苯磺酸氨氯地平对维持性血液透析患者残余肾功能的保护作用

目的:研究苯磺酸氨氯地平对维持性血液透析(MHD)患者残余肾功能的保护作用,为MHD患者降压方案的治疗提供依据。方法:选取2014年4月至2016年2月我院收治的MHD患者90例,按照随机数字表法分为硝苯地平组(A组)、血管紧张素抑制剂或血管紧张素转化酶抑制剂组(B组)、苯磺酸氨氯地平组(C组),每组各30例。各组分别给予相应药物进行治疗12个月,观察治疗前、治疗后6个月、治疗后12个月尿量、血生化指标、尿素清除指数(Kt/V)、残余肾尿素清除率(KRU)及心血管事件发生率。结果:治疗前各组患者尿量、KRU和Kt/V比较无统计学差异(P0.05),治疗后3组患者尿量、KRU均显著降低(P0.05),治疗后6个月、12个月B组和C组尿量、KRU显著高于A组(P0.05),B组C组尿量、KRU比较无统计学差异(P0.05),治疗后6个月、12个月三组Kt/V比较无统计学差异(P0.05)。三组患者治疗中急性心血管事件比较无统计学差异(P0.05),治疗后6个月、12个月A组和C组透析前高血钾发生率显著高于B组(P0.05)。治疗前、治疗后6个月、12个月三组患者平均动脉压、脱水量比较比较无统计学差异(P0.05)。结论:苯磺酸氨氯地平具有维持血液透析患者残余肾功能的作用,相较血管紧张素抑制剂或血管紧张素转化酶抑制剂其高血钾发生率较低,值得临床推广应用。     

Morphological and histochemical study of the endometrial effects of Ovral in the baboon

Summary In an effort to better understand changes induced by hormonal contraceptives, a group of female baboons were administered Ovral for a period of 9 months. During this time the endometrium was sampled by transcervical uterine biopsy from both the treated animals and from a control group. The biopsies were all obtained between 10 and 14 days of the treatment cycle or the normal menstrual cycle. The endometrial glandular cells from the treated animals exhibited an accelerated maturation compared with the controls. Ultrastructurally this was reflected by increased cell size, numerous long, slender microvilli on the apical membranes, and increased development of the Golgi complex. Differences were also observed in the predominant type of granule seen in the apical cytoplasm. After 3 and 6 months of treatment with Ovral, no significant differences were noted between groups or between animals within a group. However, after 9 months of treatment, the endometrium displayed differences from the earlier experimental groups as well as individual variations. The functional correlates of these observations are discussed and compared to human endometrium.     

Comparative Effectiveness of Tocilizumab with either Methotrexate or Leflunomide in the Treatment of Rheumatoid Arthritis

Objective

In agreement with EULAR recommendations, a DMARD in combination with a biotherapy is the reference treatment because of the superior long-term clinical and radiographic outcomes. Methotrexate (MTX) is the cornerstone of combination therapy but is in some cases contra-indicated or poorly tolerated. This observational study aimed to compare the effectiveness and safety of TCZ in combination with either MTX or leflunomide (LEF) in the treatment of patients with active rheumatoid arthritis (RA) and an inadequate response to one or more DMARDs and/or biological agents in a real-world setting.

Methods

We performed an ambispective review of 91 patients with active RA who were routinely treated with TCZ plus MTX or LEF. A comparative study between the two combinations of treatment was performed at 6 months of follow-up considering 3 outcomes: improvement of RA disease activity, evolution of functional disability, and tolerability and side effect profile.

Results

Of the 91 patients, 62 received TCZ with MTX and 29 received TCZ with LEF. Eighty-one patients were followed for 6 months, and the remaining 10 patients discontinued treatment due to serious adverse events. At baseline, there were no significant differences between the groups in terms of the main clinical and laboratory data or in the number of previous DMARDs and biological agents used. At 6 months, there were no significant differences between the combinations in terms of disease activity and functional disability. Serious adverse events occurred in 11% and 10% of the patients treated in combination with MTX and LEF, respectively.

