URINARY TRACT
INFECTIONS A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES
J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Urinary Tract Infections: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-84112-8 1. Urinary Tract Infections-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.
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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on urinary tract infections. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.
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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.
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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON URINARY TRACT INFECTIONS .................................................................. 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Urinary Tract Infections............................................................. 24 E-Journals: PubMed Central ....................................................................................................... 69 The National Library of Medicine: PubMed ................................................................................ 77 CHAPTER 2. NUTRITION AND URINARY TRACT INFECTIONS ...................................................... 121 Overview.................................................................................................................................... 121 Finding Nutrition Studies on Urinary Tract Infections............................................................ 121 Federal Resources on Nutrition ................................................................................................. 124 Additional Web Resources ......................................................................................................... 125 CHAPTER 3. ALTERNATIVE MEDICINE AND URINARY TRACT INFECTIONS ................................ 127 Overview.................................................................................................................................... 127 National Center for Complementary and Alternative Medicine................................................ 127 Additional Web Resources ......................................................................................................... 134 General References ..................................................................................................................... 140 CHAPTER 4. DISSERTATIONS ON URINARY TRACT INFECTIONS .................................................. 141 Overview.................................................................................................................................... 141 Dissertations on Urinary Tract Infections................................................................................. 141 Keeping Current ........................................................................................................................ 142 CHAPTER 5. CLINICAL TRIALS AND URINARY TRACT INFECTIONS ............................................. 143 Overview.................................................................................................................................... 143 Recent Trials on Urinary Tract Infections................................................................................. 143 Keeping Current on Clinical Trials ........................................................................................... 145 CHAPTER 6. PATENTS ON URINARY TRACT INFECTIONS ............................................................. 147 Overview.................................................................................................................................... 147 Patents on Urinary Tract Infections.......................................................................................... 147 Patent Applications on Urinary Tract Infections ...................................................................... 164 Keeping Current ........................................................................................................................ 170 CHAPTER 7. BOOKS ON URINARY TRACT INFECTIONS................................................................. 171 Overview.................................................................................................................................... 171 Book Summaries: Federal Agencies............................................................................................ 171 Book Summaries: Online Booksellers......................................................................................... 172 The National Library of Medicine Book Index ........................................................................... 175 Chapters on Urinary Tract Infections........................................................................................ 176 CHAPTER 8. MULTIMEDIA ON URINARY TRACT INFECTIONS ...................................................... 181 Overview.................................................................................................................................... 181 Video Recordings ....................................................................................................................... 181 Bibliography: Multimedia on Urinary Tract Infections ............................................................ 182 CHAPTER 9. PERIODICALS AND NEWS ON URINARY TRACT INFECTIONS ................................... 183 Overview.................................................................................................................................... 183 News Services and Press Releases.............................................................................................. 183 Newsletters on Urinary Tract Infections ................................................................................... 185 Newsletter Articles .................................................................................................................... 186 Academic Periodicals covering Urinary Tract Infections .......................................................... 187 CHAPTER 10. RESEARCHING MEDICATIONS................................................................................. 189 Overview.................................................................................................................................... 189 U.S. Pharmacopeia..................................................................................................................... 189 Commercial Databases ............................................................................................................... 191 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 195
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Overview.................................................................................................................................... 195 NIH Guidelines.......................................................................................................................... 195 NIH Databases........................................................................................................................... 197 Other Commercial Databases..................................................................................................... 200 The Genome Project and Urinary Tract Infections.................................................................... 200 APPENDIX B. PATIENT RESOURCES ............................................................................................... 205 Overview.................................................................................................................................... 205 Patient Guideline Sources.......................................................................................................... 205 Finding Associations.................................................................................................................. 217 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 219 Overview.................................................................................................................................... 219 Preparation................................................................................................................................. 219 Finding a Local Medical Library................................................................................................ 219 Medical Libraries in the U.S. and Canada ................................................................................. 219 ONLINE GLOSSARIES................................................................................................................ 225 Online Dictionary Directories ................................................................................................... 225 URINARY TRACT INFECTIONS DICTIONARY .................................................................. 227 INDEX .............................................................................................................................................. 299
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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with urinary tract infections is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about urinary tract infections, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to urinary tract infections, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on urinary tract infections. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to urinary tract infections, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on urinary tract infections. The Editors
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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.
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CHAPTER 1. STUDIES ON URINARY TRACT INFECTIONS Overview In this chapter, we will show you how to locate peer-reviewed references and studies on urinary tract infections.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and urinary tract infections, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “urinary tract infections” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •
Adolescent Urinary Tract Infections Source: Adolescent Medicine: State of the Art Reviews (STARS). 11(2): 293-313. June 2000. Contact: Available from Hanley and Belfus, Inc. Medical Publishers, Philadelphia 210 South 13th Street, Philadelphia, PA 19107. (215) 546-7293 or (215) 546-4995. (800) 9621892. Fax: (215) 790-9330. Website: www.hanleyandbelfus.com. Summary: Acute cystitis (bladder infection) is one of the most common non skin related conditions in sexually active adolescent girls. This article reviews adolescent urinary tract infections (UTIs). The authors note that a close relationship between UTI and sexual activity and, therefore, with sexually transmitted diseases (STDs) gives the
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condition heightened importance and urgency. UTIs in adolescence indicate the need for an STD evaluation and counseling for sexual activity. In most cases, the diagnosis of UTI in an adolescent is straightforward and classified as upper tract, lower tract, or both, based on symptoms. The exact incidence of UTIs in adolescence probably varies with other risk factors; the prevalence is 1 percent for girls and much less for boys. The authors discuss pathogenesis, pathology, clinical manifestations, differential diagnosis, laboratory tests (pyuria, quantitative urinalysis), etiology, virulence factors, treatment, prevention, and prognosis. A final section addresses special considerations, including asymptomatic bacteriuria, spina bifida, neurogenic bladder, vesicoureteral reflux and reflux nephropathy, kidney transplant, diabetes mellitus, fungal UTIs, viral UTIs, renal or perinephric abscess, recurrent infections, lower urinary tract anomalies, urolithiasis (urinary stones), catheter related infections, rheumatoid arthritis and Proteus mirabilis bacteriuria, and pregnancy. The authors note that overlap of urethral and gynecologic symptoms emphasizes the coexistence of STDs with UTIs. Problems with diagnosis may occur because the history may not be forthcoming and STDs may be asymptomatic. The authors encourage physicians to maintain a high index of suspicion for UTIs and STDs in any adolescent with urinary symptoms. 7 figures. 6 tables. 56 references. •
Catheter-Associated Urinary Tract Infection Is Rarely Symptomatic: A Prospective Study of 1497 Catheterized Patients Source: Archives of Internal Medicine. 160(5): 678-682. March 13, 2000. Contact: Available from American Medical Association. Subscriber Services Center, P.O. Box 10946, Chicago, IL 60610-0946. (800) 262-2350. Fax (312) 464-5831. E-mail:
[email protected]. Summary: Catheter associated urinary tract infection (CAUTI) is the most common nosocomial infection (infections originating in the hospital), accounting for more than 1 million cases each year in hospitals and nursing homes in the United States. This article reports on a prospective study of 1,497 newly catheterized patients undertaken to define the clinical features of CAUTI. Every day that the catheter was in place, a quantitative urine culture and urine leukocyte count were obtained, and the patient was queried by a research worker regarding symptoms. To more precisely define the role of CAUTI in patients' symptoms, a subset of 1,034 patients (89 of whom developed CAUTI with more than 10 to the third colony forming units per milliliter), who did not have another potentially confounding site of infection besides the urinary tract, was analyzed. There were 235 new cases of nosocomial CAUTI during the study period. More than 90 percent of the infected patients were asymptomatic; only 123 infections (52 percent) were detected by patients' physicians using the hospital laboratory. In the subset analysis, there were no significant differences between patients with and without CAUTI in signs or symptoms commonly associated with urinary tract infection (fever, dysuria, urgency, or flank pain) or in leukocytosis. Only 1 of the 235 episodes of CAUTI that were prospectively studied was unequivocally associated with secondary bloodstream infection. The authors conclude that whereas CAUTI are a major reservoir of antibiotic resistant organisms in the hospital, they are rarely symptomatic and infrequently cause bloodstream infection. Symptoms referable to the urinary tract, fever, or peripheral leukocytosis have little predictive value for the diagnosis of CAUTI. 2 tables. 46 references.
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Increasing Antimicrobial Resistance and the Management of Uncomplicated Community-Acquired Urinary Tract Infections Source: Annals of Internal Medicine. 135(1): 41-50. July 3, 2001.
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Contact: Available from American College of Physicians. American Society of Internal Medicine. 190 North Independence Mall West, Philadelphia, PA 19106-1572. Website: www.acponline.org. Summary: Community acquired urinary tract infections (UTI) are among the most common bacterial infections in women. Therapy for these infections is usually begun before results of microbiological tests are known. Furthermore, in women with acute uncomplicated cystitis, empirical therapy without a pretherapy urine culture is often used. The rationale for this approach is based on the highly predictable spectrum of etiologic agents causing UTI and their antimicrobial resistance patterns. However, antimicrobial resistance among uropathogens causing community-acquired UTIs, both cystitis and pyelonephritis, is increasing. This article reports on this increase and ponders the management of UTIs in light of this evidence. The authors note that most important is the increasing resistance of the uropathogens to trimethoprimsulfamethoxazole (TMP-SMX), the current drug of choice for treatment of acute uncomplicated cystitis in women. The authors stress that in the outpatient setting, identifying risk factors for TMP-SMX resistance and knowing the prevalence of TMPSMX resistance in the local community are important steps in choosing an appropriate therapeutic agent. When choosing a treatment regimen, physicians should consider such factors as in vitro susceptibility, adverse effects, cost-effectiveness, and selection of resistant strains. Using a management strategy that takes these variables into account is essential for maintaining the safety and efficacy of treatment for acute UTI. A patient care algorithm is included. 1 figure. 4 tables. 44 references. •
Managing Urinary Tract Infections in Men Source: Hospital Practice. 35(1): 53-60, 144. January 15, 2000. Contact: McGraw-Hill Healthcare Publications. 4530 West 77th Street, Minneapolis, MN 55435. (612) 835-3222. Fax (615) 835-3460. Summary: Despite the obvious genitourinary differences between the sexes, management of lower urinary tract infections (UTIs) in men is based largely on standards developed from studies in women. This has helped foster misconceptions that, among other problems, add needless complexity and expense to the diagnosis and treatment of male patients with UTIs. This article offers suggestions for managing UTIs in men. The article begins with an illustrative case presentation of a 68 year old man who presented with dysuria (painful urination) and increased urinary frequency. The author notes that among men who are past middle age, or who are institutionalized, the prevalence of UTI is almost the same as it is in women. Risk factors can include catheterization, lack of circumcision, sexual history (UTI in a male patient can be associated with the same pathogen found in the partner's vaginal flora), and exposure to coliform bacteria (usually through insertive anal intercourse). The author notes that in men, compared to women, the necessity of obtaining a clean catch urine specimen is reduced; first void urine specimens are an adequate choice for most men with clinical findings suggesting a bladder infection. If the symptoms are making the patient uncomfortable, empiric antimicrobial therapy for probable UTI is indicated. Once the organism has been identified and characterized, any changes in antibiotic therapy can be undertaken. In the case study, a 10 day regimen of ampicillin was used. Since symptoms resolved during treatment and because it is usually unnecessary to treat asymptomatic bacteriuria, there was no absolute need to repeat the urine culture as confirmation of cure. The author does emphasize that recurrent UTIs in male patients warrant a high degree of suspicion of an underlying structural problem requiring further evaluation.
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For example, benign prostatic hyperplasia (BPH) may result in urine retention in the bladder, with an accompanying higher risk of infection. 2 figures. 10 references. •
Imaging Studies after a First Febrile Urinary Tract Infection in Young Children Source: New England Journal of Medicine. 348(3): 195-202. January 16, 2003. Summary: Guidelines from the American Academy of Pediatrics recommend obtaining a voiding cystourethrogram and a renal ultrasonogram for young children after a first urinary tract infection (UTI); renal scanning has also been endorsed by other authorities. This article reports on a study that investigated whether imaging studies altered management or improved outcomes in young children with a first febrile urinary tract infection. In the prospective trial involving 309 children (1 to 24 months old), an ultrasonogram and an initial renal (kidney) scan were obtained within 72 hours after diagnosis, contrast voiding cystourethrography was performed 1 month later, and renal scanning was repeated 6 months later. The ultrasonographic results were normal in 88 percent of the children (272 of 309); the identified abnormalities did not modify management. Acute pyelonephritis (kidney infection) was diagnosed in 61 percent of the children (190 of 309). Thirty-nine percent of the children who underwent cystourethrography (117 of 302) had vesicoureteral reflux (return of urine from the bladder to the kidney). Repeated scans were obtained for 89 percent of the children (275 of 309); renal scarring was noted in 9.5 percent of these children (26 of 275). The authors conclude that an ultrasonogram performed at the time of acute illness is of limited value. A voiding cystourethrogram for the identification of reflux is useful only if antimicrobial prophylaxis is effective in reducing reinfections and renal scarring. Renal scans obtained at presentation identify children with acute pyelonephritis and scans obtained 6 months later identify those with renal scarring. The routine performance of urinalysis, urine culture, or both during subsequent febrile (with fever) illnesses in all children with a previous febrile UTI will probably eliminate the need to obtain either early or late scans. 3 figures. 2 tables.
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What Do We Know About the Urinary Tract Infection-Prone Individual? Source: Journal of Infectious Diseases. 183(Supplement 1): S66-S69. March 1, 2001. Contact: Available from Journal of Infectious Diseases. University of Chicago Press, Journals Division, P.O. Box 37005, Chicago, IL 60637. (773) 753-3347. Fax (773) 753-0811. E-mail:
[email protected]. Website: www.journals.uchicago.edu. Summary: Host factors play an important role in the balance between sterility and infection of the urinary tract. This article discusses current knowledge about individuals who are prone to urinary tract infection (UTI). Host defenses typically include unobstructed flow of urine (to wash out bacteria from the lower urinary tract), the antibacterial effect of urine, glycoproteins that block adherence of bacteria to the urothelial and vaginal mucosa, and immunological responses that facilitate bacterial clearance. Complicated UTIs are associated with anatomic, functional, or metabolic abnormalities of the urinary tract that disable the natural defenses and lead to significant destruction of renal tissue. Uncomplicated infections are associated with more subtle, variable alterations governed by genetic, biologic, and behavioral or environmental factors that promote bacterial access to and colonization or infection of the urinary tract. The author notes that the UTI prone individual is actually free of infection most of the time, presumably due to the innate defense mechanisms of the urinary tract. Nevertheless, transient or permanent breaches in the host defense allow bacterial access to and infection of the urinary tract. The frequency and severity of the
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episodic lapses in defense determine the type and extent of infection. Minor weaknesses in host defense allow only virulent (very strong) pathogens to cause simple cystitis (bladder infection), which will clear spontaneously or with minimal antimicrobial therapy. More severe host deficiencies are subject to invasion by less virulent strains, lead to more severe infections, and require more precise and extensive therapy. The variety of host defense and susceptibility factors frequently merge and fluctuate within a given individual, making the study, diagnosis, and management of UTIs a difficult and rewarding endeavor. •
Urinary Tract Infections: Separating the Genders and the Ages Source: Postgraduate Medicine. 101(6): 231-237. June 1997. Contact: Available from McGraw-Hill, Inc. 1221 Avenue of the Americas, New York, NY 10020. (612) 832-7869. Summary: Management of urinary tract infections (UTI) may seem quite straightforward, but the patient's age, gender, and other factors can affect management and outcome. In this article, the author reviews special situations and outlines treatment options for those cases where individualized care is crucial. The author first reviews the epidemiologic factors that may play a role in UTI, including frequency and prevalence of bacteriuria (bacteria in the urine) and gender rates of symptomatic and asymptomatic bacteriuria. Factors that increase the risk for recurrent UTI in women include anatomic or functional abnormalities; sexual intercourse with or without use of diaphragms or spermicides; genetic factors, such as nonsecretion of blood group antigens; and uroepithelial cell colonization by uropathogens. The most significant risk factors for symptomatic UTI in men are obstructive uropathy and chronic prostatitis. In ambulatory elderly patients, risk factors include instrumentation (such as catheterization), especially in men; anatomic abnormalities, such as poor emptying related to uterine prolapse, chronic prostatitis, or obstructive uropathy caused by prostatism; and debility associated with fecal incontinence or neuromuscular disease. Obstruction to outflow in both men and women is the most important factor in the development of such infections. The author notes that the most difficult decisions in management of UTI relate to whether hospitalization is needed. The author discusses the commonly used oral antimicrobial agents used for treating UTIs, including sulfamethoxazole, amoxicillin, nitrofurantoin, TMP-SMZ, fluoroquinolones, and cephalosporins. 6 tables. 16 references. (AA-M).
