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Schneeberger C.,Center for Infection and Immunity Amsterdam | Van Wassenaer A.,Emma Childrens Hospital Academic Medical Center | Bossuyt P.M.,University of Amsterdam | Vogelvang T.E.,Diakonessenhuis Utrecht | And 10 more authors.
BMC Pregnancy and Childbirth | Year: 2012

Background: The prevalence of asymptomatic bacteriuria (ASB) in pregnancy is 2-10% and is associated with both maternal and neonatal adverse outcomes as pyelonephritis and preterm delivery. Antibiotic treatment is reported to decrease these adverse outcomes although the existing evidence is of poor quality.Methods/Design: We plan a combined screen and treat study in women with a singleton pregnancy. We will screen women between 16 and 22 weeks of gestation for ASB using the urine dipslide technique. The dipslide is considered positive when colony concentration ≥105 colony forming units (CFU)/mL of a single microorganism or two different colonies but one ≥105 CFU/mL is found, or when Group B Streptococcus bacteriuria is found in any colony concentration. Women with a positive dipslide will be randomly allocated to receive nitrofurantoin or placebo 100 mg twice a day for 5 consecutive days (double blind). Primary outcomes of this trial are maternal pyelonephritis and/or preterm delivery before 34 weeks. Secondary outcomes are neonatal and maternal morbidity, neonatal weight, time to delivery, preterm delivery rate before 32 and 37 weeks, days of admission in neonatal intensive care unit, maternal admission days and costs.Discussion: This trial will provide evidence for the benefit and cost-effectiveness of dipslide screening for ASB among low risk women at 16-22 weeks of pregnancy and subsequent nitrofurantoin treatment.Trial registration: Dutch trial registry: NTR-3068. © 2012 Kazemier et al.; licensee BioMed Central Ltd.

Schneeberger C.,Center for Infection and Immunity Amsterdam | Ott A.,Certe Laboratory for Infectious Diseases | Bossuyt P.M.,University of Amsterdam | Vogelvang T.E.,Diakonessenhuis Utrecht | And 11 more authors.
The Lancet Infectious Diseases | Year: 2015

Background: Existing approaches for the screening and treatment of asymptomatic bacteriuria in pregnancy are based on trials that were done more than 30 years ago. In this study, we reassessed the consequences of treated and untreated asymptomatic bacteriuria in pregnancy. Methods: In this multicentre prospective cohort study with an embedded randomised controlled trial, we screened women (aged ≥18 years) at eight hospitals and five ultrasound centres in the Netherlands with a singleton pregnancy between 16 and 22 weeks' gestation for asymptomatic bacteriuria. Screening was done with a single dipslide and two culture media. Dipslides were judged positive when the colony concentration was at least 1×105 colony-forming units (CFU) per mL of a single microorganism or when two different colony types were present but one had a concentration of at least 1×105 CFU per mL. Asymptomatic bacteriuria-positive women were eligible to participate in the randomised controlled trial comparing nitrofurantoin with placebo treatment. In this trial, participants were randomly assigned 1:1 to receive either nitrofurantoin 100 mg or identical placebo tablets, and were instructed to self-administer these tablets twice daily for 5 consecutive days. Randomisation was done by a web-based application with a computer-generated list with random block sizes of two, four, or six participants rendered by an independent data manager. 1 week after the end of treatment, they provided us with a follow-up dipslide. Women, treating physicians, and researchers all remained unaware of the bacteriuria status and treatment allocation. Women who refused to participate in the randomised controlled trial did not receive any antibiotics, but their outcomes were collected for analysis in the cohort study. We compared untreated and placebo-treated asymptomatic bacteriuria-positive women with asymptomatic bacteriuria-negative women and nitrofurantoin-treated asymptomatic bacteriuria-positive women. The primary endpoint was a composite of pyelonephritis with or without preterm birth at less than 34 weeks, analysed by intention to treat at 6 weeks post-partum. This trial is registered with the Dutch Trial Registry, number NTR3068. Findings: Between Oct 11, 2011, and June 10, 2013, we enrolled 5621 women into our screening cohort, of whom 5132 were eligible for screening. After exclusions for contaminated dipslides and patients lost to follow-up, in our final cohort of 4283 women, 248 were asymptomatic bacteriuria positive, of whom 40 were randomly assigned to nitrofurantoin and 45 to placebo for the randomised controlled trial, whereas the other 163 asymptomatic bacteriuria-positive women were followed without treatment. The proportion of women with pyelonephritis, preterm birth, or both did not differ between untreated or placebo-treated asymptomatic bacteriuria-positive women and asymptomatic bacteriuria-negative women (6 [2·9%] of 208 vs 77 [1·9%] of 4035; adjusted odds ratio [OR] 1·5, 95% CI 0·6-3·5) nor between asymptomatic bacteriuria-positive women treated with nitrofurantoin versus those who were untreated or received placebo (1 [2·5%] of 40 vs 6 [2·9%] of 208; risk difference -0·4, 95% CI -3·6 to 9·4). Untreated or placebo-treated asymptomatic bacteriuria-positive women developed pyelonephritis in five [2·4%] of 208 cases, compared with 24 [0·6%] of 4035 asymptomatic bacteriuria-negative women (adjusted OR 3·9, 95% CI 1·4-11·4). Interpretation: In women with an uncomplicated singleton pregnancy, asymptomatic bacteriuria is not associated with preterm birth. Asymptomatic bacteriuria showed a significant association with pyelonephritis, but the absolute risk of pyelonephritis in untreated asymptomatic bacteriuria is low. These findings question a routine screen-treat-policy for asymptomatic bacteriuria in pregnancy. Funding: ZonMw (the Netherlands Organisation for Health Research and Development). © 2015 Elsevier Ltd.