Conclusion

Our preliminary data support the argument that LEF is an effective and safe (equivalent) alternative to MTX for combination treatment with TCZ.     

Mating behavior, serum testosterone and semen characteristics in vasectomized and short scrotum rams

Ten similar rams were either vasectomized (VAS) or altered by securing the testes near the abdomen using elastrator bands (short scrotum, SS). Semen characteristics (electroejaculation) were similar (P>0.10) between groups before treatment and ejaculate volumes remained relatively constant (P>0.10) throughout the trial. Remaining sperm cells were nonmotile and 95% abnormal by 6 days after vasectomy. By 12 days after surgery, ejaculates contained no cells. Two SS rams had detectable sperm numbers at 12 days after treatment, but 95% were abnormal and all but 1% were nonmotile. Ejaculates collected 3 months after surgery were similar between treatments, in that all existing cells were nonmotile and abnormal. Partial spermatogenic function was regained in SS rams 15 months after treatment as indicated by the presence of low concentrations of motile sperm. Three and 15 months after treatment, sexual activity was estimated by exposing rams to a group of four estrous ewes. During the 15-minute exposure, VAS males exhibited more (P<0.10) nonmating sexual approaches than did SS animals during the first year. However, nonmating approaches and incomplete and completed matings were similar (P>0.10) between VAS and SS rams during the second year. No treatment differences in serum testosterone were observed before, during or after either libido trial. Shortening the scrotum of 6-month-old ram lambs has little effect on libido or testosterone when compared with VAS rams. However, the SS method of alteration does not result in complete sterility as indicated by the presence of motile spermatozoa in ejaculates 15 months after SS treatment.     

Thymus, peripheral lymphoid tissues and immunological responsiveness of the pituitary dward mouse (author's transl)]

Snell's pituitary dwarf mice (dw) were used for studies on the relationship between hypophysis and lymphoid organs. The age-dependent changes of thymus or spleen weights of dwarf mice were compared with those of normal littermates. The suppression of growth of the thymus or spleen in dwarf mice was recognized at 5th day of age. Although involution of the thymus varied among animals, a strong positive correlation was demonstrated between relative thymus weight and body weight in 30 approximately 40 days old dwarf mice. Lymphoid organs of dwarf mice were reconstituted by injection of growth hormone and or thyroxin. Relative thymus weight significantly increased in dwarf mice when the treatment with growth hormone started at 7 days of age, but the same treatment at 3 months of age did not show any effect on the increment of relative thymus weight. On the other hand, the antibody-forming capacitiy against sheep erythrocytes of dwarf mice was significantly increased even when the treatment with growth hormone was started at 3 months of age. A marked increase in the number of lymphoid cells in dwarf mice was observed by treatment with thyroxin, even if treatment was started either at 7 days or 3 months of age. Similar changes were also obtained in the antibody-forming capacity.     

Effects of prolonged artificial photoperiod on circulating prolactin and melatonin levels in seasonal ewes

Crossbred ewes exposed to long days for 46 months prior to photoperiod reversal showed no alteration in the duration or amplitude of the circulating melatonin peak between 24 and 46 months of continuous long day exposure. By 3 months after photoreversal to short days, both the amplitude and duration of the peak had adapted to the new scotophase. In short day treated ewes, the melatonin peak was abolished by 46 but not 24 months of short day exposure, and was not fully restored in all ewes 3 months after photoreversal. Mean prolactin levels over 24 h remained high up to 46 months of long day treatment, and declined 3 months after short day exposure. Conversely, mean prolactin levels remained low up to 46 months of short day treatment, increasing 3 months after exposure to long days. Thus: (i) depletion of the melatonin-synthesizing capability of the ovine pineal gland by prolonged exposure to long nights is not completely reversed after 3 months of continuous long day exposure, and (ii) a nocturnal melatonin peak is not essential for maintenance of plasma prolactin levels under these conditions.Special issue dedicated to Dr. Lawrence Austin.     

