Microbiological profile of asymptomatic bacteriuria in pregnancy

Background: Asymptomatic bacteriuria is the presence of actively multiplying bacteria within the urinary tract in the absence of any symptoms. Anatomical and physiological changes make women more susceptible to UTI in pregnancy. The objective of present study was to determine the percentage of pregnant women with asymptomatic bacteriuria and its microbiological profile.Methods: A total of 555 antenatal women who had no clinical features of urinary tract infection were recruited for this study over a period of one year. Clean catch mid-stream urine sample was collected and semi quantitatively cultured immediately. Significant bacteriuria was identified and antibiotic sensitivity found out by conventional methods.Results: Significant growth was observed in 26 samples. There was no association between age, parity, gravidity, period of gestation and asymptomatic bacteriuria. Gram stain was found to be the best screening test. Escherichia coli were the commonest organism isolated. Escherichia coli and Staphylococcus saprophyticus were the most resistant organisms.Conclusions: Escherichia coli, the most common organism isolated, was resistant to most of the commonly used antibiotics. Wet film examination, the most commonly used screening test in our set up, was less sensitive and specific. So culture has to be done in all antenatal cases for screening asymptomatic bacteriuria of pregnancy

Breast Cancer Pathology, Receptor Status, and Patterns of Metastasis in a Rural Appalachian Population

Breast cancer patients in rural Appalachia have a high prevalence of obesity and poverty, together with more triple-negative phenotypes. We reviewed clinical records for tumor receptor status and time to distant metastasis. Body mass index, tumor size, grade, nodal status, and receptor status were related to metastatic patterns. For 687 patients, 13.8% developed metastases to bone (n=42) or visceral sites (n=53). Metastases to viscera occurred within five years, a latent period which was shorter than that for bone (P=0.042). More women with visceral metastasis presented with grade 3 tumors compared with the bone and nonmetastatic groups (P=0.0002). There were 135/574 women (23.5%) with triple-negative breast cancer, who presented with lymph node involvement and visceral metastases (68.2% versus 24.3%; P=0.033). Triple-negative tumors that metastasized to visceral sites were larger (P=0.007). Developing a visceral metastasis within 10 years was higher among women with triple-negative tumors. Across all breast cancer receptor subtypes, the probability of remaining distant metastasis-free was greater for brain and liver than for lung. The excess risk of metastatic spread to visceral organs in triple-negative breast cancers, even in the absence of positive nodes, was combined with the burden of larger and more advanced tumors

Association of guideline-concordant initial systemic treatment with clinical and economic outcomes among older women with metastatic breast cancer in the United States

Purpose: We examined guideline-concordant initial systemic treatment among women with metastatic breast cancer, its predictors, and if guideline-concordant treatment was associated with mortality, healthcare utilization and Medicare expenditures. Methods: This retrospective observational cohort study was conducted using the Surveillance, Epidemiology, End Results-Medicare linked database. Women aged 66–90 years diagnosed with metastatic breast cancer during 2010–2013 (N = 1282) were included. The National Comprehensive Cancer Network treatment guidelines were used to determine the guideline-concordant initial systemic treatment following cancer diagnosis. A logistic regression analysis was conducted to examine significant predictors of guideline-concordant treatment. Generalized linear regressions were used to examine the association between guideline-concordant treatment and healthcare utilization and average monthly Medicare expenditures. Results: About 74% of the study cohort received guideline-concordant initial systemic treatment. Women who received guideline-concordant treatment were significantly more likely to be comparatively younger (p \u3c 0.05), were married/partnered (p = 0.0038), had HER2 positive tumors, and had good performance status. Adjusted hazards ratios for all-cause (2.364, p \u3c 0.0001) and breast-cancer specific mortality (2.179, p \u3c 0.0001) were higher for women who did not receive guideline-concordant treatment. Rates of healthcare utilization were also higher for women not receiving guideline-concordant treatment. Average monthly Medicare expenditures were 100.4% higher (95% confidence interval: $77.3%–126.5%) for women who did not receive guideline-concordant treatment compared to those who received guideline-concordant treatment (p \u3c 0.0001). Conclusion: One fourth of the study cohort did not receive guideline-concordant initial systemic treatment. Guideline-concordant initial treatment was associated with reduced mortality, and lower healthcare utilization and Medicare expenditures in women with metastatic breast cancer

Prevalence of early childhood caries among preschool children in Trivandrum and its association with various risk factors

Background: Early childhood caries (ECC) is a severe form of dental decay with multi-factorial origin. Objectives: The aim of this cross-sectional study was to determine the prevalence and related risk factors of ECC among preschool children residing in rural and urban areas of Trivandrum district in Kerala. Methods: A sample size of 1329 preschool children of <60 months of age was randomly selected from rural and urban areas of Trivandrum and decayed missing filled teeth indices were recorded. A standardized questionnaire was distributed to the parents. The data were subjected to SPSS version 16 and statistically analyzed with Chi-square test. Results: Prevalence of ECC in the study sample was found to be 54%. Furthermore, a positive association was obtained between ECC and age of the child, location of residence, dietary habits, and oral hygiene habits. Conclusion: There is an urgent need to implement preventive and curative oral health programs for preschool children in rural and urban areas