van Os M.A.,Medical Center | van Wassenaer A.,Emma Childrens Hospital Academic Medical Center | Bloemenkamp K.W.M.,Leiden University | Willekes C.,Academic Hospital | And 10 more authors.
BMC Pregnancy and Childbirth | Year: 2011

Background: Women with a short cervical length in mid-trimester pregnancy have a higher risk of preterm birth and therefore a higher rate of neonatal mortality and morbidity. Progesterone can potentially decrease the number of preterm births and lower neonatal mortality and morbidity. Previous studies showed good results of progesterone in women with either a history of preterm birth or a short cervix. However, it is unknown whether screening for a short cervix and subsequent treatment in mid trimester pregnancy is effective in low risk women.Methods/Design: We plan a combined screen and treat study among women with a singleton pregnancy without a previous preterm birth. In these women, we will measure cervical length at the standard anomaly scan performed between 18 and 22 weeks. Women with cervical length ≤ 30 mm at two independent measurements will be randomly allocated to receive either vaginal progesterone tablets or placebo between 22 and 34 weeks. The primary outcome of this trial is adverse neonatal condition, defined as a composite outcome of neonatal mortality and severe morbidity. Secondary outcomes are time to delivery, preterm birth rate before 32, 34 and 37 weeks, days of admission in neonatal intensive care unit, maternal morbidity, maternal admission days for preterm labour and costs. We will assess growth, physical condition and neurodevelopmental outcome of the children at two years of age.Discussion: This study will provide evidence for the usefulness and cost-effectiveness of screening for short cervical length at the 18-22 weeks and subsequent progesterone treatment among low risk women.Trial registration: Netherlands Trial Register (NTR): NTR207. © 2011 van Os et al; licensee BioMed Central Ltd.

Shao Q.,Suzhou Municipal Hospital | Shao Q.,Wake forest University | Xu J.,Wake forest University | Adams T.,Wake forest University | And 9 more authors.
Journal of X-Ray Science and Technology | Year: 2013

PURPOSE: To perform a retrospective study to compare the efficiency, safety and costs using aspiration-sclerotherapy with 95% ethanol vs. laparoscopic decortications in management of symptomatic simple renal cysts. MATERIALS AND METHODS: Patients with simple renal cysts (diamante ≥ 4 cm) were recruited from our hospital between October 2008 and October 2012. A total of 986 patients (Group 1) underwent aspiration-sclerotherapy with 95% ethanol and 208 patients (Group 2) underwent laparoscopic decortication. All patients were followed up with ultrasonography or computerized tomography (CT) for one year. Regression rates, recurrence rates and costs were compared. RESULTS: Similarity in symptoms (back pain, cloudy urine or mass in abdomen), renal cyst size, and cyst distribution, complete regression rate after treatment between the two groups; A higher recurrence rate, but shorter procedure times and lower cost in Group 1 compared to Group 2. The procedures used for both groups were safe and had minimum complications. CONCLUSION: Aspiration-sclerotherapy, as well as laparoscopic decortication are effective and safe therapy for symptomatic simple renal cysts. Aspiration-sclerotherapy is more suitable for medium size of renal cysts, while Laparoscopic decortication is superior to the cysts in large sizes. © 2013 IOS Press and the authors.

Maity P.P.,Indian Institute of Technology Kharagpur | Maity A.K.,Midnapure Medical College and Hospital | Mukhopadhya S.,Medical College | Sadhu A.,and MRI Center | And 6 more authors.
International Conference on Systems in Medicine and Biology, ICSMB 2010 - Proceedings | Year: 2010

In pathology, phyllodes and fibroadenoma of breast are two well-known tumors with differential malignant potentialities and aetio-pathology. But diagnostic ambiguity prevails, particularly in the condition of stromal hyper-cellularity. To address such classification problem, current study evaluated fresh breast tumor biopsies in respect to expression of some candidate genes by immunohistochemistry (IHC) and structurally by swept source-optical coherence tomography (SS-OCT). The IHC assessed the expression of p63 and α-SMA in myoepithelial cells (MECs) and collagen I and III in stroma. Through skin SS-OCT, the cross-sectional structural features were noted non-invasively. In phyllodes, expressions of P63 and α-SMA were less in comparison to fibroadenoma and their normal counterpart whereas it was just reverse for collagen I and III. The OCT images demonstrated differential optical features of the biopsies in terms of presence of foaminess in phyllodes in contrast to compactness of fibroadenoma. Thus, the current study identified differential structural and molecular signatures in these tumors, to address the diagnostic ambiguities. © 2010 IEEE.

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