粪菌移植治疗难治性肠易激综合征的效果观察

观察粪菌移植(FMT)对难治性肠易激综合征的治疗效果, 为该病的治疗提供参考。

招募我院32例难治性肠易激综合征患者并分为治疗组(n=17)和对照组(n=15), 两组患者均给予马来酸曲美布汀片口服, 治疗组进一步通过鼻肠管行FMT。分别于治疗1个月和3个月时评估两组患者临床疗效及安全性, 并严格记录不良反应。

治疗组患者FMT治疗前、治疗1个月和治疗3个月时IBS-SSS评分和粪便分型逐渐降低(均P < 0.05), 而对照组患者这3个时间点IBS-SSS评分和粪便分型差异无统计学意义(均P > 0.05)。FMT治疗前两组患者IBS-SSS评分和粪便分型差异无统计学意义(均P > 0.05)。治疗1个月和治疗3个月时, 两组患者IBS-SSS评分差异均有统计学意义(均P < 0.05)。治疗组患者FMT治疗前、治疗1个月和治疗3个月时IBS-QOL和HAD评分逐渐降低(均P < 0.05), 而对照组患者这3个时间点的IBS-QOL和HAD评分差异无统计学意义(均P > 0.05)。FMT治疗前, 两组患者IBS-QOL和HAD评分差异无统计学意义(均P > 0.05)。治疗1个月时两组患者IBS-QOL评分差异有统计学意义(P < 0.05), 而HAD评分差异无统计学意义(P > 0.05)。治疗3个月时两组患者IBS-QOL和HAD评分差异均有统计学意义(均P < 0.05)。治疗组患者症状缓解率高于对照组(88.2% vs 53.3%)。治疗3个月后两组患者均未出现明显不良反应且未发现传染性疾病。

FMT对难治性肠易激综合征有一定的临床疗效, 且安全可靠。

     

Auxological and biochemical evaluation of pubertal suppression with the GnRH agonist leuprolide acetate in early and precocious puberty

We studied the auxological effects of treatment with the GnRH agonist leuprolide acetate (Lucrin((R))) at 3.75 mg/ 28 days in 38 children with early or precocious puberty. We present our newly developed scoring system, the Puberty Suppression Score (PSS), in which clinical and biochemical parameters determine whether suppression was effective. Leuprolide acetate suppressed pubertal development in the majority of cases. During treatment there was a significant correlation between the number of times that PSS was >0 and gain in predicted adult height (PAH) compared to initial prediction at the start of treatment. After 6 months of treatment, ineffective suppression measured by PSS was associated with the magnitude of gain in PAH. We conclude that a leuprolide acetate dosage of 3.75 mg every 28 days effectively suppresses puberty. PSS is helpful in monitoring the suppressive capacity of a GnRH agonist. We recommend to start with leuprolide acetate at 3.75 mg/28 days and to increase the injection frequency or dose in case PSS is >0 after 6 months of treatment.     

Comparison of Serological Response to Doxycycline versus Benzathine Penicillin G in the Treatment of Early Syphilis in HIV-Infected Patients: A Multi-Center Observational Study

Background

While doxycycline is recommended as an alternative treatment of syphilis in patients with penicillin allergy or intolerance, clinical studies to compare serological response to doxycycline versus benzathine penicillin in treatment of early syphilis among HIV-infected patients remain sparse.

Methods

We retrospectively reviewed the medical records of HIV-infected patients with early syphilis who received doxycycline 100 mg twice daily for 14 days (doxycycline group) and those who received 1 dose of benzathine penicillin (2.4 million units) (penicillin group) between 2007 and 2013. Serological responses defined as a decline of rapid plasma reagin titer by 4-fold or greater at 6 and 12 months of treatment were compared between the two groups.