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Vaginal Mucosal Immunization for Recurrent Urinary Tract Infection: Extended Phase II Clinical Trial Source: Journal of Infectious Diseases. 183(Supplement 1): S81-S83. March 1, 2001. Contact: Available from Journal of Infectious Diseases. University of Chicago Press, Journals Division, P.O. Box 37005, Chicago, IL 60637. (773) 753-3347. Fax (773) 753-0811. E-mail:
[email protected]. Website: www.journals.uchicago.edu. Summary: Many women remain susceptible to ascending urinary tract infections (UTIs) despite the absence of a demonstrable anatomic abnormality. Repeated treatment with antibiotics is often necessary for these women but may lead to adverse reactions and infection with antibiotic resistant organisms. This article reports on a study based on the concepts of mucosal immunity in the genitourinary tract. The researchers have been working to develop an effective mucosally applied vaginal immunogen to help prevent ascending UTIs (infection that goes from the bladder to the ureters and kidneys). The study included 36 women (18 to 74 years old) who had all experienced three or more
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UTIs during the previous year. Antibiotic prophylaxis (if any) was discontinued at the beginning of the study; during the 24 week trial, infections were treated with 3 days of appropriate antibiotics. For vaginal suppository instillation, the suppository was inserted, and the patients remained lying down for 15 minutes. The suppository was SolcoUrovac, a whole cell vaccine containing heat killed bacteria from 10 human uropathogenic (causing disease in the urinary tract) strains. There were 3 randomized treatment groups: Group 1 received vaccine suppositories at weeks 0, 1, 2, 6, 10, and 14; group 2 also received vaccine suppositories at weeks 0, 1, and 2, but at weeks 6, 10, and 14, they received placebo suppositories; and group 3 received six placebo suppositories at the same time points. The women in the 3 groups did not differ in mean age, estrogen usage, sexual activity, or vaginal lactobacillus colonization. No patient discontinued treatment for adverse reactions or reported heavy vaginal discharge or interference with sexual intercourse. Women who received the initial vaccine doses plus three booster doses (Group 1) had a significant delay in the time until the first reinfection over their entire study period as compared with placebo treated women (Group 3). The authors conclude that vaginal immunization for recurrent UTIs is a safe and effective treatment method. 1 figure. 2 tables. 16 references. •
Voiding Dysfunction Associated with Incontinence, Vesicoureteral Reflux and Recurrent Urinary Tract Infections Source: Current Opinion in Urology. 10(6): 599-606. November 2000. Contact: Available from Lippincott Williams and Wilkins. 241 Borough High Street, London, SE1 1GB, UK. +44 (0) 171940-7500. E-mail:
[email protected]. Summary: Over the last several decades, voiding dysfunction in children has primarily been associated with urinary incontinence and thought to be secondary to bladder instability from delayed brain maturation. Full urodynamic evaluation became the standard recommendation and treatment centered on early institution of anticholinergics. Recently, this strategy has been questioned as medical programs including pelvic floor muscle treatments have shown tremendous success in curing incontinence, decreasing surgical rates for vesicoureteral reflux (return of urine from the bladder back into the kidneys), and decreasing recurrent urinary tract infections (UTIs). This article reviews the advances that have been made in the understanding and treatment of nonneuropathic voiding dysfunction. New computer technologies (biofeedback) have made it possible to train children to successfully isolate the pelvic floor muscles as an outpatient. Treatment evidence suggests the pelvic floor may be the main control center. Pelvic floor retraining can correct pelvic floor laxity, pelvic floor hyperactivity, or, via inhibition control, uninhibited bladder contractions. This form of treatment along with a conservative medical program is successful in the majority of patients with voiding dysfunction. Some centers have had good success initiating this noninvasive treatment program without first obtaining full urodynamics (diagnostic tests of the urination process). Only a minority of patients who fail this conservative approach would require a more invasive evaluation. 3 figures. 38 references (17 annotated).
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Patient-Initiated Treatment of Uncomplicated Recurrent Urinary Tract Infections in Young Women Source: Annals of Internal Medicine. 135(1): 9-16. July 3, 2001.
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Contact: Available from American College of Physicians. American Society of Internal Medicine. 190 North Independence Mall West, Philadelphia, PA 19106-1572. Website: www.acponline.org. Summary: Recurrent urinary tract infections (UTIs) are a common outpatient problem, resulting in frequent office visits and often requiring the use of prophylactic antimicrobial agents. Patient-initiated treatment of recurrent UTIs may decrease antimicrobial use and improve patient convenience. This article reports on a study undertaken to determine the safety and feasibility of patient-initiated treatment of recurrent UTIs. The prospective clinical trial included 172 women who, after selfdiagnosing UTI on the basis of symptoms, initiated therapy with ofloxacin or levofloxacin. The results showed that 88 of 172 women self-diagnosed a total of 172 UTIs. Laboratory evaluation showed a uropathogens in 144 cases (84 percent), sterile pyuria (white blood cells in the urine) in 19 cases (11 percent), and no pyuria or bacteriuria in 9 cases (5 percent). Clinical and microbiological cures occurred in 92 percent and 96 percent, respectively, of culture-confirmed episodes. No serious adverse events occurred. The authors conclude that adherent women can accurately self diagnose and self treat recurrent UTIs. 2 figures. 2 tables. 23 references. •
Stenotrophomonas (Xanthomonas) Maltophilia Urinary Tract Infection: A Disease That Is Usually Severe and Complicated Source: Archives of Internal Medicine. 156(4): 433-435. February 26, 1996. Summary: Stenotrophomonas (Xanthomonas) maltophilia has emerged as a causative agent of serious nosocomial infections. However, documented cases of urinary tract infection (UTI) with this organism have rarely been reported. This article reports on a study consisting of a review of the medical records of patients admitted to a large cancer center with cultures yielding S. maltophilia from urinary sources during a period of 15 months. All UTIs were serious: 13 were complicated and 2 were acute uncomplicated pyelonephritis. The urinary tracts of 13 other patients were colonized with S. maltophilia. Most of the colonized and infected patients were hospitalized with genitourinary malignancy, underwent urinary catheterization, and were receiving antibiotics inactive against S. maltophilia. Neutropenia and urinary structural abnormalities were significantly associated with infection. The clinical course of infection was usually severe: fever (100 percent), sepsis disorder (47 percent), neutrophilia (70 percent of patients without neutropenia), bacteremia (13 percent), and death (7 percent). Still, response to treatment was prompt. The authors conclude that, in the presence of the risk factors outlined, treatment for S. maltophilia should be considered in patients with urinary colonization by the organism or in those with nosocomial UTI caused by an unknown pathogen and who are unresponsive to therapy with the antibiotics that are used to treat the common uropathogens. 1 table. 12 references. (AA-M).
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Urinary Tract Infections: Antimicrobial Resistance (editorial) Source: Current Opinion in Urology. 10(1): 23-24. January 2000. Contact: Available from Lippincott Williams and Wilkins. 241 Borough High Street, London, SE1 1GB, UK. +44 (0) 171940-7500. E-mail:
[email protected]. Summary: The ability of microorganisms to develop resistance to antibiotics has been of concern from the onset of antibiotic use in medicine. However, the success of the pharmaceutical industry in developing new antimicrobial agents has caused clinicians to view this as a problem of little consequence. Nevertheless, urinary tract infections
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(UTIs) caused by antimicrobial resistant organisms result in significantly more morbidity, mortality, and cost than those caused by susceptible bacteria. This article reviews the reasons for emergence of resistance and strategies for minimizing antimicrobial resistance. The author outlines five approaches for minimizing resistance: use a drug that is appropriate for the type and risk associated with the UTI; maintain a favorable therapeutic index; avoid antimicrobial use in trivial infections; avoid long term antimicrobial treatment; and avoid use when therapy is likely to be unsuccessful (for example, in elderly patients with asymptomatic bacteria or in patients with indwelling catheters). The use of these guidelines should prolong the therapeutic value of the current antimicrobials for the treatment of UTIs. 7 references. •
Urinary Tract Infections in the Elderly Source: Current Urology Reports. 2(4): 330-333. August 2001. Contact: Current Science, Inc. 400 Market Street, Suite 700, Philadelphia, PA 19106 (800) 427-1796. Fax (215) 574-2225. E-mail:
[email protected]. Website: http://www.current-reports.com. Summary: The elderly population is now increasing in the world. A higher incidence of bacteriuria (bacteria in the urine) and urinary tract infection (UTI) is observed in elderly patients, in both long-term care (LTC) facilities and at home. The management of elderly patients with UTI is increasing in clinical significance. Almost all UTI in the elderly is complicated, rather than simple, UTI. Control of the underlying diseases in the urinary tract is quite important in the management of UTIs in elderly patients. For patients with pyelonephritis (kidney inflammation), the author recommends switch therapy using aminoglycosides and fluoroquinolones, carbapenems, third-generation cephalosporins, or penicillins as selections of choice. The recommended duration of treatment for patients with pyelonephritis is 14 days. Seven to 10 days of treatment using fluoroquinolones or trimethoprim-sulfamethoxazole is recommended for the treatment of elderly patients with symptomatic cystitis (bladder infection). Although asymptomatic bacteriuria is quite common in the elderly population, antibiotic treatment has no benefit for such patients. Intravaginal estrogen replacement is one of the choices for the prevention of recurrent UTIs in postmenopausal women. 27 references.
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Uropathogenic Escherichia Coli Causing Urinary Tract Infections Source: Indian Journal of Medical Research. 114: 207-211. December 2001. Contact: Available from Medical Economics. 5 Paragon Drive, Montvale, NJ 07645. (800) 432-4570. Fax (201) 573-4956. Summary: The information on the characteristics of Escherichia coli causing urinary tract infections (UTIs) is limited. This article reports on a study that characterized the urovirulence factors of E. coli isolated from symptomatic patients with UTIs in order to determine their pathogenic (disease causing) potential and the antibody sensitivity profile. Semi-quantitative urine culture was done on 370 symptomatic patients suffering from UTIs. Phenotypic characterization of the urovirulence factors of E. coli was undertaken and the antibiotic susceptibility was determined. E. coli was responsible for 45.5 percent of infections. Resistance to amoxicillin, clotrimoxazole nalidixic acid, norfloxacin, and ciprofloxacin among E. coli isolates ranged from 70 to 95 percent. Serotype O101 was found to be the most common serotype (7 of 26). The authors conclude that antibiotic resistance was high among the strains circulating which emphasizes the need for judicious use of antibiotics. Certain virulence factors like
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hemolysin production and presence of fimbriae in the E. coli may be associated with the urovirulence. 1 figure. 17 references. •
Acquired Versus Congenital Renal Scarring After Childhood Urinary Tract Infection (editorial) Source: Journal of Pediatrics. 136(1): 2-4. January 2000. Contact: Available from Mosby, Inc. 11830 Westline Industrial Drive, St. Louis, MO 63146-3318. (800) 453-4351 or (314) 453-4351. Fax (314) 432-1158. Website: www.mosby.com. Summary: The initial radiologic evaluation of young children who have a urinary tract infection (UTI) uncovers a small percent (6 to 15 percent) with acute, nonobstructive renal parenchymal scarring. This cohort is then at risk for long term sequelae including hypertension and renal insufficiency. Identification of factors that put children with UTI at risk for renal scarring, such as urinary tract obstruction, delay in treatment, young age at onset, vesicoureteral reflux (VUR), and recurrent UTIs, is important if approaches to management and evaluation are to change outcome. So contends the author of this editorial, writing in support of a research article (published in the same issue of this journal). The editorial briefly reviews the findings of the research, then concludes that it is becoming clearer that dilated VUR should not be viewed as a primary pathophysiologic process leading to hypoplasia or dysplasia, but rather as a consequence of a genetically controlled, developmental process gone awry. The author explores the embryonic origin of the ureteric epithelium and the collecting system of the kidney. The author then considers the evolving evidence that recurrent UTI, especially recurrent pyelonephritis, is a significant and potentially preventable risk factor for renal scarring. Because of this, the American Academy of Pediatrics Subcommittee on Urinary Tract Infection emphasizes recurrent UTI as a significant risk factor for renal scar formation. The author concludes that, because the primary goal of management of UTI is to preserve renal function by preventing scar formation, some experts now recommend antibiotic prophylaxis for children who have three recurrences within a year. 16 references.
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Widespread Distribution of Urinary Tract Infections Caused by A MultidrugResistant Escherichia Coli Clonal Group Source: New England Journal of Medicine. 345(14): 1007-1013. October 4, 2001. Summary: The management of urinary tract infections (UTIs) is complicated by the increasing prevalence of antibiotic-resistant strains of Escherichia coli. This article reports on a study of the clonal composition of E. coli isolates that were resistant to trimethoprim-sulfamethoxazole from women with community-acquired UTIs. Of the 255 E. coli isolates, 55 (22 percent) from a California university cohort were resistant to trimethoprim-sulfamethoxazole as well as to other antibiotics. There was a common pattern of DNA fingerprinting, suggesting that the isolates belonged to the same clonal group (clonal group A), in 28 of 55 isolates with trimethoprim-sulfamethoxazole resistance (51 percent) and in 2 of randomly selected isolates that were susceptible to trimethoprim-sulfamethoxazole. In addition, 11 of 29 resistant isolates (38 percent) from a Michigan cohort and 7 of 18 (39 percent) from a Minnesota cohort belonged to clonal group A. The authors conclude that in three geographically diverse communities, a single clonal group accounted for nearly half of community-acquired UTIs in women that were caused by E. coli strains with resistance to trimethoprim-sulfamethoxazole.
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The widespread distribution and high prevalence of E. coli clonal group A have major public health implications. 2 figures. 3 tables. 37 references. •
Evaluating the Benefits of Antimicrobial Prophylaxis to Prevent Urinary Tract Infections in Children: A Systematic Review Source: CMAJ. Canadian Medical Association Journal. 163(5): 523-529. September 5, 2000. Contact: Available from Canadian Medical Association (CMA). International Media Services of New York, 100 Walnut Street, Number 3, P.O. Box 1518, Champlain, NY 12919-1518. (800) 428-3003. Summary: The recurrence rate for urinary tract infections (UTIs) in children is estimated at between 30 and 40 percent. The use of low doses of antibiotics as prophylaxis (prevention) for recurrent UTIs is common clinical practice. However, prolonged antimicrobial therapy has the potential to contribute to problems of bacterial resistance and antimicrobial side effects. This article reports on a research review undertaken to systematically examine the available evidence for the effectiveness of this intervention. The authors searched three electronic databases for the period 1966 to 1999, searched bibliographies from conference proceedings, and contacted content experts to ensure completeness of the research database. Most of the studies identified were case series and cohort studies. Only six randomized trials fulfilled the inclusion criteria; all were of low quality. Three trials dealt with children who had anatomically normal urinary tracts, and three included children with neurogenic bladder. The rate of infections for patients with normal urinary tracts ranged from 0 to 4.0 per 10 patient years for the treatment groups and from 4.0 to 16.7 for the control groups. The recurrence rates for patients with neurogenic bladders in two trials were 2.9 and 17.1 per 10 patient years for the treatment groups and 1.5 and 33.0 for the control groups. The authors conclude that the available evidence for using antimicrobial prophylaxis to prevent UTI in children with normal urinary tracts or with neurogenic bladder is of low quality. This suggests that the magnitude of any benefit should at best be questioned. The surprising lack of data for children with reflux (return of the urine from the bladder back into the kidneys) is of concern. The authors call for well designed trials to optimize the use of antimicrobials in children with recurrent UTI. 1 figure. 3 tables. 59 references.
