Most studies were retrospective with variable standards of reporting, although there was an increasing number of prospective registered trials. Focal therapy was mainly delivered to men with low and intermediate disease, although some high-risk cases were treated that had known, unilateral, significant cancer. In most of the cases, biopsy findings were correlated to specific preoperative imaging, such as multiparametric magnetic resonance imaging or Doppler ultrasound to determine eligibility. Follow-up varied between 0 and 11.1 yr. In treatment-naïve prostates, pad-free continence ranged from 95% to 100%, erectile function ranged from 54% to 100%, and absence of clinically significant cancer ranged from 83% to 100%. In focal salvage cases for radiotherapy failure, the same outcomes were achieved in 87.2-100%, 29-40%, and 92% of cases, respectively. Biochemical disease-free survival was reported using a number of definitions that were not validated in the focal-therapy setting. CONCLUSIONS: Our systematic review highlights that, when focal therapy is delivered with intention to treat, the perioperative, functional, and disease control outcomes are encouraging within a short- to medium-term follow-up. Focal therapy is a strategy by which the overtreatment burden of the current prostate cancer pathway could be reduced, but robust comparative effectiveness studies are now required

A review of the positive and negative effects of cardiovascular drugs on sexual function: a proposed table for use in clinical practice

Several antihypertensive drugs, such as diuretics and β-blockers, can negatively affect sexual function, leading to diminished quality of life and often to noncompliance with the therapy. Other drug classes, however, such as angiotensin II receptor blockers (ARBs) are able to improve patients’ sexual function. Sufficient knowledge about the effects of these widely used antihypertensive drugs will make it possible for cardiologists and general practitioners to spare and even improve patients’ sexual health by switching to different classes of cardiac medication. Nevertheless, previous data (part I) indicate that most cardiologists lack knowledge about the effects cardiovascular agents can have on sexual function and will thus not be able to provide the necessary holistic patient care with regard to prescribing these drugs. To be able to improve healthcare on this point, we aimed to provide a practical overview, for use by cardiologists as well as other healthcare professionals, dealing with sexual dysfunction in their clinical practices. Therefore, a systematic review of the literature was performed. The eight most widely used classes of antihypertensive drugs have been categorised in a clear table, marking whether they have a positive, negative or no effect on sexual function

Phenotypic and diagnostic approach of genetic syndromes: recording and clustering in electronic database