Results

During the study period, 123 and 271 patients in the doxycycline and penicillin group, respectively, completed 6 months or longer follow-up. Ninety-one and 271 patients in the doxycycline and penicillin group, respectively, completed 12 months or longer follow-up. Clinical characteristics were similar between the two groups, except that, compared with penicillin group, doxycycline group had a lower proportion of patients with secondary syphilis (65.4% versus 41.5%, P<0.0001) and a higher proportion of patients with early latent syphilis (25.3% versus 49.6%, P<0.0001). No statistically significant differences were found in the serological response rates to doxycycline versus benzathine penicillin at 6 months (63.4% versus 72.3%, P = 0.075) and 12 months of treatment (65.9% versus 68.3%, P = 0.681). In multivariate analysis, secondary syphilis, but not treatment regimen, was consistently associated with serological response at 6 and 12 months of follow-up.

Conclusions

The serological response rates to a 14-day course of doxycycline and a single dose of benzathine penicillin were similar in HIV-infected patients with early syphilis at 6 and 12 months of follow-up. Patients with secondary syphilis were more likely to achieve serological response than those with other stages.     

Risk Factors for Disseminated Histoplasmosis in a Cohort of HIV-Infected Patients in French Guiana

Disseminated histoplasmosis is the first AIDS-defining infection in French Guiana. A retrospective cohort study studied predictive factors of disseminated histoplasmosis in HIV-infected patients between 1996 and 2008. Cox proportional hazards models were used. The variables studied were age, sex, last CD4/CD8 count, CD4 nadir, herpes or pneumocystosis, cotrimoxazole and fluconazole use, antiretroviral treatment and the notion of recent initiation of HAART. A total of 1404 patients were followed for 6833 person-years. The variables independently associated with increased incidence of disseminated histoplasmosis were CD4 count<50 per mm3, CD4 count between 50 and 200 per mm3, a CD4 nadir <50 per mm3, CD8 count in the lowest quartile, herpes infection, and recent antiretroviral treatment initiation (less than 6 months). The variables associated with decreased incidence of histoplasmosis were antiretroviral treatment for more than 6 months, fluconazole treatment, and pneumocystosis. There were 13.5% of deaths at 1 month, 17.5% at 3 months, and 22.5% at 6 months after the date of diagnosis of histoplasmosis. The most important predictive factors for death within 6 months of diagnosis were CD4 counts and antiretroviral treatment. The present study did not study environmental/occupational factors but provides predictive factors for disseminated histoplasmosis and its outcome in HIV patients in an Amazonian environment during the HAART era.     

Fadrozole hydrochloride, a new nontoxic aromatase inhibitor for the treatment of patients with metastatic breast cancer.

Eighty previously treated postmenopausal women with metastatic breast cancer were randomized to receive fadrozole (CGS 16 949A), a new aromatase inhibitor, 1 or 4 mg orally per day. Seventy eight patients were evaluable for toxicity and response. Only mild to moderate toxicity, namely hot flushes (28%), nausea and vomiting (13%), fatigue (8%) and loss of appetite (5%) occurred. Complete response was documented in 10% and partial response in 13% of patients with 45% having a no change status for at least 2 months. The median time to treatment failure is 4.1 months. The median survival is 23.7 months. The median survival is 23.7 months. The response and survival in patients with estrogen receptor positive and estrogen receptor unknown disease were not significantly different. Neither response nor survival was significantly different between the patients receiving 1 or 4 mg of fadrozole per day. Fadrozole is a well tolerated, effective second line treatment for women with metastatic breast cancer.     