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Association Between Use of Spermicide-Coated Condoms and Escherichia Coli Urinary Tract Infection in Young Women Source: American Journal of Epidemiology. 144(5): 512-520. September 1, 1996. Summary: The use of a diaphragm with spermicide increases the risk of urinary tract infection (UTI) in women. To determine whether spermicide-coated condoms are also associated with an increased risk of UTI, the authors of this article conducted a casecontrol study at a large health maintenance organization in Seattle, Washington. Cases were sexually active young women with acute UTI caused by Escherichia coli, identified from computerized laboratory files from 1990 to 1993. Age-matched controls were randomly selected from the enrollment files of the plan. Of 1,904 eligible women, 604 cases and 629 controls (65 percent) were interviewed. During the previous year, 40 percent of the cases and 31 percent of the controls had been exposed to any type of condom. Exposure to spermicide-coated condoms conferred a higher risk of UTI. In multivariate analyses, intercourse frequency, history of UTI, and frequency of spermicide-coated condom exposure were independent predictors of UTI. Spermicide-
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coated condoms were responsible for 42 percent of the UTIs among women who were exposed to these products. 1 figure. 5 tables. 20 references. (AA-M). •
Development of Renal Scarring in Children With Urinary Tract Infections Source: Current Opinion in Urology. 6(1): 49-52. January 1996. Contact: Available from Rapid Science Publishers. 400 Market Street, Suite 750, Philadelphia, PA 19106. (800) 552-5866 or (215) 574-2210. Fax (215) 574-3533. Summary: This article covers the development of renal scarring in children with urinary tract infections (UTIs). The author notes that the understanding of this scarring has improved considerably with the use of renal cortical scintography, the first reliable means of detecting renal scars. The author also notes that an episode of acute pyelonephritis appears to be the common factor in the pathogenesis of these scars. In a comprehensive review, he presents the role of renal and cortical scintography in screening patients at risk, and in following patients that have developed scars. The author presents a concise, cost-effective method to use scintography in young children; he recommends followup with studies in subsequent years or after repeated infections. 33 references. (AA-M).
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Recurrent Urinary Tract Infections in Otherwise Healthy Adult Women: Rational Strategies for Work-Up and Management Source: Nurse Practitioner. 20(2): 48, 51-52, 54-56. February 1995. Contact: Available from Elsevier Science, Inc. 655 Avenue of the Americas, New York, NY 10010. Summary: This article presents rational strategies for the work-up and management of recurrent urinary tract infections (UTIs) in otherwise healthy adult women. Topics include the natural history of UTIs; the pathogenesis of uncomplicated recurrent UTIs, including host and microbial factors, and behavioral factors; the clinical approach to patients with recurrent UTIs; drug therapy; and nonpharmacologic preventive measures. The author notes that effective management options include daily or postcoital antimicrobial prophylaxis, or patient-initiated treatment. Patients can be reassured of an excellent prognosis. 3 tables. 48 references. (AA-M).
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Uncomplicated Urinary Tract Infection in Women: Diagnostic and Therapeutic Recommendations Source: Postgraduate Medicine. 105(5): 181-183, 187-188. May 1, 1999. Contact: Available from McGraw-Hill, Inc. 1221 Avenue of the Americas, New York, NY 10020. (612) 832-7869. Summary: This article presents the guideline on urinary tract infection (UTI), the first guideline developed by the Institute for Clinical Systems Integration (ICSI). The guideline features an 11 point patient care flowchart, with each of the 11 points discussed briefly in the text. The author notes that when this UTI guideline was created, clinicians were voicing concern about how the development of the guidelines would affect them. Their primary worry was that guidelines would become rigid templates for diagnosis and treatment and would not allow for individualized management. In deference to these concerns, this guideline is flexibile. A key part of the guideline development process was to separate those patients needing further attention from those with an uncomplicated UTI. For patients with an uncomplicated UTI, a 3 day
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course of inexpensive antibiotics, without the need for an expensive provider visit, is now the standard of care. A growing body of evidence supports the practice of presumptive treatment of UTI in women without complicating factors based on symptoms alone. For clinicians more comfortable with laboratory evaluation as an aid to diagnosis of UTI, urinalysis using the clean catch method is recommended. The use of this guideline has saved considerable money and has been welcomed by patients as a more convenient form of management. 1 figure. 1 table. 1 reference. •
Urinary Tract Infection: Current Management Strategies Source: Postgraduate Medicine. 100(5): 229-236, 239. November 1996. Summary: This article provides a practical review of current approaches to the evaluation and treatment of urinary tract infection (UTI). Topics include definitions; pathogenic factors; host defenses; predisposing factors for UTI including aging, diabetes, urinary tract calculi, and obstruction; causative organisms; and management strategies for acute uncomplicated cystitis, recurrent cystitis, and uncomplicated pyelonephritis, complicated UTI, catheter-related infection, UTI in men, and asymptomatic bacteriuria. The author notes that, in some cases, the causative organisms are highly predictable and empirical therapy without pretreatment culture is recommended. Other infections (e.g., pyelonephritis) require at least 10 days of antimicrobial therapy, and if complications are present, hospitalization may be warranted. 2 figures. 2 tables. 25 references. (AA-M).
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Prospective Study of Risk Factors for Symptomatic Urinary Tract Infection in Young Women Source: New England Journal of Medicine. 335(7): 468-474. August 15, 1996. Summary: This article reports on a prospective study of risk factors for symptomatic urinary tract infection (UTI) in young women. The researchers recruited sexually active young women who were starting a new method of contraception at a university health center or a health maintenance organization (HMO) and monitored them for 6 months for symptomatic UTI. Daily diaries and serial interviews were used to collect data on potential risk factors. Among 796 women (total of both cohorts), there were strong doseresponse relations between the risk of infection and both recent use of a diaphragm with spermicide and recent sexual intercourse. The risk of acute infection was also associated with a history of recurrent infection, but not with cervical-cap use, ABO-blood-group nonsecretor phenotype, or delayed postcoital voiding. 1 figure. 4 tables. 30 references. (AA-M).
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Urodynamic Pattern in Infants with Urinary Tract Infection Source: Journal of Urology. 160(2): 522-526. August 1998. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2334. Fax: (301) 824-7290. Website: www.lippincott.com. Summary: This article reports on a study of the urodynamic patterns in infants with urinary tract infection (UTI). Cystometry was combined with voiding cystourethrography (video cystometry) in 90 male and 68 female infants admitted to the hospital with first time UTI. Evaluation was performed 1 to 30 days and 32 to 78 days after diagnosis in 93 and 65 infants, respectively. Bladder instability was found in two thirds of male and female infants. Compared to older children, male infants had high
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voiding detrusor pressure and low bladder capacity (hypercontractility). Female infants also had increased voiding pressure levels, but they were significantly lower than those in male infants. The voiding detrusor pressure was even higher in both sexes when evaluation was delayed after the infection. The authors note that bladder hypercontractility was less pronounced early after infection, suggesting that the infectious agents inhibit detrusor muscle contractility. Whether hypercontractility is a normal urodynamic pattern in infancy or represents bladder dysfunction can only be addressed by urodynamic studies of healthy infants. 3 figures. 4 tables. 20 references. •
Efficacy and Safety of Self-Start Therapy in Women with Recurrent Urinary Tract Infections Source: Journal of Urology. 161(1): 207-211. January 1999. Summary: This article reports on a study that evaluated the efficacy of self-start therapy in women with recurrent urinary tract infections (UTIs). Women with recurrent urinary tract infections received a dip slide urine culture kit and 6 tablets of norfloxacin (400 mg). At each symptomatic UTI episode, the patient performed a culture and initiated therapy. The culture was returned and the patient was resupplied with another kit and norfloxacin. Patients were seen 5 to 9 days and 4 to 6 weeks after therapy to assess treatment outcome. A total of 34 women were enrolled in the study and were evaluable for treatment outcomes. Six women followed for 74 months were asymptomatic, and 9 followed for 103 months had no infections. A total of 28 women followed for 355 months had 84 symptomatic episodes and 25 had 67 UTIs. Patients had symptomatic episodes at a rate of 2.8 per patient year (range 0 to 9) and infections at a rate of 2.3 per patient year (range 0 to 9). The greatest risk of symptoms of infection or infection occurred in the first 3 months and among patients with a higher rate of infection before entering the study. Of the 84 symptomatic episodes, 78 (92 percent) responded clinically. Of 78 cultured episodes 11 (14 percent) were negative. The remaining 67 culture-documented infections were cured microbiologically 5 to 7 days after therapy. No adverse effects occurred. The annual cost unaccompanied by a symptomatic episode was $86, and $259 if symptomatic episodes occurred. The authors conclude that intermittent self-start therapy is effective, safe, and economical in women with recurrent UTIs. 1 figure. 3 tables. 22 references. (AA).
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Routine Diagnostic Imaging for Childhood Urinary Tract Infections: A Systematic Overview Source: Journal of Pediatrics. 128(1): 15-22. January 1996. Summary: This article reports on a study to assess the quality of the evidence on which current recommendations for the routine diagnostic imaging for childhood urinary tract infection (UTI) are based. The authors undertook a systematic overview of the literature; preset criteria were used to categorize study sample and design, and interrater reliability was assessed with a random sample. A total of 434 publications were evaluated, and 63 studies met the criteria for inclusion (100 percent interrater agreement on eligibility and classification). No controlled trials or analytic studies evaluating routine diagnostic imaging were found. All 63 studies were descriptive, and only 10 were prospective. None of the studies provided evidence of the impact of routine imaging on the development of renal scars and clinical outcomes in children with their first UTI. The authors conclude that methodologically sound, prospective studies are needed to assess whether children with their urinary tract infection who have routine diagnostic imaging are better off than children who have imaging for specific
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indications. They stress that current recommendations are not based on firm evidence. 1 figure. 2 tables. 84 references. (AA-M). •
Evaluation of the Diagnostic Workup in Young Women Referred for Recurrent Lower Urinary Tract Infections Source: Urology. 57(6): 1068-1072. June 2001. Contact: Available from Urology. P.O. Box 2126, Marion, OH 43306-8226. (800) 215-4692. Fax (740) 382-5866. Summary: This article reports on a study undertaken to evaluate the current practice of the diagnostic workup in the Netherlands and the clinical relevancy of the outcome of various diagnostic procedures in young women referred for recurrent lower urinary tract infections (UTIs). A questionnaire was sent to all urologic departments in the Netherlands (n = 104) inquiring about the diagnostic procedures used for recurrent lower UTIs. Furthermore, the authors performed a prospective study in 100 consecutive young female patients (18 to 40 years old) referred for evaluation of recurrent lower UTIs. All patients underwent a standardized workup: questionnaire, voiding diary, physical examination, urinalysis and culture, abdominal x ray with ultrasound or intravenous urography, and cystoscopy. The response rate to the questionnaires was 92 percent. The standard procedures were laboratory blood tests in 56 percent, cytoscopy in 69 percent, plain abdominal x ray in 91 percent, and abdominal ultrasound in 59 percent. Only 18 percent of the urologists asked every patient to make a voided urine frequency volume chart. In the authors' group of patients, the radiologic procedures revealed only one relevant abnormality. Cytoscopy confirmed cystitis (bladder infection) in 22 patients, but never revealed relevant findings. None of these diagnostic procedures ever contributed to the diagnosis. The 24 hour urine output was less than 1.5 liters in 43 patients, which was considered insufficient. The individual self reports of fluid intake were unreliable. The authors note that many Dutch urologists perform an extensive routine workup in patients referred for recurrent lower UTIs. The results of this study revealed that the yield of most diagnostic procedures in these patients is low. The focus in evaluating these patients should be directed toward the behavioral aspects. Thus, the routine workup can be restricted to a voiding diary, urinalysis, and urine culture. 1 figure. 1 table. 29 references.
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AAP Practice Parameter on Urinary Tract Infections in Febrile Infants and Young Children Source: American Family Physician. 62(8): 1815-1822. October 15, 2000. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. Summary: This article reports on the practice parameter on the diagnosis, treatment, and evaluation of the initial urinary tract infection (UTI) in febrile (with fever) infants and young children, ages 2 months to 2 years. The practice parameter, developed by the Committee on Quality Improvement of the American Academy of Pediatrics (AAP), consists of 11 recommendations and four areas for future research. Recommendations 1 through 5 address diagnosis and emphasize the need for culturing appropriately collected specimens; diagnosis should not be based on urinalysis or on culture of specimens from urine collection bags. Recommendations 6 through 10 address treatment, identifying trimethoprim sulfamethoxazole as superior to amoxicillin and establishing the duration of treatment as 7 to 14 days. Children should receive antimicrobial coverage until imaging studies have been completed. Recommendation 11
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addresses imaging: all infants should undergo ultrasonography, and a lower urinary tract study is strongly encouraged as well. Future research should quantitatively address the relationship between renal scarring in childhood and renal impairment and hypertension in adults. Less invasive methods of diagnosis and imaging are highly desirable and should be developed. 2 figures. 2 tables. 4 references. •
Urinary Tract Infections: Disease Panorama and Challenges Source: Journal of Infectious Diseases. 183(Supplement 1): S1-S4. March 1, 2001. Contact: Available from Journal of Infectious Diseases. University of Chicago Press, Journals Division, P.O. Box 37005, Chicago, IL 60637. (773) 753-3347. Fax (773) 753-0811. E-mail:
[email protected]. Website: www.journals.uchicago.edu. Summary: This article reprints a presentation that served as an introduction to a conference that reviewed new advances in the understanding of the pathogenesis (development) of urinary tract infections (UTIs) from the perspective of both the pathogen (e.g., bacteria) and the host. This initial presentation provided an appropriate context for subsequent discussion by providing an overview of the etiology and epidemiology of UTI, diagnostic and therapeutic approaches, current management strategies, evolution of antimicrobial resistance, and current approaches to prevention. A bacterial etiology (cause) can usually be demonstrated for most episodes of UTI, and the most common bacterial species seen in various patient groups have now been well defined. UTIs are still usually diagnosed by urine culture results; the authors call for the development of a rapid, accurate, inexpensive test that would allow the practitioner to decide whom to treat at the time of examination. In part due to the managed care environment, many doctors are now advocating that acute uncomplicated UTI in women be managed effectively and safely by utilizing empiric antibiotic therapy without doing a urine culture or even looking for pyuria (white blood cells in the urine). General trends in the treatment of UTIs have been toward the use of shorter regimens (even single dose therapy) and in the case of acute pyelonephritis and complicated UTI, the provision of therapy in the outpatient setting (for most patients). The authors conclude that despite considerable advances in the understanding of the pathogenesis of UTI, researchers have not yet developed new, clinically useful means for preventing UTIs. 20 references.