Congenital anomalies or birth defects are morphological or structural abnormalities that are presented at birth or even later. They are distinguished in major and minor anomalies and their incidence ranges between 3-4% of neonates, having a leading role in the etiology of infantile mortality. In approximately 40% of cases they are caused by genetic or environmental factors. It is estimated that single gene defects are the cause of about 7.5% of all congenital anomalies, 6% are associated with chromosomal abnormalities and 5% with environmental causes. An additional 20% of all malformations are due to multifactorial etiology, where there is a combination of genetic and environmental factors. Despite the progress of Genetics, in 40-60% of cases of congenital anomalies it is not possible to clarify the exact etiology. Congenital anomalies are distinguished in single or multiple system defects. According to the embryological stage at which the damage is done they are classified in malformations, disruptions, deformations and dysplasias. Risk factors for the appearance of anomalies are advanced maternal and paternal age, inbreeding, twin gestations, while there is no accordance in the literature regarding the various techniques used in assisted reproduction. Nowadays secondary prevention of birth defects is of particular importance. This concerns detection at the prenatal period with the utilisation of serological testing in pregnancy and invasive methods, such as amniocentesis and chorionic villous sampling, while the ultrasound control is considered the method of choice. Prenatal detection of congenital anomalies offers better follow-up of the gestation and provides information regarding prognosis and decision for an elective abortion. In the present retrospective study, medical information related to genetic diseases of patients referred for evaluation in the Laboratory of Medical Genetics of the University of Athens in the time period 1996-2002, was recorded in an electronic database. Clustering in groups of the dyspmorphic syndromes that were identified was performed, as well as evaluation of the information resulting from the processing of the data recorded in the electronic database. This study included 1002 patients that were referred for genetic evaluation because of congenital anomalies with or without mental retardation. Medical history, congenital anomalies, laboratory evaluation (cytogenetic, molecular analysis, congenital infections, metabolic and radiological control) were recorded. The data collected were processed using the electronic database created with the program Microsoft Access 2000. The aetiology of congenital anomalies was revealed in 429 patients (42.8%) and was attributed to genetic syndromes (39.9%), environmental factors (0.6%) and in anomalies of multifactorial aetiology (2.3%). In 519 patients (51.8%) the cause of congenital anomalies was not identified, while 54 patients were excluded from the study due to minor anomalies, constituting polymorphic variants or physiologic traits...Οι συγγενείς ανωμαλίες είναι μορφολογικές ή δομικές ανωμαλίες που εμφανίζονται στη γέννηση ή και αργότερα. Διακρίνονται σε μείζονες και σε ελάσσονες με συχνότητα εμφάνισης 3 με 4% στο σύνολο των νεογνών και κατέχουν πρωταγωνιστικό ρόλο στην αιτιολογία της βρεφικής θνησιμότητας. Περίπου στο 40% των περιπτώσεων είναι γενετικής ή περιβαλλοντικής αιτιολογίας. Συγκεκριμένα ποσοστό περίπου 7.5% αφορά μονογονιδιακά νοσήματα, 6% χρωμοσωμικές ανωμαλίες και 5% ανωμαλίες περιβαλλοντικής αιτιολογίας. Το υπόλοιπο 20% αφορά ανωμαλίες πολυπαραγοντικής αιτιολογίας όπου συνδυάζονται τόσο γενετικοί όσο και περιβαλλοντικοί παράγοντες. Παρά την πρόοδο της Γενετικής επιστήμης, στο 40 με 60% των περιπτώσεων συγγενών ανωμαλιών δεν είναι δυνατό να διευκρινισθεί η αιτιολογία τους. Οι συγγενείς ανωμαλίες διακρίνονται σε μονήρεις ή πολλαπλές ενώ ανάλογα με το στάδιο της εμβρυογένεσης κατά το οποίο προκλήθηκε η βλάβη σε δυσμορφίες, διασπάσεις, παραμορφώσεις, δυσπλασίες. Παράγοντες κινδύνου για την εμφάνιση ανωμαλιών αποτελούν η μεγάλη ηλικία της μητέρας, η προχωρημένη ηλικία του πατέρα, η ενδογαμία, οι πολύδυμες κυήσεις ενώ δεν προκύπτει βιβλιογραφική ομοφωνία σχετικά με τη συσχέτιση συγγενών ανωμαλιών και των διαφόρων τεχνικών υποβοηθούμενης αναπαραγωγής. Ιδιαίτερη σημασία έχει σήμερα η δευτεροβάθμια πρόληψη των ανωμαλιών, δηλαδή η ανίχνευση τους κατά την προγεννητική περίοδο με τη χρησιμοποίηση ορολογικών μετρήσεων στην έγκυο αλλά και επεμβατικών μεθόδων, όπως η αμνιοπαρακέντηση και η λήψη χορειακής λάχνης ενώ ο υπερηχογραφικός έλεγχος θεωρείται η μέθοδος εκλογής. Η προγεννητική ανίχνευση των συγγενών ανωμαλιών προσφέρει καλύτερη παρακολούθηση της κύησης και παροχή σωστών πληροφοριών για την πρόγνωση και ενδεχομένως τη λήψη απόφασης για τη διακοπή της. Στην παρούσα αναδρομική μελέτη έγινε καταγραφή των γενετικών προβλημάτων και πληροφοριών του ιατρικού ιστορικού των ασθενών που παραπέμφθηκαν για γενετική αξιολόγηση στο Εργαστήριο Ιατρικής Γενετικής του Πανεπιστημίου Αθηνών την χρονική περίοδο 1996-2002, σε ειδική ηλεκτρονική βάση δεδομένων, ταυτοποίηση και ομαδοποίηση σε δυσμορφικά σύνδρομα και αξιολόγηση των συμπερασμάτων που προέκυψαν από την επεξεργασία όλων των δεδομένων. Το υλικό της μελέτης αποτέλεσαν 1002 ασθενείς που παραπέμφθηκαν στο ιατρείο Ιατρικής Γενετικής του Χωρεμείου Ερευνητικού Εργαστηρίου, λόγω εμφάνισης συγγενών ανωμαλιών με η χωρίς ψυχοκινητική καθυστέρηση. Έγινε λήψη λεπτομερούς ιστορικού, καταγραφή των μορφολογικών ανωμαλιών και σύμφωνα με την κλινική εικόνα ο ανάλογος εργαστηριακός έλεγχος (κυτταρογενετικός έλεγχος, μοριακή ανάλυση DNA, έλεγχος συγγενών λοιμώξεων, μεταβολικός και απεικονιστικός έλεγχος). Η καταγραφή και η ομαδοποίηση (σύμφωνα με τα κύρια φαινοτυπικά χαρακτηριστικά ή τις κύριες δομικές ανωμαλίες) βασίστηκε στη λειτουργία ηλεκτρονικής βάσης δεδομένων που δημιουργήθηκε χρησιμοποιώντας το πρόγραμμα Microsoft Access 2000..