Enzyme clusters during the metamorphic period of Ambystoma mexicanum: role of thyroid hormone

Enzyme activities and DNA content have been measure in axolotl liver during the metamorphic period (4-8 months after spawning). Three different types of enzyme activity profiles were observed. In the type I profile (carbamoyl-phosphate synthase, arginase, ornithine transcarbamoylase, and glutamate dehydrogenase) enzyme activity is high in the youngest animals studied, and shows a minimum at 5 months followed by a maximum at 8 months of age. Thereafter activities do not change or slightly decrease. In the type II profile (tyrosine aminotransferase, glucose-6-phosphatase) enzyme activity shows a peak at 5 months of age and is low thereafter. Hexokinase, the enzyme with a type III profile, shows high activity throughout the metamorphic period. DNA content remains high throughout the metamorphic period but decreases 50% between 9 and 12 months of age, probably due to an increase in the size of the hepatocytes. No glucokinase activity was detected. High activities of cluster II enzymes represent early metamorphic events, while the rising part of cluster I is associated with late metamorphic events. The apparent molecular specific activity increases during natural development between 5 and 9 months of age, or precociously, upon thyroid hormone treatment. This change in apparent molecular specific activity is correlated to the advent of ureotelism.     

Comparison between perindopril and nifedipine in hypertensive and normotensive diabetic patients with microalbuminuria. Melbourne Diabetic Nephropathy Study Group.

OBJECTIVE--To compare the efficacy of angiotensin converting enzyme inhibition with calcium antagonism in diabetic patients with microalbuminuria. DESIGN--Randomised study of diabetic patients with microalbuminuria treated with perindopril or nifedipine for 12 months and monitored for one or three months after stopping treatment depending on whether they were hypertensive or normotensive. Patients were randomised separately according to whether they were hypertensive or normotensive. SETTING--Diabetic clinics in three university teaching hospitals. PATIENTS--50 diabetic patients with persistent microalbuminuria. In all, 43 completed the study: 30 were normotensive and 13 hypertensive; 19 had type I diabetes and 24 had type II diabetes. INTERVENTIONS--For 12 months 20 patients were given perindopril 2-8 mg daily and 23 were given nifedipine 20-80 mg daily. MAIN OUTCOME MEASURES--Albumin excretion rate, blood pressure, and glomerular filtration rate. RESULTS--Both perindopril and nifedipine significantly reduced mean blood pressure. During treatment there was no significant difference between those treated with perindopril and those treated with nifedipine with respect to albuminuria or mean blood pressure. Stopping treatment with both drugs was associated with a sustained increase in albuminuria and mean blood pressure. There was a significant correlation between mean blood pressure and albuminuria and also between the reduction in mean blood pressure and the decrease in albuminuria during treatment with both drugs. In hypertensive patients both drugs caused significant decreases in mean blood pressure and albuminuria. In normotensive patients there was no significant reduction in albuminuria with either regimen. CONCLUSIONS--In diabetic patients with microalbuminuria blood pressure seems to be an important determinant of urinary albumin excretion. Perindopril and nifedipine have similar effects on urinary albumin excretion, both preventing increases in albuminuria in normotensive patients and decreasing albuminuria in hypertensive patients.     

Treatment of Obese Non-Diabetic Patients with Phenformin. A Double-Blind Cross-Over Trial

The effect of 50 mg. of sustained release phenformin capsules administered twice daily was compared with a placebo as an aid to weight reduction in obese non-diabetic patients. Phenformin and placebo were administered alternately in two three-month periods.Weight loss on a 1,200-calorie diet was greater in the first three months than in the second three months regardless of treatment. There was no difference in weight loss between the phenformin and placebo groups in either the first or second three-month period. Serum cholesterol levels tended to fall in association with weight loss, but not apparently in relation to the size of the weight loss or to the treatment.     

Growth,testicular and endocrine function of boars exposed to 8, 16 or 24 hours of light daily before puberty

Sixty Yorkshire boars were used in two replicates to evaluate the influence of duration of photoperiod on growth, testicular and reproductive endocrine function. Boars born in May and July were exposed to either 8, 16 or 24 h of fluorescent light (200 1x) daily between 2 and 8 months of age. Body weights were obtained at 2-week intervals. At 4, 6 and 8 months of age, venous cannulae were placed in five boars from each treatment and samples of serum were collected to evaluate concentrations of luteinizing hormone (LH) and testosterone. Samples of boars from each treatment were castrated at 6 and 8 months of age, and weights and sperm content of the testes and epididymides were determined. Body weights of boars were similar for all treatments throughout the experiment. Duration of photoperiod did not affect weights of the testes or epididymides or total numbers of sperm within these tissues at either 6 or 8 months of age. Testicular and epididymidal weights and epididymidal sperm numbers increased between 6 and 8 months of age. Concentrations of luteinizing hormone (LH) and testosterone in serum at 4, 6 or 8 months of age were not affected by duration of photoperiod. These results indicate that growth rate and testicular development of prepubertal Yorkshire boars born in May and July are not influenced by duration of photoperiod.     