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Urinary Tract Infections in Children: Epidemiology, Evaluation, and Management Source: Pediatric Clinics of North America. 44(5): 1133-1169. October 1997. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452. Summary: This article reviews advances in the epidemiology, evaluation, and management of urinary tract infections (UTIs) in children. Several genetically coded bacterial virulence factors have been identified that enhance the potential of uropathogenic organisms to cause symptomatic disease, such as the ability of certain strains of bacteria to adhere or attach to human uroepithelium. Experimental studies combined with clinical observations have clearly demonstrated the critical role that infection plays in producing irreversible renal (kidney) scarring, the most severe long term complication of childhood UTIs. This awareness has led to greater emphasis being placed on the nonsurgical management of conditions, such as vesicoureteral reflux (VUR) and nonobstructive hydronephrosis. Meanwhile, the recognition of the important role of voiding and bowel dysfunction in the cause of recurrent UTIs has led to improved management of these children, who were previously subjected to unnecessary
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and usually ineffective cystoscopic procedures and urethral dilations. The imaging modalities involved in the evaluation of children with UTIs have also changed, with replacement of intravenous pyelography (IVP) by sonography, renal cortical scintigraphy, or both. The article reports a case of a 9 month old girl admitted with a febrile UTI; this case vividly illustrates the potential for severe renal parenchymal damage, which can follow a single severe UTI in young children. Treatment of UTIs in children ideally commences with culture specific antimicrobial therapy, although treatment may be started in sick children before culture results are available. Short course treatment (3 to 5 days) is sufficient for children with acute uncomplicated lower UTIs. Children with acute pyelonephritis require 10 to 14 days of antibiotics. Longterm antibiotic prophylaxis is indicated for children with frequent symptomatic recurrences of UTI and for those with known VUR. 11 figures. 1 table. 144 references. •
Urinary Tract Infections in Elderly Women Source: American Family Physician. 53(1): 175-182. January 1995. Summary: This article reviews the current philosophy on urinary tract infections (UTIs) in elderly women. The authors stress that it is important to differentiate between symptomatic and asymptomatic UTIs. Recent evidence suggests that treatment of asymptomatic bacteriuria may not be necessary. Symptomatic bacteriuria may occur with low colony counts cultured from either clean-catch or catheter-obtained specimens. Although few studies have targeted elderly women, longer treatment with a broadspectrum antibiotic is recommended for this group. To minimize recurrence of UTIs, attention should be paid to disposing factors, particularly impaired bladder emptying, genital prolapse, urolithiasis, estrogen depletion, and perineal hygiene. 1 table. 29 references. (AA-M).
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Management of Recurrent Urinary Tract Infection and Vesicoureteral Reflux in Children Source: Current Opinion in Urology. 10(1): 25-28. January 2000. Contact: Available from Lippincott Williams and Wilkins. 241 Borough High Street, London, SE1 1GB, UK. +44 (0) 171940-7500. E-mail:
[email protected]. Summary: This article reviews the management of recurrent urinary tract infection (UTI) and vesicoureteral reflux (VUR, return of urine from the bladder back up the ureters into the kidneys) in children and neonates, a continuing challenge for health care providers. The author critically summarizes the highlights and current innovations in diagnosis and therapy, focusing on the peer reviewed literature of the past year. The main approaches include diagnosis as early as possible, routine screening of siblings, identifying the gene for familial primary VUR, use of radionuclide cystography or ultrasound contrast VCUG (voiding cystourethrogram) without any radiation exposure in diagnosis and followup, and high resolution ultrasound transducers with power Doppler equipment used by operators experienced in detection of renal scarring. The primary goal of treatment of recurrent UTI or VUR in children is preventing renal (kidney) injury, symptomatic pyelonephritis (kidney infection), and other complications of reflux. Medical therapy is based on the principal that reflux often resolves with time, and antibiotics maintain urine sterility and prevent infections while the patient awaits spontaneous resolution. Future developments and research efforts are also briefly discussed. 15 references (9 annotated).
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When to Consider TMP-SMX Resistance in Treating Acute Urinary Tract Infections? (commentary) Source: Consultant. 40(1): 18-20. January 2000. Contact: Available from Cliggott Publishing Company. 55 Holly Hill Lane, Box 4010, Greenwich, CT 06831-0010. Summary: This commentary, in the form of a letter, offers advice on when to consider TMP SMX resistance in treating acute urinary tract infections (UTIs). The authors note that they recently reported on antibiotic resistance among urinary pathogens that caused acute, uncomplicated cystitis. Resistance of Escherichia coli to TMP and TMP SMX (trimethoprim sulfamethoxazole) rose from 9 percent in 1992 to 18 percent in 1996. The authors also briefly report additional clinical data on the outcomes of patients who receive TMP SMX for UTIs. The authors conclude that, collectively, these data suggest that TMP SMX may no longer be the optimal empiric therapy for women with acute, uncomplicated UTIs, at least in areas where the prevalence of resistance is high. Alternative therapies, such as fluoroquinolone that is primarily excreted through the urine, should be considered for the empiric treatment of UTIs. The letter is published with a further commentary in which Dr. S. G. Mulholland suggests that using the alternative drugs for empiric therapy may be unnecessary because there are many communities where the resistance to TMP SMX is not high. 8 references.
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Sex and Urinary Tract Infections (editorial) Source: New England Journal of Medicine. 335(7): 511-512. August 15, 1996. Summary: This editorial serves as an introduction for another article in this issue on the relationship between heterosexual intercourse and urinary tract infections (UTIs) in females. The author of the editorial contemplates the costs involved in treating sexrelated UTIs and considers various preventive measures. He calls for additional studies that address women's health, reproductive health, and sexually transmitted infections. 14 references.
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Urinary Tract Infections: What's New? Source: Journal of Urology. 168(6): 2351-2358. December 2002. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2334. Fax (301) 824-7290. Summary: This review article provides practicing urologists with important basic information about urinary tract infections (UTIs) that can be applied to everyday clinical problems. The author reviews provocative and controversial concepts in the current literature. Bacterial virulence mechanisms are critical for overcoming the normal host defenses. Increasing antimicrobial resistance of uropathogens has led to reconsideration of traditional treatment recommendations in many areas. For effective patient management, the first issue is to define complicating urological factors. Managing complicated UTIs, particularly in urology, is determined by clinical experience to define the pertinent anatomy and to determine the optimal interventions. The author summarizes new clinical data on UTIs in long-term care patients, behavioral risks for UTI in healthy women, and anatomical differences associated with an increased risk for UTI. The rationale is present for UTI prophylaxis using cranberry juice, immunization, and bacterial interference. Current treatment trends for UTI include empiric therapy (without urine culture and sensitivity testing), short-course therapy, patient-
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administered (self start) therapy, and outpatient therapy for uncomplicated pyelonephritis (kidney infection). 4 tables. 92 references. •
Urinary Tract Infection: Treatment Guidelines for Older Women Source: Consultant. 37(8): 2135-2138, 2141-2142. August 1997. Contact: Available from Consultant. Cliggott Publishing Company, 55 Holly Hill Lane, Box 4010, Greenwich, CT 06831-0010. Summary: Urinary tract infection (UTI) in older women differs in many ways from UTI in younger women. This article outlines treatment guidelines for older women with UTI. In older women, bladder dysfunction and atrophic urethritis are more likely to be predisposing features, and the range of infecting bacteria is broader. Empiric therapy with a fluoroquinolone that is excreted into the urine in high concentrations, such as levofloxacin, ofloxacin, or ciprofloxacin, is preferable to trimethoprim-sulfamethoxazole, and a 10 day course of treatment is prescribed for most cases. Estrogen therapy may increase urethral pressure and improve stress urinary incontinence (another risk factor for UTI) in many older women. Estrogen therapy also fosters vaginal colonization with lactobacilli, which lowers vaginal pH, thereby inhibiting the growth of many potential uropathogens. Asymptomatic bacteriuria, which is common in older women, especially those with comorbid chronic illnesses or general debility, does not usually require antibiotic treatment. 2 tables. 51 references. (AA-M).
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Vesicoureteral Reflux and Urinary Tract Infections Source: Current Opinion in Urology. 10(6): 587-592. November 2000. Contact: Available from Lippincott Williams and Wilkins. 241 Borough High Street, London, SE1 1GB, UK. +44 (0) 171940-7500. E-mail:
[email protected]. Summary: Urinary tract infection (UTI) is a common problem in children. The combination of vesicoureteral reflux (VUR, return of urine from the bladder to the kidneys) and urinary tract infection may predispose children to pyelonephritis (kidney infection) and subsequent complications. This review article outlines the modifications suggested in the recent literature in the protocol for investigating and diagnosing VUR. VUR is present in 25 to 40 percent of children with acute pyelonephritis. Cyclic cystography may have a higher yield of diagnosis compared to VCUG (voiding cystourethrogram). Recent interest has been expressed in studying certain molecular markers to measure noninvasively renal (kidney) damage in children with VUR. Long term results of comparative trials between medical and surgical management revealed no difference in the long term outcome of renal status or the development of hypertension. However, those studies demonstrated that children managed medically have an increased incidence and severity of pyelonephritis episodes. 31 references (13 annotated).
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Evaluation and Treatment of Urinary Tract Infections in Children Source: American Family Physician. 57(7): 1573, 1576-1580. April 1, 1998. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. Summary: Urinary tract infection (UTI) is defined as the presence of bacteria in urine along with symptoms of infection. This article for primary care physicians reviews the evaluation and treatment of urinary tract infections in children. The authors note that
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although UTIs do not occur as frequently in children as in adults, they can be a source of significant morbidity in children. Indeed, a minority of UTIs in children progress to renal scarring, hypertension, and renal insufficiency. Clinical presentation of UTI in children may be nonspecific, and the appropriateness of certain diagnostic tests remains controversial. The diagnostic workup should be tailored to uncover functional and structural abnormalities such as dysfunctional voiding, vesicoureteral reflux, and obstructive uropathy. A more aggressive workup, including renal cortical scintigraphy, ultrasound, and voiding cystourethrography, is recommended for patients at greater risk for pyelonephritis and renal scarring, including infants less than 1 year of age and all children who have systemic signs of infection concomitant with a UTI. Antibiotic prophylaxis is used in patients with reflux or recurrent UTI who are at greater risk for subsequent infections and complications. 3 figures. 3 tables. 36 references. (AA). •
Early Catheter Removal Decreases Incidence of Urinary Tract Infections in Renal Transplant Recipients Source: Transplantation Proceedings. 30(8): 4314-4316. December 1998. Contact: Available from Appleton and Lange. P.O. Box 86, Congers, NY 10920-0086. (203) 406-4623. Summary: Urinary tract infection (UTI) is the most frequent form of bacterial infection among renal transplant recipients. This article reports on a retrospective review of 100 consecutive renal transplants. The review was undertaken to determine the effect of early catheter removal on the incidence of urinary tract infections and urologic complications 1 month after renal transplantation. Prophylactic immunosuppression and bladder preparation followed a standard protocol. Urine cultures were obtained intraoperatively. Throughout the first postoperative month, urine cultures and microscopic analyses were obtained on a weekly basis. Urologic complications, including ureteral stricture, bladder leakage, and urinary retention were noted, and treatment and outcome were recorded. In the first postoperative month, 14 percent of patients experienced a UTI at an average of 8.6 days after transplantation. Origin of kidney (donor factor), method of urinary tract reconstruction, length of stay in the hospital, immunosuppressive regimen, and rejection episodes were unrelated to incidence of UTI when predisposing factors for development of UTI were examined. The average time of urethral catheter removal in the patients with UTI (mean 2.6 days) was not significantly different from that of the whole study population (mean 2.4 days). Factors that led to an increased risk of UTI are consistent with those previously reported. The authors report that early removal of urethral catheter significantly decreases the incidence of UTI in the first month postoperatively without increasing the incidence of urologic complications in renal transplant recipients. Urethral catheters may be removed much earlier than is currently practiced at most transplant centers, and this will result in the reduction of UTIs in renal transplant recipients without an increase in urologic complications. 2 tables. 16 references.
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Urinary Tract Infections: Treatment and Prevention Source: Diabetes Self-Management. 19(4): 4545-46, 49. July-August 2002. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Website: www.diabetes-self-mgmt.com. Summary: Urinary tract infections (UTIs) are a serious health problem affecting millions of people each year. They are of particular interest to people with diabetes because both the incidence of UTIs and the incidence of serious UTI complications appears to be
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higher among people who have diabetes. This article reviews the treatment and prevention of UTIs in people with diabetes. Topics include the common bacteria that colonize the urinary tract, risk factors (including the higher risks for females), how diabetes adds to these risk factors, diagnostic tests, treatment options (primarily antibiotics), and preventive strategies, including the avoidance of chronic UTIs. 1 figure. •
Identification and Management of Urinary Tract Infection in the Preschool Child Source: Journal of Pediatric Health Care. 13(6, part 1): 268-272. November-December 1999. Contact: Available from Mosby. 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 6542452 or (407) 345-4000. Fax (407) 363-9661. Summary: Urinary tract infections (UTIs) commonly occur in preschool children and can be associated with significant morbidity if they are not identified quickly and treated appropriately. This article, written for pediatric nurses, reviews the diagnosis and management of UTI in the preschool child. Young children often have vague symptoms such as weight loss and failure to thrive, contributing to what many believe is a low rate of diagnosis for this infection. The authors note that vesicoureteral reflux (return of the urine through the ureters to the kidney) or VUR, is found in a larger proportion of these patients, compared to older children with UTI. Recognizing and treating risk factors such as dysfunctional voiding may help in the resolution of VUR and reduce the recurrence of UTIs. Dysfunctional voiding symptoms include daytime or nighttime wetting, UTI with or without fever, decreased or increased urinary frequency, constipation, squatting or hold maneuvers to stay dry, straining to empty, and urinary urgency. The authors discuss the conditions associated with increased risk of UTI (and the interventions for each condition), the physical examination of the child, specimen collection, the use of antibiotics, prophylaxis, and imaging. 3 figures. 2 tables. 13 references.
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Methods for the Reduction of Urinary Tract Infection Source: Current Opinion in Urology. 7(1): 47-51. January 1997. Contact: Available from Rapid Science Publishers. 400 Market Street, Suite 750, Philadelphia, PA 19106. (800) 552-5866 or (215) 574-2210. Fax (215) 574-3533. Summary: Urinary tract infections (UTIs) continue to be a major cause of morbidity and mortality. This article describes methods for the reduction of UTI, particularly in several patient groups known to be at risk for developing UTI. Recent clinical trials have evaluated measures for use in children, pregnant women, women with a history of recurrent UTI, catheterized patients, the elderly, and patients who are undergoing genitourinary tract surgery. Antimicrobial agents play a significant role in reducing infection; however, the authors stress that nonantibiotic-based strategies may also be effective and are currently under evaluation. The authors discuss behavior modification, immune therapy, and biotherapeutic agents with respect to their roles in the reduction of UTI. Other topics include prophylaxis in children, in premenopausal women, and in the elderly; prophylaxis and the indwelling urinary catheter; prophylaxis and urinary tract calculi; and prophylaxis and genitourinary surgery. They conclude that strategies for preventing infection must be customized for each patient, taking into account the patient's underlying predisposing factors and the nature of any planned intervention. Antimicrobial prophylaxis is most appropriate for selected individuals who are undergoing genitourinary procedures. Careful attention should be paid to reducing unnecessary and prolonged urinary tract catheterization. Behavioral and immunologic
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modulation may contribute significantly to UTI reduction in a selected group of individuals. 29 references (11 annotated). (AA-M). •
Dynamic Interactions Between Host and Pathogen During Acute Urinary Tract Infections Source: Urology. 57(6A Supplement): 56-61. June 2001. Contact: Available from Urology. P.O. Box 2126, Marion, OH 43306-8226. (800) 215-4692. Fax (740) 382-5866. Summary: Urinary tract infections (UTIs) have traditionally been viewed as acute and often self-limiting infections caused predominantly by noninvasive Escherichia coli. However, this concept has been challenged by recent findings demonstrating that an acute bladder infection results from a complex series of host-pathogen interactions that can lead to bacterial invasion and persistence and that ultimately can determine the course of the infectious disease. This article reviews the dynamic interactions between host and pathogen during acute UTIs. The ability of E. coli to gain a foothold in the bladder is greatly facilitated by type 1 pilus-mediated attachment to and invasion of bladder epithelial cells. Invasion allows uropathogenic strains of E. coli to exploit the intracellular environment by replicating within these epithelial cells while evading a multitude of host defenses. An intracellular location also provides them a safe haven from many common antibiotic therapies. However, attachment and invasion also activates a cascade of innate host defenses, leading to the death and exfoliation of bladder cells and the production of inflammatory mediators. The ability of uropathogenic E. coli to flux out of cells and colonize surrounding cells provides them a mechanism to subvert these defense mechanisms and persist in the bladder epithelium for weeks following the acute infection. The authors conclude that the persistence of E. coli in bladder tissue may be relevant to more chronic diseases of the urinary tract such as recurrent UTIs and interstitial cystitis (IC). 1 figure. 29 references.