Switching to Denosumab or Bisphosphonates After Completion of Teriparatide Treatment in Women With Severe Postmenopausal Osteoporosis

ObjectiveTo compare bone mineral density (BMD) changes after 12 months of treatment with denosumab or bisphosphonates in postmenopausal women with severe osteoporosis after stopping teriparatide therapy.MethodsWe retrospectively analyzed 140 postmenopausal women (mean age, 74.2 years) with severe osteoporosis who had been treated with teriparatide for 18 to 24 months at our outpatient clinic in a tertiary endocrine center between 2006 and 2015. After stopping teriparatide therapy, they continued treatment with a bisphosphonate (alendronate, risedronate, ibandronate, or zoledronic acid) or denosumab while receiving daily vitamin D and calcium. BMD at the lumbar spine (LS), total hip (TH), and femoral neck (FN) was measured by dual energy x-ray absorptiometry when teriparatide therapy was discontinued (baseline) and after 12 months of further treatment. Multivariate linear regression models were used to identify the predictors of BMD gain.ResultsAfter stopping teriparatide therapy, 70 women continued treatment with bisphosphonates and 70 received denosumab. LS, but not TH or FN, BMD gain was significantly greater in the denosumab group than in the bisphosphonates group at 12 months. Multivariate analysis showed that BMD gain at the LS was negatively associated with bisphosphonate versus denosumab treatment and positively associated with baseline serum total procollagen type I N-terminal propeptide. BMD gains at the FN were predicted by higher baseline serum urate levels. BMD gains at the TH and FN were negatively associated with pretreatment BMD gains at the same site.ConclusionTwelve months after stopping teriparatide therapy, sequential denosumab treatment appeared to yield higher additional LS BMD gain on average compared with bisphosphonates treatment.     

Arthroscopic surgery compared with supervised exercises in patients with rotator cuff disease (stage II impingement syndrome)

OBJECTIVE--To compare the effectiveness of arthroscopic surgery, a supervised exercise regimen, and placebo soft laser treatment in patients with rotator cuff disease (stage II impingement syndrome). DESIGN--Randomised clinical trial. SETTING--Hospital departments of orthopaedics and of physical medicine and rehabilitation. PATIENTS--125 patients aged 18-66 who had had rotator cuff disease for at least three months and whose condition was resistant to treatment. INTERVENTIONS--Arthroscopic subacromial decompression performed by two experienced surgeons; exercise regimen over three to six months supervised by one experienced physiotherapist; or 12 sessions of detuned soft laser treatment over six weeks. MAIN OUTCOME MEASURES--Change in the overall Neer shoulder score (pain during previous week and blinded evaluation of function and range of movement by one clinician) after six months. RESULTS--No differences were found between the three groups in duration of sick leave and daily intake of analgesics. After six months the difference in improvement in overall Neer score between surgery and supervised exercises was 4.0 (95% confidence interval -2 to 11) and 2.0 (-1.4 to 5.4) after adjustment for sex. The condition improved significantly compared with placebo in both groups given the active treatments. Treatment costs were higher for those given surgery (720 pounds v 390 pounds). CONCLUSIONS--Surgery or a supervised exercise regimen significantly, and equally, improved rotator cuff disease compared with placebo.     