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Pediatric Urinary Tract Infection and Reflux Source: American Family Physician. 59(6): 1472-1478. March 15, 1999. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. Summary: Urinary tract infections in children are sometimes associated with vesicoureteral reflux, which can lead to renal scarring if it remains unrecognized. This article reviews pediatric urinary tract infection (UTI) and reflux. Since the risk of renal scarring is greatest in infants, any child who presents with a urinary tract infection prior to toilet training should be evaluated for the presence of reflux. Children who may not have been tracked and those who have recurrent UTIs should also be evaluated. The preferred method for evaluation of urinary reflux is a voiding cystourethrogram. Documented reflux is initially treated with prophylactic (preventive) antibiotics. Patients who have breakthrough infections on prophylaxis, develop new renal scarring, have high grade reflux, or cannot comply with long term antibiotic prophylaxis should be considered for surgical correction. The preferred method of surgery is ureteral reimplantation. A newer method involves injection of the bladder trigone with collagen. 3 figures. 28 references. (AA).
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Federally Funded Research on Urinary Tract Infections The U.S. Government supports a variety of research studies relating to urinary tract infections. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to urinary tract infections. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore urinary tract infections. The following is typical of the type of information found when searching the CRISP database for urinary tract infections: •
Project Title: ALTERNATIVE THERAPIES FOR BENIGN PROSTATIC SYMPTOMS Principal Investigator & Institution: Naslund, Michael J.; Surgery; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-MAR-2009 Summary: (provided by applicant): The purpose of this request is to establish a cooperative group of approximately 10 prostate evaluation and treatment centers nationwide which will develop and conduct a prospective, randomized, double-blind, placebo controlled clinical trial to determine whether Saw Palmetto(SP) and/or Pygeum Africanum(AP) can prevent the clinical progression of benign prostatic hyperplasia (BPH). BPH is a common disease in men over 50 which can lead to bothersome voiding symptoms, urinary retention, permanent bladder damage, renal failure, urinary tract infections, urosepsis or urinary incontinence. Treatment options with documented efficacy include medication, several thermotherapy options, and surgical prostatectomy. Phytotherapy is another treatment option for BPH which is used widely in Europe and is experiencing increasing utilization in the United States. Two common phytotherapeutic agents SP and PA. Despite the widespread use of these substances, there is no convincing data in the literature which demonstrates efficacy for the treatment of BPH. These phytotherapeutic substances do appear to be safe from the patients' perspective. The objective of this trial is to determine if SP and/or PA can prevent the clinical progression of BPH, as defined by the development of: acute urinary retention, renal insufficiency due to BPH, recurrent urinary tract infections, urinary incontinence, or an increase in the international prostate symptom score (IPSS) of 4 or more points over a four year trial. Parameters to be assessed in the subjects enrolled in this trial include IPSS, peak urinary flow rate, post void residual volumes, quality of life and sexual health questionnaires, prostate size determined by prostatic ultrasound, blood count and blood chemistries, urinalysis, serum hormone levels, a history and physical examination. Patients will be assessed every 3 months over a four year trial period. The chosen group of collaborators will meet to design the protocol including
2 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
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diagnostic criteria, inclusion/exclusion criteria, safety measurements and quality of life outcome measurements. The trial will commence after the protocol has been developed, an operations manual has been completed and data collection techniques have been established. Each site will obtain IRB approval of the final protocol. When the study is complete and the data has been analyzed, publication of relevent results will be done. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ANIMAL TESTING OF A BLOCKING ANTIBODY OF PCRV Principal Investigator & Institution: Sawa, Teiji; Intermune Pharmaceuticals, Inc. 1710 Gilbreth Rd, #301 Burlingame, Ca 94010 Timing: Fiscal Year 2002; Project Start 01-JAN-2002; Project End 30-JUN-2003 Summary: (provided by applicant): This grant will determine the efficacy of a humanized monoclonal antibody in treating a lethal Pseudomonas-induced lung injury. We have shown that the airspace instillation of a strain of Pseudomonas aeruginosa that contains the type Il system predictably causes lung necrosis, sepsis and death (J Clin Invest 1999). We have also shown that the systemic administration of polyclonal antibody raised against recombinant PcrV, a type III bacterial protein involved in translocating the bacterial toxins into eukaryotic cells, prevented lung injury and death in mice pretreated with the antibody (Nature Med 1999). More recently, we have identified a mouse antiPcrV monoclonal antibody that when administered prior to the bacterial instillation, prevented mortality in mice airspace-infected with the virulent Pseudomonas. The proposed experiments will determine whether the systemic or lung administration of a humanized monoclonal antibody after the airspace instillation of the virulent Pseudomonas improves hemodynamics, gas exchange and/or improves the septicemia in airspace-infected, anesthetized rabbits. These results will be critical for deciding how to plan a clinical trial; the results will determine whether the antibody should be utilized as a therapy or as a prophylactic treatment. PROPOSED COMMERCIAL APPLICATIONS: Pseudomonas aeruginosa is a major cause of hospital infection, accounting for 20% of nosoconual pneumonias, 10-15% of nosocomial urinary tract infections, and 10% of sepsis. In addition, P. aeruginosa infection is the major cause of mortality in cystic fibrosis. Current treatment is associated with a high rate of antibiotic resistance and a 25-50% failure rate. The proposed treatment provides a novel approach to the prevention of P. aeruginosa infection in patients at high risk for this infection, including patients on ventilators, burn patients, patients with in-dwelling catheters, neutropenic patients, an patients with cystic fibrosis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: ANTIBIOTIC USE AND BACTERIURIA IN THE RURAL NURSING HOME Principal Investigator & Institution: Rubin, Michael A.; Internal Medicine; University of Utah Salt Lake City, Ut 84102 Timing: Fiscal Year 2003; Project Start 15-SEP-2003; Project End 31-AUG-2008 Summary: (provided by the applicant): The goal of this proposal is to improve the care and safety of residents of nursing homes (NHs) in rural areas of Utah by addressing the growing problem of antibiotic resistance and inappropriate antibiotic use in this setting. Antibiotics are heavily used in nursing homes, and the selection pressure exerted by this level of antibiotic use, particularly in a contained environment, is enormous. Not surprisingly, antibiotic resistance in NHs and the risk of infection with an antibioticresistant organism are rising. This is of particular concern in a clinical setting where
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elderly residents already have a significantly increased risk of infection. The focus of this work will be antibiotic resistance among gram-negative urinary isolates and the management of catheter-associated bacteriuria and urinary tract infections (UTI) in the rural NH setting. It is hypothesized that the problems of antibiotic resistance and inappropriate antibiotic use are considerable in rural NHs, where little is known about management practices and surveillance is rarely, if at all, performed. These hypotheses will be investigated by two approaches. The first will employ a personal digital assistant (PDA)-based surveillance tool at NHs throughout rural Utah to track antimicrobial resistance among gram-negative urinary isolates, particularly those from long-term catheterized patients. The second will use a similar PDA-based tool to prospectively assess management of bacteriuria and UTI in long-term catheterized patients from rural Utah NHs. These studies will lay the groundwork for a third project, where the candidate will implement an intervention using a PDA-based decision-support tool to improve the management of catheter-associated asymptomatic bacteriuria and symptomatic urinary tract infection for residents of rural SNFs, emphasizing its impact on patient care, patient safety, and overall costs. This project is an ideal blend of observational and interventional epidemiology with the tools and techniques of medical informatics, applying them to the enormous clinical problem of antibiotic use and resistance in the NH setting. The NIH-funded K30 program at the University of Utah, along with the outstanding mentorship and research group assembled, will provide a superb educational and research environment for the mastering of these techniques as well as for maximizing the potential of this project and this candidate. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: BACTERIAL INTERACTIONS WITH THE BLADDER MUCOSA Principal Investigator & Institution: Mulvey, Matthew A.; Pathology; University of Utah Salt Lake City, Ut 84102 Timing: Fiscal Year 2001; Project Start 01-APR-2001; Project End 31-MAR-2003 Summary: (adapted from application abstract): This is a study of host- pathogen interactions at the molecular level, specifically the structural functional relationship of bacterial attachment to host epithelial cells. Urinary tract infections (UTIs) affect a large proportion of the world population and account for significant morbidity and high medical costs. Escherichia coli is the etiologic agent in the majority of all UTIs, including cyctitis. Other members of the Enterobacteriaceae family, including Klebsiella species and Proteus mitabilis, and Gram-positive organisms, including Staphylococcus saprophyticus and opportunistic enterococci species, are also associated with UTIs. To act as pathogens, these various bacteria must first adhere to host mucosal surfaces within the urinary tract. Without the ability to specifically adhere to host tissues, these pathogens would be readily expelled from the host and disease would not occur. Bacterial attachment can initiate a cascade of molecular crosstalk between bacterial and host cells that can directly influence the course of an infection. Virtually all uropathogenic strains of E. coli and most members of the Enterobacteriaceae family encode filamentous surface adhesive organelles called type 1 pili. These structures can mediate bacterial attachment to bladder epithelial cells by interacting with host receptor complexes comprised of integral membrane proteins known as uroplakins. The candidate proposes to use type 1-piliated uropathogenic E. coli as a model to study the structural basis of bacterial attachment and the functional consequences of the attachment event. The specifics of the interactions between type 1 pili and uroplakin receptor complexes will be examined. In addition, the bacterial and host factors that come into play as a consequence of bacterial adherence and influence the pathogenesis
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of UTIs will be analyzed at both the cellular and molecular level. This work will lead to enhanced understanding of pathogenic processes both within the urinary tract and at other sites of microbial entry and will facilitate the development of novel antimicrobial therapeutics and vaccines. The specific aims are to: 1.Characterize interactions between type 1 pili and the uroplakin receptor complexes that coat the lumenal surface of the bladder. Mutational analysis of recombinant uroplakin protein complexes and of type 1 pili along with biochemical, microscopic, and crystallographic techniques will provide detailed insight into the host-pathogen interactions involved in the establishment of UTIs by uropathogenic E. coli. 2.Investigate virulence factors and mechanisms that enable uropathogenic E. coli to invade, disseminate, and persist within the bladder following the initial attachment event mediated by type 1 pili. The possibility that recurrent UTIs may, in some cases, be a manifestation of a lingering chronic infection will be tested. 3.Elucidate host responses to uropathogenic E. coli, including the identification and characterization of innate and adaptive host defenses that function to limit and clear invading bacteria from the urinary tract. Cell culture systems and a murine cystitis model will be used to delineate vital constituents of an effective host response to infection by type 1-piliated E. coli. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: BACTERIAL VAGINOSIS-VAGINAL BIOFILM ANALYSIS Principal Investigator & Institution: Hedges, Spencer R.; Medicine; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2004; Project Start 05-DEC-2003; Project End 30-NOV-2005 Summary: (provided by applicant): Bacterial vaginosis (BV) is the most prevalent cause of symptomatic vaginal discharge in the U.S. and has been associated with numerous complications including pre term delivery of infants, pelvic inflammatory disease (PID), urinary tract infections (UTI) and acquisition/transmission of sexually transmitted diseases (STDs) including human immunodeficiency virus (HIV). Control of BV has been advocated as a means of decreasing the prevalence of these complications yet the etiology of BV remains unknown and the current treatment regimens are inadequate in terms of initial cure and recurrence rates. Until further insight is gained into the infectious etiology of BV, efforts to improve therapy and to prevent complications will be difficult. Although the bacteriology of BV has been well described using standard microbiological culture methods, it has been estimated that only <1% of microorganisms are culturable using standard techniques. Denaturing gradient gel electrophoresis (DGGE) combined with PCR is a powerful molecular technique that has been used to successfully detect microbial diversity in the gastrointestinal tract and the oral cavity. We propose to use DGGE to determine differences in the microbial biofilm of women with and without BV as well as comparing women with symptomatic and asymptomatic BV to understand more about the pathogenesis of BV. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: CARE PLANNING INTEGRITY & NURSING HOME RESIDENT OUTCOMES Principal Investigator & Institution: Taunton, Roma Lee.; Professor; None; University of Kansas Medical Center Msn 1039 Kansas City, Ks 66160 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-APR-2005 Summary: (provided by applicant) Care planning is the foundation of the nursing process. Compared to the 1.4 million persons served by nursing facilities in 1995, today's
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average nursing facility resident is older and frailer, more acutely ill, and more impaired. Comprehensive, individualized care plans are essential in meeting their needs. In 1999 21 percent of nursing facilities nationally were cited for general quality of care deficiencies, 13.4 percent for poor resident assessment, and 16.1 percent for failure to provide a comprehensive care plan. Regulations resulting from OBRA 1987 defined a Minimum Data Set (MDS) and specific tools to standardize care planning in nursing facilities. Nonetheless, our preliminary studies indicate that the integrity of the care planning process varies across facilities in regard to several elements likely to impact its quality and efficiency. We propose to (1) examine facility care planning processes for differences in centralization, interdisciplinary team, leadership, integration, and rehabilitation perspective; (2) identify the associations between the characteristics of the care planning process and resident outcomes (weight loss, falls with injury, pressure ulcers, urinary tract infections, and behavior that affects others); (3) estimate the costs and assess the efficiency of care planning; and for, a subsample of facilities, (4) analyze the associations between the elements of care planning integrity and resident, family, and staff satisfaction. The sample will be 100 randomly selected Kansas and Missouri nursing homes. Primary data about care planning will be collected via telephone interview with key staff from each facility. Other variables will be obtained form KS and MO administrative databases-MDS, OSCAR, and Medicaid Cost Report. Twelve facilities will be selected for onsite collection of resident, family and staff satisfaction data. Data will be analyzed using multi-level structural equation modeling procedures, data envelopment analysis, stochastic frontier estimation, and mixed model variance component analysis. The findings regarding the elements of care planning integrity that result in the most positive outcomes for residents at the lowest cost to the facility will drive the development of new strategies to improve care. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CHARACTERIZATION OF THE REGULATORY PROTEIN, URER Principal Investigator & Institution: Dattelbaum, Jonathan D.; Microbiology and Immunology; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2002; Project Start 01-MAR-2002 Summary: (provided by the applicant): Urinary tract infections (UTIs) are one of the most frequently diagnosed kidney and urological disorders. While Proteus mirabilis is responsible for only a few percent of all UTIs, individuals with anatomical abnormalities or long-term indwelling medical devices are highly susceptible to P. mirabilis bladder and kidney infections. A hallmark of P. mirabilis UTI is the formation of bladder and kidney stones due to the urea-induced activity of urease. Ammonia formed by the urease-catalyzed breakdown of urea increases local pH resulting in crystallization of magnesium and calcium metal salts. Urease statement is regulated by UreR, a member of the AraC family of transcriptional regulators. UreR DNA-binding properties and transcriptional activity have been partially characterized. We hypothesize that urea binds directly to UreR resulting in a conformational change in the protein which alters its interaction DNA. Purified recombinant UreR will be used to study the effect of urea and DNA on UreR dimerization. Equilibrium dialysis will be used to measure the urea binding constant for UreR. In the absence of urea, we hypothesize that UreR stimulates DNA looping which shuts off transcription of urease. The ability of UreR to induce bends in DNA will be evaluated using circular permutation analysis. Further work will be performed using DNA minicircles containing UreR binding sites. We will determine if an inverted UreR dimer is formed in the presence and absence of urea. This research
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will be used to develop a model for the UreR-mediated transcription regulation of the urease operon. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: DEVICE USE IN NURSING HOMES: REDUCING RISK OF INFECTION Principal Investigator & Institution: Mody, Lona; Internal Medicine; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2008 Summary: (provided by applicant): Dr. Mody's primary research interest is epidemiology of nosocomial infections in long-term care and developing effective infection control strategies targeted at reducing these infections with a goal to reduce antimicrobial usage, antimicrobial resistance, and adverse events related to antibiotics. Nosocomial infections and adverse drug events particularly related to antibiotics are common preventable medical problems in nursing homes. Dr. Mody's goal is to develop infection control strategies that are targeted and practical while recognizing staffing, budget and care concerns of older adults in nursing homes. Indwelling devices, especially urinary catheters and feeding tubes, are commonly used and appear to play a key role in the development of urinary tract infections and aspiration pneumonias. Dr. Mody's immediate research goals during the Career Development Program are: 1. To assess the epidemiology of colonization with antibiotic-resistant pathogens associated with commonly used devices (urinary catheters, feeding tubes & intravenous lines) in nursing homes in Southeast Michigan. 2. Quantify infection risk and antimicrobial usage attributed to devices. 3. To assess knowledge, attitudes, opinions, and practices of nursing personnel to existing infection control guidelines to prevent device-related infections 4. Assess the efficacy of a targeted infection control program in reducing infections related to devices incorporating educational needs of healthcare workers in nursing homes. This Career Development Award will serve 3 goals: First, this grant will allow Dr. Mody to build on her previous projects conducted during residency and fellowship focusing on the epidemiology and prevention of infection in older adults. Second, it will provide her with an opportunity to take formal coursework in epidemiology and health services research, which will be instrumental to advancing her research career. Third, it will give me a chance to collaborate with a group of community nursing homes in Southeast Michigan. The primary goal of this collaboration will be to design and conduct further outcomes based research projects focusing on nosocomial infections as adverse events and leading to meaningful strategies to improve quality of care of older adults in institutional setting. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: DIABETES: LOWER URINARY TRACT DYSFUNCTION AND INFECTIONS Principal Investigator & Institution: Brown, Jeanette S.; Professor and Director; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2007 Summary: Diabetes, lower urinary tract dysfunction (LUTD) and urinary tract infections (UTI) are common health problems in older women. Although it has been suggested that LUTD and UTI are more common in women with diabetes, little is known of prevalence, incidence, risk factors and pathogenesis of these health problems in women with diabetes. In particular, there has been limited research on specific
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aspects of diabetes severity (duration, treatment, glycemic control, presence of complications) that may contribute to the development or severity of lower urinary tract dysfunction and infection. We are completing the Reproductive Risk factors for urinary Incontinence Study at Kaiser (RRISK), a 2100 community- dwelling cohort of ethnically racially diverse women ages 40 to 69 on which we have extensive assessment of urinary incontinence and potential risk factors. Project #1 of our SCOR wilt follow the women for 5 years. We propose to compare 400 women with type 2 diabetes to a group of 400 women without diabetes from the RRISK cohort. To attain a sample of 400 women with type 2 diabetes, we will sample additional women from the Kaiser population using the same methods. Both groups will be followed for 5 years to determine the incidence and increases in severity LUTD and UI. We will also determine risk factors, especially measures of diabetes severity associated with increase risk. We will compare the accuracy ofnon-invasive diagnostic measures to an extensive objective exam including postvoid residual volume, uroflow and urodynamics for LUTD. We will also determine the role of biological factors that may increase risk for UTI including secretor status, secretion of IL-6 in urine and adherence of uropathogens to vaginal epithelial cells. The proposed study offers a unique and efficient opportunity to understand the natural history and possible mechanisms for LUTD and UTI in women with type 2 diabetes. Our overarching goal is to facilitate a better understanding risk factors for and pathogenesis for LUTD and UTI with the aim of guiding the development of preventive interventions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: DNA METHYLATION AND PILI GENE REGULATION Principal Investigator & Institution: Low, David Alan.; Associate Professor; Molecular, Cellular & Dev Biol; University of California Santa Barbara 3227 Cheadle Hall Santa Barbara, Ca 93106 Timing: Fiscal Year 2003; Project Start 01-APR-1987; Project End 31-OCT-2006 Summary: (provided by applicant): The goal of this proposal is to understand the mechanisms by which DNA adenine methylase (DAM), leucine-responsive regulatory protein (Lrp), and PapI orchestrate the reversible switch between OFF and ON Pap pili expression states in uropathogenic Escherichia coli (UPEC). Since Pap pili are an essential virulence determinant of UPEC, this work has direct application to addressing the problem of urinary tract infections. This work will serve as a paradigm to understand how DNA methylation patterns control heritable gene expression states. The core switch involves PapI-dependent translocation of Lrp between pap promoter proximal sites 1,2,3 and distal sites 4,5,6. The methylation states of two GATC sites within the central pap sites 2 and 5 (GATCprox and GATCdist, respectively) control binding of Lrp and Lrp-PapI. Binding of Lrp to promoter proximal sites represses pap transcription whereas binding of Lrp to distal sites is essential for activation of pap transcription. The first aim is to determine how PapI and DAM control binding of Lrp to sites 1,2,3 and 4,5,6. The hypothesis that PapI enhances binding of Lrp to sites 2 and 5 by interacting with pap DNA sequences and Lrp in a ternary complex will be tested. The base-pair contacts between Lrp-PapI and sites 2 and 5 will be identified by missing contact, SELEX, and methylation analyses. Regulatory mutant pap DNA's which bind Lrp normally but are no longer PapI-responsive will be used to test the hypothesis that methylation of GATCprox facilitates OFF to ON switching by specifically blocking PapI enhancement of Lrp binding at sites 1,2,3. The second aim is to identify amino acids of Lrp that play important roles in responsiveness to PapI and DNA methylation, which will be accomplished by isolation of lrp mutants with altered responses to these factors
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and by a genetic suppressor approach using pap mutants isolated in Aim 1. Photocrosslinking studies are proposed to directly identify amino acids within Lrp that interact with sites 2 and 5, and to determine how these interactions are altered by GATC site methylation. Amino acids at the protein-protein binding interface of PapI and Lrp will be identified using yeast one-hybrid and beta-lactamase complementation analyses. The third aim is to analyze real-time in vivo dynamics of phase variation, which will include a test of the hypothesis that DNA replication is required for Pap phase switching. This will be carried out by monitoring Pap pili gene expression by fluorescence activated cell sorting in synchronized cells following induction of Pap I. Further analysis of the methylation states of the pap GATC sites in wild-type and regulator mutant pap operons following passage of the replication fork will be done to link in vitro studies with in vivo switch dynamics. These studies will also provide a detailed framework for understanding epigenetic regulatory mechanisms in other prokaryotes and eukaryotes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: EFFECT OF NAVAJO INTERPRETERS ON DIABETES OUTCOMES Principal Investigator & Institution: Mccabe, Melvina; Associate Professor; Family and Community Medicine; University of New Mexico Albuquerque Controller's Office Albuquerque, Nm 87131 Timing: Fiscal Year 2001; Project Start 30-SEP-2000; Project End 29-SEP-2005 Summary: The state of New Mexico contains a significant portion of the Navajo Nation which is the second largest American Indian (AI) tribe with 2.5 times the rate of diabetes compared to the US general population. The age-adjusted diabetes death rate for AI's is 41.1/100,000 compared to 12.4/100,000 for the US All Races. The proposal will evaluate the effect that formally trained diabetes medical interpreters have on diabetes outcomes and health care utilization patterns compared to usual care interpreters (no formal medical interpreter or diabetes knowledge training). The project is a pre-test/post-test randomized group design. The specific aims of the proposal are: 1. to avoid development of pathology (retinopathy, creatinine, proteinuria, foot pathology) or improve intermediate clinical outcomes (A1C, blood pressure (B/P), low density lipoprotein (LDL), weight). 2. to evaluate participant adherence to selected examinations and laboratory tests for diabetes care (Opthalmology referrals, urine protein, lipid profile, Podiatry referral, immunizations, and diabetes educator referrals). 3. to evaluate the change in diabetes knowledge. 4. to evaluate the change in self-care practices (selfblood glucose monitoring (SBGM), medication adherence, daily activities and physical fitness). 5. to evaluate participant health care utilization patterns (hospitalizations for hypoglycemia, hyperosmotic non-ketotic states including coma, diabetic ketoacidosis, pneumonia, infections of the feet, skin, pyelonephritis; emergency/urgent care visits for medication refills, foot problems, hypoglycemia, urinary tract infections, pyelonephritis). The two research sites are the Indian Health Service (IHS) diabetes clinics located at the Gallup Indian Medical Center (GIMC) in Gallup, New Mexico, and the Northern Navajo Medical Center (NNMC) in Shiprock, New Mexico. Long term objectives of the study are the development and implementation of a Navajo culturebased medical interpreters training program and the expansion of the culture-based medical interpreters training program to other American Indian peoples. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: EPIDEMIOLOGY OF AN UROPATHOGENIC E COLI CLONAL GROUP Principal Investigator & Institution: Riley, Lee W.; Professor of Infectious Diseases and Epi; Public Hlth Bio & Epidemiology; University of California Berkeley Berkeley, Ca 94720 Timing: Fiscal Year 2002; Project Start 20-SEP-2002; Project End 19-SEP-2004 Summary: (provided by applicant): This is a pilot project that aims to characterize the epidemiology of a recently identified clonal group of uropathogenic Escherichia coli designated as CgA. CgA refers to a set of multidrug-resistant E. coli strains that have identical ERIC PCR patterns and identical or similar pulsed field gel electrophoresis (PFGE) patterns, that belong to serotypes O11:nt and O77:nt, and that share identical or similar virulence factor profiles. In a multicenter study, we discovered that CgA accounted for a substantial proportion of community-acquired drug-resistant urinary tract infections (UTI) in 3 distinct university communities in the United States. The widespread dissemination of CgA raised the possibility that this clonal group of E. coli may be spread by contaminated ingestible vehicles. We hypothesize that the increase in prevalence of drug-resistant UTI in a community is affected not only by the frequency in the use of antimicrobial agents, but also by the introduction into such communities of clonal groups of drug-resistant uropathogenic E. coli by contaminated vehicles. In this application, we wish to: (1) identify the geographic distribution of CgA and the clinical spectrum of infections caused by this organism, including complications of UTI; and (2) reservoir and risk factors for infection with CgA. The geographic distribution of CgA will be studied by the analyses of E. coli archives obtained by the PI from northern California, Brazil, and New York, and by the collaborator (Dr. James Johnson) from Minnesota, Iowa, Washington, and a WHO Reference Laboratory. The incidence and prevalence of complications of UTI (pyelonephritis and bacteremia) caused by CgA will be determined by the analyses of E. coli isolates obtained from patients in a San Francisco hospital in collaboration with Dr. Francoise Perdreau-Remington. The possible animal reservoir for CgA will be examined by the analysis of all available O11:nt and O77:nt E. coli isolates from animals in collaboration with Dr. Chobi DebRoy. Through this pilot study, we wish to provide preliminary evidence in support of the hypothesis that drug-resistant uropathogenic E. coli can be spread by contaminated ingestible vehicles, and use the data generated from this project to design long-term studies to better characterize risk factors associated with CgA infection. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: FECAL-INCONTINENCE MONITOR Principal Investigator & Institution: Putnam, David L.; Pacific Technologies 21806 Ne 1St Redmond, Wa 98053 Timing: Fiscal Year 2003; Project Start 01-AUG-2000; Project End 30-JUN-2005 Summary: (provided by applicant): The goal of this project is to develop a sensor system for fecal-incontinent patients to alert the individual, or send a signal to their health-care attendants, of a bowel movement and that attention is required. The objective is to ultimately produce a small portable battery operated optical| sensing system that can be worn by the incontinent patient. The system will employ a disposable sensor placed in an individual's undergarment, which will act, like a "sniffer" and respond to odor associated with defecation. Specific aims and the research of Phase II encompass the following: Wearable fecal monitoring systems with electronic reporting/data logging capability will be designed and fabricated. These will be initially used to actively sense
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within briefs worn by incontinent patients, obtaining tracking data yielding information about background signal level that are typically encountered day-to-day within an elderly population in a convalescent care facility. This continuous monitoring data will be used to refine sensor signal discrimination schemes designed to define the system's "alarm triggers" indicating a fecal event. After programming sensors for discrimination, clinical trials with incontinent patients will sere to establish the sensitivity and selectivity of the fecal monitoring system. Additional patient trials will demonstrate medical and psychological benefits of fecal monitoring to incontinent patients through long-term clinical crossover study. Reduction of the duration of patient exposure to fecal matter is the critical health-care benefit this monitor provides. By reducing exposure time, there should be direct medical benefits of reduced frequency, severity, and associated cost of treating fecec-skin contact related skin infections, sores, and urinary tract infections. In addition to improving the quality of life and dignity of the incontinent, monitoring is expected to help prolong independent living, with significant reduction in health-care dollars spent, because incontinence is a major factor contributing to the decision to enter an assisted care facility. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: INFECTION
FUNCTIONAL
GENOMIC
STUDIES
OF
URINARY TRACT
Principal Investigator & Institution: Gordon, Jeffrey I.; Professor and Head; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2007 Summary: We have used functional genomics (i.e., DNA microarrays with follow-up real time quantitative RT-PCR and in situ hybridization analyses) to examine the bladder responses of adult C57B1/6 female mice during the first steps of infection with virulent (FimH+) and isogenic avimlent (FimH-) UPEC strains. Project 3 will extend these analyses with four specific aims. (1) Further characterize the evolution of the response of the adult female C57B1/6 mouse bladder to infection with two genotyped clinical isolates. Our previous studies focused on the acute phase of infection with the cystitis isolate NU14. We will now use DNA microarrays to profile gene expression in the bladders of adult female C57B1/6 mice from 1.5h to 6 weeks after infection with UTI89 (a virulent strain whose geneme will be sequenced in Project 1), and a genotyped asymptomatic bacteriuria (ASB) strain. The temporal evolution as well as the celtular origins of selected responses will be defined using real time quantitative (q) RT-PCR, laser capture microdissection (LCM), in situ hybridization, and multi-label immunohistochemical analyses. (2) Define the impact of specified UPEC genes on the response of the adult female C57B1/6 mouse bladder to infection. We will examine host responses to isogenic strains of UPEC that have engineered mutations in genes expected to alter various steps in the proposed 6 step pathogenic cascade. These mutants will be generated in Project 1 and will include (el) genes targeted based on results obtained from the UT 189 genome sequence, results obtained from differential genotyping of clinical strains, and results garnered from studies of bacterial gene regulation; (b) genes identified during screens of a random transposon-tagged library and (c) mutants in already suspected virulence factors. (3) Define the response of the adult female C57B!/6 mouse bladder to a Gram-positive uropathogen. Enterococcus spp are an important cause of nosocomial infection. A functional genomics-based comparison of the responses to infection with isogenic wild type and fimH strains of an Enterococcus faecalis cystitis isolate will provide insights about how the bladder responds to attachment of Gram-positive uropathegens (4) Define host genes that regulate responses