Work of a nurse in a health centre treatment room

In six months there were 1,704 attendances at the treatment room of a small health centre. The attendance rate for the population registered with the health centre doctors was 448 per 1,000 patients per year. Females between 15 and 44 years and males under 15 had the highest attendance rates. There were 256 casual attenders, 58 (23%) of whom were referred to a doctor or hospital for further advice or treatment.It is suggested that in a health centre treatment room about six hours of nursing time a week for every 1,000 patients is required, and that a case can be made out for some of the routine work of casualty departments being done in health centres.     

Male Sex,African American Race or Ethnicity,and Triiodothyronine Levels at Diagnosis Predict Weight Gain After Antithyroid Medication and Radioiodine Therapy for Hyperthyroidism

ObjectiveTo determine whether racial or ethnic differences affect weight gain after treatment of hyperthyroidism and to reassess established risk factors such as sex, age, and cause of hyperthyroidism.MethodsWe conducted a retrospective review of medical records of 111 patients treated with radioiodine (RAI) for hyperthyroidism, with or without preceding antithyroid medication, during 2002 to 2005. We ascertained age, sex, race or ethnicity, insurance status, compliance with visits, serum triiodothyronine (T₃) level at diagnosis, and cause of hyperthyroidism. Weights and serum thyroidstimulating hormone levels were obtained at diagnosis, at time of RAI therapy, and at 0 to 4 months, 4 to 8 months, 8 to 12 months, and 24 months after RAI treatment.ResultsThere was a significant weight increase after treatment of hyperthyroidism. Levels of T₃ at initial diagnosis of hyperthyroidism, male sex, and black or Hispanic ethnicity were found to be independent predictors of weight gain after RAI treatment. We found a significant interaction between race or ethnicity and sex in multivariate models. There was no difference in thyroid function across racial or ethnic groups or the sexes. Age, cause of hyperthyroidism, posttreatment thyroid-stimulating hormone level, compliance, and insurance status were not found to be significant predictors of weight gain.ConclusionThe T₃ level at the time of diagnosis of hyperthyroidism is a strong predictor of weight gain after treatment of hyperthyroidism. Black race or ethnicity and male sex are also risk factors for weight gain. (Endocr Pract. 2010;16:609-616)     

Diagnosis and antibiotic treatment of acute otitis media: report from International Primary Care Network.

STUDY OBJECTIVE--The relation between a history of disorders suggestive of acute otitis media, symptoms, and findings of an examination of the tympanic membrane and doctors'' certainty of diagnosis. Also, to examine differences in prescribing habits for acute otitis media among doctors from different countries. DESIGN--Questionnaires were completed by participating doctors for a maximum of 15 consecutive patients presenting with presumed acute otitis media. SETTING--General practices in Australia, Belgium, Great Britain, Israel, The Netherlands, New Zealand, Canada, Switzerland, and the United States. PATIENTS--3660 Children divided into the three age groups 0-12 months, 13-30 months, and greater than or equal to 31 months. MAIN OUTCOME MEASURES--General practitioners'' responses to questions on their diagnostic certainty and resolution of patients'' symptoms after two months. RESULTS--The diagnostic certainty in patients aged 0-12 months was 58.0%. This increased to 66.0% in those aged 13-30 months and 73.3% in those aged greater than or equal to 31 months. In all age groups diagnostic certainty was positively associated with the finding of a tympanic membrane that was discharging pus or bulging. Redness of the membrane and pain were also associated with certainty in patients aged 13-30 months, and a history of decreased hearing or recent upper respiratory infection was positively associated in patients aged greater than or equal to 31 months. The proportion of patients prescribed antibiotics varied greatly among the countries, from 31.2% in The Netherlands to 98.2% in both Australia and New Zealand, as did the duration of treatment. Patients who did not take antibiotics had a higher rate of recovery than those who did; the rate of recovery did not differ between different types of antibiotic. CONCLUSIONS--Doctors'' certainty of diagnosis of acute otitis media was linked to patient''s age. Improved criteria or techniques for diagnosing acute otitis media, especially in very young children, need to be developed. Antibiotic treatment did not improve the rate of recovery of patients in this study.