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Urinary Tract Infections
to infection with isogenic wild type and mutant strains of UPEC and E. faecalis. Toll-like receptor (TLR) pathways are involved in the response to infections by both Gramnegative and Gram-positive bacteria. We will perform a comparative functional genomics analysis of the host response to FimH+ UPEC and FimH + E. faecalis in adult female C57BI/6 mice homozygous for wild type tlr alleles, versus the responses of C57B1/6 mice homozygous for tlr4 or tlr2 nuU alleles. We will also examine the contributions of inducible nitric oxide synthase (iNOS), matrilysin (MMP-7) and A20 by infecting genetically engineered C57B1/6 mice homozygous for null alleles of these genes with wild type and mutant strains of bacteria characterized in aims 2 and 3. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: GENE EXPRESSION PATTERNS BY URINARY TRACT PATHOGENS Principal Investigator & Institution: Lory, Stephen; Professor; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2001; Project Start 01-FEB-2001; Project End 31-JAN-2002 Summary: The ability of pathogenic bacteria to sense the changes in their environment and respond by expressing essential virulence is one of the key components of the infectious process. The long term objectives of the proposal are to examine the patterns of gene expression of two important human uropathogens-Escherichia coli and Pseudomonas aeruginosa-during various growth conditions, including growth in the urinary tract of infected patients. Specifically, a library will be prepared of cloned DNA from a uropathogenic E. coli strain containing sequences which are absent in the genomes of laboratory E. coli strains. Similarly, a genomic library of uropathogenic P. aeruginosa strain will be constructed. These libraries will be used to prepare filters containing high-density DNA arrays of clones, and they will be probed with cDNA probes derived from mRNAs isolated under various conditions that mimic the human urinary tract. Two such conditions will include growth in human urine, and bacterial attachment to human bladder epithelial cells in culture. In order to identify genes that are differentially expressed, the hybridization patterns of two different probes with the cloned DNA in arrays will be compared. RNA will be isolated from the pathogens propagated in urine or in the presence of primary bladder epithelial cells, and the same organisms grown in standard laboratory media. Probes from E. coli and P. aeruginosa, directly isolated in urine samples from patients with urinary tract infections will also be prepared, and these will be used for the analysis of gene expression during natural infections of humans. Genes of E. coli and P. aeruginosa, which are expressed in isolates from patients with urinary tract infections-or under conditions mimicking such infections-will be cloned and sequenced. The transcriptional start sites of these genes will be determined, in order to identify any urine-tract specific regulatory genes, which may be targets of transcriptional regulators. It is believed that the proposed research will lead to the identification of genes and regulatory circuits which are responsible for the expression of virulence factors in the human urinary tract infected by uropathogenic E. coli and P. aeruginosa. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: GENETIC DETERMINANTS OF URINARY TRACT INFECTION IN WOMEN Principal Investigator & Institution: Hooton, Thomas M.; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 30-JUN-2008
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Summary: Acute uncomplicated urinary tract infections (UTIs) occur in an estimated 711 million women each year and annual costs of caring for these women are thought to approach $1.6 billion. While most young women experience only sporadic episodes of cystitis, approximately 20-30% suffer from recurrent infections, 5% from highly recurrent infections, and as many as 5-10% develop acute pyelonephritis, often necessitating hospitalization and parenteral antimicrobials. In the aggregate, UTIs in young women result in substantial morbidity, time lost from work, and medical costs. An improved understanding of the pathogenic mechanisms underlying recurrent UTIs and pyelonephritis could result in novel approaches to their prevention and reduced morbidity and antimicrobial use. Behavioral factors such as sexual and contraceptive practices have been shown to be strongly associated with risk of recurrent UTI (RUTI) in these women, and there is increasing evidence that recurrent RUTIs are also associated with genetic factors. Genetic variation has been used to implicate genes in the susceptibility to many infections. The main objective of this project is to determine whether DNA variations in selected candidate host genes influence human susceptibility to RUTI or pyelonephritis. Based on accumulating evidence implicating them as important in animal models of UTI, the candidate genes selected for study are toll-like receptors (TLR2, TLR4, and TLR5), chemokine receptors (CXCR1 and CXCR2) and interferon gamma receptors (IFN-gammaR1 and IFNgammaR2). In this project, we will perform full gene sequencing of these candidate genes in 100 women with a strong family history of RUTI or pyelonephritis to discover novel nucleotide variations in these groups. We will then examine, via a case-control study of 1700 women that identifies all incident cases and two population-based control groups, whether known or novel genetic variations in these candidate genes are associated with the syndromes of RUTI and/or pyelonephritis. We will also determine how genetic variations may modify the association between behavioral risk factors and RUTI and pyelonephritis. A better understanding of the role of genetics in the pathogenesis of RUTI and pyelonephritis, and the relationship between behavioral factors and genetic variations, is critical to the development of optimal prevention and management strategies for these very common syndromes in women. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: GU INFECTION SELF-DIAGNOSIS FOR DEPLOYED MILITARY WOMEN Principal Investigator & Institution: Ryan-Wenger, Nancy A.; Professor; None; Ohio State University 1960 Kenny Road Columbus, Oh 43210 Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 31-JAN-2005 Summary: Approximately 347,000 women serve in the U.S. military, and regularly deploy to austere military environments where harsh climate and terrain, primitive hygiene facilities, and unavailable or unacceptable health care resources for women increase women's risk for development of vaginitis and urinary tract infections (UTI). Untreated or inadequately treated symptoms of bacterial vaginosis, trichomonas vaginitis, candida vaginitis, and UTI are miserable, embarrassing, distracting and significantly interfere with women's quality of life, comfort, and concentration. In deployment situations, a viable solution to the problem is a field-expedient kit for selfdiagnosis and self-treatment of these symptoms. Preliminary work supports the need for such a kit and the feasibility of developing a kit that is user-friendly, sensitive and specific. In this study, 1560 Army and Navy women who seek care from a military clinic for vaginal or urinary symptoms, will conduct a self-diagnosis using a Decision-Making Guide and selected materials to measure vaginal and urinary symptoms, and vaginal
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Urinary Tract Infections
pH and amines. We will test the sensitivity and specificity of military women's selfdiagnoses in comparison with laboratory reference standards (urine culture and DNA probe testing for gardnerella vaginalis, trichomonas vaginalis, and candida species). A research advanced practice nurse (APN) will enroll women in the study, conduct a protocol-driven clinical diagnostic examination, and treat the women with selected single-dose oral medications that will ultimately be included in the field-expedient selfcare kit. The women's observations on the Decision-Making Guide will be compared with the APN's clinical observations to evaluate the extent to which each item in the Guide contributes to the true diagnosis. We will also estimate the frequency with which women would have made an error in self-treatment based on their self- diagnoses if they had used this kit during deployment. The women will return to the clinic for follow-up visits with the APN in order to evaluate their satisfaction with the selfdiagnosis process and the single-dose oral treatment of their symptoms, and for their recommendations for improvement of the kit. While this proposed research focuses on a self-care intervention for military women, it has a much broader potential for use by civilian women who find themselves in austere environments for other reasons, i.e. missionary work, Peace Corps, humanitarian missions, expeditions, or foreign travel. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: H2O2-PRODUCING LACTOBACILLI AND POSTMENOPAUSAL UTI Principal Investigator & Institution: Gupta, Kalpana; Medicine; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2001; Project Start 30-SEP-2000; Project End 31-AUG-2005 Summary: (adapted from the application) Urinary tract infections affect over 7 million women per year, and the incidence of UTI increases with advancing age. Although marked strides have been made in our understanding of the pathogenesis of UTI in young adult women, the pathogenesis and epidemiology of UTI among postmenopausal women remain poorly understood, especially among the noninstitutionalized segment of the population. Vaginal colonization with E. coli has been shown to be an important event preceding UTI, and it is highly prevalent in postmenopausal women. In vitro studies suggest that the predominant constituents of normal vaginal flora, H202-producing lactobacilli, are inhibitory to E. coli. Our recent data demonstrate that there is, indeed, an inverse relationship between the presence of H202-producing lactobacilli and E. coli vaginal colonization in premenopausal women with recurrent UTI. However, the prevalence of H202-producing lactobacilli, and their relationship to vaginal E. coli colonization and to the incidence of UTI among postmenopausal women has not been characterized. A prospective evaluation of the incidence of and risk factors for UTI in 1000 community-dwelling postmenopausal women (DK43134, Stephan D. Fin, MD, MPH) has been initiated at the Group Health Cooperative of Puget Sound, a population-based HMO in western Washington. Based on our findings in premenopausal women, we are proposing additional studies which will enable us to (1) establish the prevalence of vaginal lactobacilli, characterized by H202 status and by species, in postmenopausal women; (2) examine the relationship between H202-producing lactobacilli and E. coli vaginal colonization; (3) relate this information to the incidence of UTI and asymptomatic bacteriuria in postmenopausal women while accounting for exposures such as estrogen use, diabetes, and antimicrobial use; (4) assess the prevalence of urovirulence genes in E. coli strains causing cystitis in postmenopausal women; and (5) assess the feasibility of using a lactobacillus probiotic to prevent UTI in postmenopausal women. These additional studies will entail a combination of epidemiological, biostatistical, and laboratory methods which, in
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combination with structured didactic and classroom instruction, will provide an excellent training experience for the development of the Candidate into a successful, independent, clinical investigator. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: IDENTIFICATION OF VIRULENCE GENES OF PATHOGENIC E COLI Principal Investigator & Institution: Roesch, Paula L.; Medical Microbiol & Immunology; University of Wisconsin Madison 750 University Ave Madison, Wi 53706 Timing: Fiscal Year 2001; Project Start 01-SEP-2001 Summary: The majority of urinary tract infections (UTIs) are caused by uropathogenic strains of Escherichia coli. These strains are known to harbor many virulence factors such as hemolysin, aerobactin and several types of fimbriae including P, S and type 1. The genes encoding bacterial virulence factors are often clustered together on the bacterial chromosome in areas termed "pathogenicity islands" (PAIs). The PAIs vary in size, location and genetic content between strains. However, at present they share the characteristic of being largely undefined. The overall goal of this research is to further elucidate the unique attributes of uropathogenic E. coli (UPEC) that distinguish them from other commensal and pathogenic strains. A problem with identifying novel virulence factors is that many or most of these genes are not expressed under in vitro conditions. However, new techniques have been developed to overcome this barrier. One of these techniques, differential fluorescence induction (DFI), has been particularly successful in the identification of genes differentially expressed under various environmental conditions (including inside of eukaryotic cells) and will be utilized in these studies. Additionally, putative virulence factors will be identified on the basis of sequence homologies to other known virulence genes. All candidate virulence factors will be further investigated by making allelic knockouts with subsequent testing in the murine model of ascending urinary tract infection to determine their significance in vivo. An epidemiological survey of candidate virulence genes will then be carried out. The discovery of new virulence factors may lead to a better understanding of how urinary tract isolates differ from benign, commensal strains of E. coli. In addition, these studies may provide insight into how bacterial gene expression is modulated in response to the host cell environment and lead to new targets for therapeutics and vaccine development. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: IMMUNIZATION AGAINST URINARY TRACT INFECTION Principal Investigator & Institution: Uehling, David T.; Professor of Surgery; Surgery; University of Wisconsin Madison 750 University Ave Madison, Wi 53706 Timing: Fiscal Year 2001; Project Start 01-APR-1982; Project End 30-NOV-2002 Summary: (Adapted from the Applicant's Abstract): Urinary tract infections (UTI) remain among the most common bacterial infections and constitute a large public health cost to society. UTI's are caused primarily by E. coli which infect the bladder by an ascending route. Even in patients without demonstrable vesico-ureteral reflux or obstruction, an lower tract UTI may proceed to pyelonephritis. The overall goal of this research continues to be establishment of a safe and effective vaccine treatment against UTI. The current approach of treating women with recurrent UTI is to prevent reinfection by long term administration of low dose antibiotics. However, extended use of antibiotics may cause adverse reactions in patients and the development of
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Urinary Tract Infections
antibiotics-resistant uropathogens. An alternative treatment approach is to boost innate resistance to UTI by immunization. In animal models and clinical trials, vaginal mucosal immunization with a multi-strain vaccine can be shown to lessen the severity and duration of experimentally induced UTI's and prolong the time til reinfection in susceptible female patients. This investigation is now focused on prolonging the protective period in susceptible women by giving immunization boosters at the times when protection in our Phase II trial appears to be decreasing. The specific aims of the proposal are: 1. Complete and extended Phase II clinical trial with a multi-strain immunogen given as a vaginal suppository, with additional immunizations timed to provide sustained protection. 2. Utilize an animal model to clarify the immunologic basis for the increased resistance to UTI following vaginal immunization and to evaluate adjuvants and vaccination regimes that optimize immunogenicity and efficacy of UTI vaccines. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: INNOVATIVE INTRAVESICAL TREATMENT APPROACH FOR IC Principal Investigator & Institution: Bhavanandan, Veer P.; Professor; Biochem and Molecular Biology; Pennsylvania State Univ Hershey Med Ctr 500 University Dr Hershey, Pa 17033 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 31-AUG-2003 Summary: Interstitial cystitis is poorly understood, and the causes and pathophysiology for IC are still unknown. Many theories have been proposed about the etiology of IC, but none has been definitively proven. There are no cures for IC and clinicians use a variety of empiric treatments, based on the proposed causes for IC. However, none of these treatments are consistently effective, and some patients remain unable to find any relief. One popular theory about IC is that the glycocalyx of the bladder epithelium is deficient. Accordingly, some of the current treatments are aimed at replacing the missing glycoconjugates by intravesical or oral administration of sulfated polysaccharides, such as heparin and pentosan polysulfate (Elmiron). It is unknown why these treatments show improvement of symptoms in only some IC patients, and why the response is usually slow. One possible reason is that the highly anionic and readily water-soluble sulfated polysaccharides do not adhere to the bladder well enough to exert their beneficial effect. An exploratory study is proposed for the development of an innovative approach that should not only increase the efficiency of sulfated polysaccharides for patients who respond, but may also benefit some patients who do not currently respond. The plan is to improve the binding and thereby strengthen and prolong the adherence of intravesically administered drugs to the bladder. The experimental strategy is to modify the sulfated polysaccharides with specific saccharide ligands, so that they will bind to endogenous lectins in the bladder. In order to choose the saccharide structures for this purpose it is first necessary to identify the lectins present in the bladder epithelium of rabbit (an animal model for initial binding studies) and human. Preliminary studies have demonstrated the presence of galactose- and Nacetylglucosamine-binding lectins in both rabbit and human bladders. Further detailed investigations are needed to complete the biochemical characterization of the major bladder lectins and specifically, elucidate their saccharide specificities. Once identified, the saccharide ligands will be conjugated to sulfated polysaccharides and the binding of the conjugates to bladder will be evaluated. Although the initial studies will be on sulfated polysaccharide treatments of IC, the same strategy could also be applied to improve treatment of various other bladder diseases. For example, prolonged binding of antibiotics to the urothelium may help to treat or prevent urinary tract infections.
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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: LIGAND RECEPTOR INTERACTIONS IN UTIS Principal Investigator & Institution: Abraham, Soman N.; Associate Professor; Pathology; Duke University Durham, Nc 27706 Timing: Fiscal Year 2001; Project Start 01-AUG-1976; Project End 30-JUN-2004 Summary: (Adapted from the Applicant's Abstract): Urinary tract infections (UTIs) are a major cause of morbidity in women and the aged. Over 80% of UTIs are caused by E. coli and most of these strains express the type 1 fimbriae. Since these fimbriae are also expressed on nonpathogenic E. coli their role in virulence is unclear. However, the investigators have detected considerable heterogeniety in binding among different type 1 fimbriae which could determine to which strains are virulent and the nature of the inflammatory response in the host. MC are prominent inflammatory cells in the bladder and are found in close proximity to the bladder epithelial cells (BEC). they have also found that certain type 1 fimbriated strains of E. coli can gain access into mast cells (MC) and then subsequently escape without loss of bacterial viability. The trafficking process is triggered by the specific binding of type 1 fimbriae to CD48 on the MC membrane. Interestingly, BEC were found to modulate the trafficking of E. coli in MC as a reservoir may in release of stem cell factor (SCF). This capacity of type 1 fimbriated E. coli to utilize MC as a reservoir may in part explain recurrent UTIs. To extend their observations they plan to (i), determine if and how type 1 fimbriae from uropathogenic E. coli isolates display distinct binding traits compared to commensal isolates (ii), determine whether different E. coli type 1 fimbriae bind separate receptors on the host cells and if there is diversity in the host cell's responses (iii), elucidate the molecular mechanisms of CD48 mediated trafficking of type 1 fimbriated E. coli in MC and (iv), elucidate how SCF modulates MC carriage of bacteria. The information derived from these studies could promote the development of novel strategies for the prevention and management of E. coli -induced UTIs including recurrences. In the age of increasing antibiotic resistance in bacteria and where the population of the aged and immunocompromised individuals continues to grow, these studies could prove to be extremely valuable. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: MECHANISM OF THE USHER IN ASSEMBLY AND SECRETION OF PILI Principal Investigator & Institution: Thanassi, David G.; Assistant Professor; Molecular Genetics & Microbiol; State University New York Stony Brook Stony Brook, Ny 11794 Timing: Fiscal Year 2001; Project Start 01-APR-2001; Project End 31-MAR-2006 Summary: (provided by the applicant): Pathogenic bacteria must assemble and secrete virulence factors in order to interact with their hosts and cause disease. Gram-negative bacteria have an outer membrane in addition to a cytoplasmic membrane and must secrete virulence factors across both these barriers. The mechanisms by which this occurs can be quite complex and are not well understood. The chaperone/usher pathway is a virulence protein secretion pathway that requires two components for secretion across the outer membrane: a periplasmic chaperone and an outer membrane protein termed an usher. The chaperone directs proper folding of the secreted proteins and prevents their engagement in non-productive interactions. The usher serves as an assembly platform at the outer membrane and provides a secretion channel to the cell surface. The chaperone/usher pathway is required for assembly and secretion of a
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superfamily of adhesive structures in a broad range of Gram-negative pathogens. The prototypical organelles assembled by this pathway are the P and type 1 pili expressed by uropathogenic Escherichia coli, the primary causative agent of urinary tract infections. P and type 1 pili are critical virulence factors, allowing binding and colonization of the kidney and bladder, respectively. The long-term goal of this proposal is to use pilus biogenesis by uropathogenic E. coli as a model system with which to understand virulence factor secretion in Gram-negative bacteria. More specifically, the structure and function of the usher will be investigated to elucidate the molecular mechanisms governing secretion across the outer membrane. The first specific aim is to create a detailed model of the structural arrangement of the usher in the outer membrane using computer analysis and epitope mapping techniques. The second specific aim is to probe function of the usher through generation and analysis of mutants. The third specific aim is to establish a cell-free system for pilus biogenesis based on reconstitution of the usher into liposomes. Such a system will provide an invaluable tool for studying the chaperone/usher pathway and analyzing mutants. The work described in this proposal will elucidate mechanisms of virulence factor secretion and create opportunities for the development of novel antimicrobial agents to treat not only urinary tract infections, but also a broad range of infectious diseases. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MEDICAL THERAPY FOR BPH--DATA COORDINATING CENTER Principal Investigator & Institution: Noble, William; Associate Professor; Statistics; George Washington University 2121 I St Nw Washington, Dc 20052 Timing: Fiscal Year 2001; Project Start 30-SEP-1992; Project End 31-MAR-2004 Summary: The Biostatistics Center of The George Washington University proposes to work in cooperative agreement with the National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK-NIH) to serve as the Data Coordinating Center (DCC) for a proposed multi-center clinical trial of the medical therapy of benign prostatic hyperplasia (BPH). the purpose of the NIH-BPH Clinical Trial is to determine the safety and efficacy of the pharmacotherapies finasteride (an inhibitor of 5-alpha-reductase) and doxazosin (a blocker of alpha-1 adrenoreceptors) on the clinical progression of BPH. The objective of the transition phase is to finalize the protocol, operations manual and data collection forms to be implemented in a 6 year full-scale clinical trial. The trial will require randomization of 2,800 participants with a diagnosis of BPH over a 2 year period in 17 clinical centers. Eligible participants will be randomly assigned, double-masked, to one of four treatment groups: (1) active finasteride (5 mg., once per day) and active doxazosin (4 mg or 8 mg, once per day); (2) active finasteride and doxazosin placebo; (3) finasteride placebo and active doxazosin; or (4) finasteride placebo and doxazosin placebo. Randomized participants will be followed for a minimum of 4 years (maximum of 6 years) with quarterly follow-up visits. Clinical progression of BPH is defined by the incidence of acute urinary retention, renal insufficiency, recurrent urinary tract infections, incontinence, or a pre-specified increase in the American Urological Association (AUA) symptom score. Secondary outcomes include differences over time among the four treatment groups with respect to AUA symptom score Quality of Life and maximal uroflow. Tissue biopsies will be obtained in 20 percent of the participants to provide information on the histopathobiology of BPH and to test existing biomarkers for their prognostic ability regarding response to medical therapy. The specific aims of the DCC are to provide centralized support and biostatistical consultation in the transition of the pilot study's patient management protocols, operations manual, data collection forms and randomization procedures to the full-scale clinical trial;
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implementation of a data processing system including data quality assessment; interim analysis of protocol performance, patient safety and treatment efficacy; ad final analysis for publication of the NIH-BPH Clinical Trial results in collaboration with the clinical investigators. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MEDICAL THERAPY IN BENIGN PROSTATIC HYPERPLASIA Principal Investigator & Institution: Lieber, Michael M.; Mayo Clinic Rochester 200 1St St Sw Rochester, Mn 55905 Timing: Fiscal Year 2001; Project Start 27-APR-1995; Project End 31-MAR-2003 Summary: Two different types of medical therapy for the symptoms of benign prostatic hyperplasia (BPH) now have been approved by the U.S. Food and Drug Administration. The first was finasteride, a 5-alpha reductase inhibitor; the other was terazosin, a selective alpha-1-adrenergic receptor inhibitor. Both of these drugs as well as other alpha blockers, such as doxazosin and prazosin, now are being used widely in the United States and around the world, both by urologists and primary care physicians, to treat the symptoms of prostatism. However, it is not known whether treatment with these agents will reduce or prevent the clinical progression of BPH when these medications are taken chronically. Clinically important BPH endpoints include acute urinary retention, increasing renal failure, severe bladder decompensation with chronic retention and incontinence, recurrent urinary tract infections and progressive voiding symptoms requiring surgical intervention. The Urology and Clinical Trials Program of the NIH NIDDK appropriately has developed a prospective randomized clinical research study investigating the long- term medical therapy of BPH using finasteride, doxazosin, the combination of finasteride and doxazosin, and a placebo arm. With this application, clinical research personnel from the Mayo Clinic Department of Urology (Rochester, Minnesota) are applying to be one of the "Clinical Centers" as described in the new RFA. Our research group seeks to further utilize talent and experience generated over the preceding six years by Mayo personnel prospectively studying men with BPH. We already have had extensive experience in conducting multi-center prospective clinical trials investigating the natural history of BPH without treatment, and also in numerous multi-center prospective randomized industry sponsored clinical trials investigating finasteride, alpha- blockers and new devices for BPH. Our clinical research team also has had current experience in enrolling over 400 middle-aged male patients in the past eight months for the new NCI-SWOG chemoprevention trial of prostate cancer (PCPT) which has finasteride and placebo arms and which has many similarities to the proposed NIDDK BPH study in terms of overall organization of the multi-center trial and duration. We believe the ability and experience of the Mayo Clinic Department of Urology clinical investigation team in carrying out prospective trials of prostate disease should make us a strong candidate to become one of the clinical centers as described in the current NIDDK RFA. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: MEDICAL THERAPY OF PROSTATIC SYMPTONS (MTOPS) Principal Investigator & Institution: Foley, John P.; Henry M. Jackson Fdn for the Adv Mil/Med Rockville, Md 20852 Timing: Fiscal Year 2001; Project Start 27-APR-1995; Project End 31-MAR-2003 Summary: The objective of this two-by-two, prospective, blinded trial is to determine if finasteride and/or doxazosin will delay or alter the development of benign prostatic
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hyperplasia (BPH) in a population of at- risk men with mild to moderate symptoms of BPH. Progression of BPH will be defined as development of urinary retention, renal insufficiency, urinary tract infections, or incontinence as well as an increase in the AUA symptom score of greater than or equal to 4 points. The trial includes a two-year accrual phase followed by four years of follow-up and a one-year study closeout period. From a large population of retired military health care beneficiaries in the San Antonio metropolitan area, including a large proportion of African American and Hispanic men, the Urology Service, BAMC proposes to identify eligible men for the trial, conduct regular screening clinics and randomize 200 men during a two year period. Particular emphasis will be placed on recruitment of minority populations. Compliance to the dosing schedule of study drugs will be assured through a schedule of regular telephone contacts with participants and will be monitored through regular pill counts. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MICROBIAL RESERVOIRS AND UTI IN WOMEN Principal Investigator & Institution: Hooten, Thomas M.; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2007 Summary: Acute uncomplicated urinary tract infections (UTIs) occur in an estimated 711 million women each year, and the annual costs of caring for these women are thought to approach $1.6 billion. Approximately 20-30% of women suffer from frequent recurrent infections. UTIs in young women result in substantial morbidity, time lost from work, and medical costs. An improved understanding of the pathogenic mechanisms underlying UTIs could result in novel approaches to their prevention and reduced morbidity and antimicrobial use. In this project we seek a better understanding of the pathogenesis of UTI. The widely accepted model of UTI pathogenesis is that vaginal colonization with uropathogens from the rectal flora precedes urethral and bladder colonization and subsequent UTI, but the temporal relationship between these events has not been established and some women with UTI cannot be found to harbor vaginal uropathogens. Moreover, recent data from studies in mice strongly suggest that persistent bladder epithelial infection follows an initial bladder infection. In this project, we will prospectively follow a large cohort of women with recurrent UTI to determine 1) the temporal relationships between vaginal colonization with a uropathogen, asymptomatic bacteriuria and symptomatic UTI and 2) the presence of persistent bladder epithelial infection following symptomatic UTI and its relationship to samestrain recurrence of UTI. We will thus be able to determine the relative importance of vaginal colonization vs. persistent infection of the bladder epithelium as the origin of the infecting strain in same-strain recurrent UTI. Uropathogenic strains isolated from wellcharacterized episodes of UTI and asymptomatic bacteriuria will undergo genotyping in Project 1 to identify unique genes or gene dusters that may contribute to their clinical phenotype. The molecular pathogenesis of representative strains will also be examined in Project 1 and their effect on host response will be determined by functional genomic analysis in Project 3. A better understanding of the molecular and epidemiologic basis of UTI is critical in developing optimal prevention and management strategies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: MICROBICIDAL LACTOBACILLI FOR PREVENTION OF GENITAL INFECTION Principal Investigator & Institution: Hillier, Sharon L.; Professor; Carnegie-Mellon University 5000 Forbes Ave Pittsburgh, Pa 15213
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Timing: Fiscal Year 2001 Summary: Lactobacilli function as microbicides in the human vagina through production of H2O2, acids and other products which inhibit the survival and/or growth of genital pathogens. The goal of the proposed project is to evaluate the efficacy of Lactobacillus capsule in colonizing the vagina and decreasing acquisition of bacterial vaginosis. Longitudinal cohort data supports the association between lack of vaginal lactobacilli and acquisition of bacterial vaginosis. A vaginal capsule containing Lactobacillus crispatus has been developed and shown to colonize women during a phase II study. The proposed study is a double-blind placebo-controlled trial of a Lactobacillus crispatus capsule in women attending an Adolescent Medicine Clinic (n=200), the Allegheny County Health Department (n=250). Women will be followed at 3 month intervals for 1 year. The presence of genital tract infection and vaginal lactobacilli will be determined at baseline and each follow-up visit. The hypothesis is that monthly use of exogenous lactobacilli intravaginally will decrease acquisition of bacterial vaginosis. The specific aims are 1) to assess the relationship between genital infection and lack of lactobacilli in a population of women of reproductive age; 2) to assess the effect of the Lactobacillus capsule on the vaginal ecosystem (vaginal pH, lactobacilli, other microorganisms); 3) to determine whether women randomized to receive the Lactobacillus capsule have decreased acquisition of bacterial vaginosis compared to placebo-treated women after accounting for potentially confounding behaviors; 4) to evaluate the effect of the Lactobacillus capsule on acquisition of other infections including chlamydia, trichomoniasis, vulvovaginal candiddiasis, urinary tract infections and pelvic inflammatory disease; 5) assess the immunologic response to Lactobacillus crispatus among women assigned to the L. crispatus capsule versus placebo; and 6) to assess demographic, behavioral and microbiologic factors associated with loss or acquisition of H2O2-producing and H202-negative lactobacilli. This project will yield new information on lactobacilli as endogenous microbicides and suggest new strategies for prevention of STD's and their sequelae. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MOLECULAR ADAPTATION OF UROPATHOGENIC BACTERIA Principal Investigator & Institution: Sokurenko, Evgeni V.; Assistant Professor; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 30-JUN-2008 Summary: The primary goal of this study is to characterize on a genomic scale the adaptive evolution of Escherichia coli clones in the course of long-term urinary tract infections (UTI), in particular, episodes of recurrent cystitis and UTI characterized by a shift between the asymptomatic and symptomatic state. The main hypothesis to be tested is that adaptive evolution of uropathogenic E. coli is among the key mechanisms underlying the shift from the acute form of UTIs to recurrent infection and from asymptomatic to symptomatic infection. Molecular adaptation of bacterial pathogens in the course of infection involves point mutations in structural or regulatory genes as well as deletion or duplication of whole genes or chromosomal regions. These pathogenicityadaptive mutations can confer a selective advantage by improving the ability of the bacteria to adhere to or invade the uroepithelium or evade host defenses. There is strong evidence from both published and our preliminary studies that E. coli undergoes pathogenicity-adaptive evolution in the course of recurrent or long-term UTI. The studies proposed here will expand our understanding of this phenomena to the genomic level by employing two novel technologies, high-density microarrays and a wholegenome mutation scan developed in our laboratory. Both of these technologies will be
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utilized to perform a comparative analysis of sequential or matching clones of E. coli that have been isolated from patients with long-term UTI or in a chronic animal model of UTI. We will also define how adaptive evolution of uropathogens affects their ability to bind and invade uroepithelial cells, resist cellular host defenses and colonize in a mouse model of UTI. We expect that the proposed studies will clarify the mechanisms of long-term adaptive evolution of uropathogenic E. coli and provide a basis for future studies directed at a detailed understanding of the molecular pathogenesis of persistent and recurrent UTIs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MOLECULAR AND CELLULAR PATHOGENESES OF URINARY INFECTION Principal Investigator & Institution: Warren, John W.; Professor; Medicine; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2001; Project Start 01-MAY-1995; Project End 30-JUN-2005 Summary: Urinary tract infections (UTI) are among the most common infections in humans which can be asymptomatic or cause cystitis, acute pyelonephritis and blood stream invasion. About 80% of UTIs in otherwise normal urinary tracts, the incidence of UTI is much higher and is caused by a wider spectrum of organisms; among these, Proteus mirabilis assumes importance not only because of its production of renal stones. Among patients with catheters or other foreign devices in the urinary tract, Candidate infections are becoming increasingly prominent. In this PO1, a group of accomplished and resource investigators has the following objectives: 1) to discover the mechanisms of pathogenesis of UT1 caused by E. coli, P. mirabilis. Our strategy is to use the powerful tools of molecular biology and a well established mouse model of UTI to examine known virulence factors and, via new techniques including signature tagged mutagenesis and in vivo expression technology, heretofore unknown virulence factors. Similar resources will be used to develop candidate vaccines assembled from P. mirabilis subunits. This work will be done in the context of a strong history in infectious diseases, particularly molecular pathogenesis and vaccine development. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: MOLECULAR BASIS OF E. COLI ADHESINS IN BLADDER DISORDERS Principal Investigator & Institution: Hultgren, Scott J.; Professor; Molecular Microbiology; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2002; Project Start 01-JAN-1997; Project End 31-DEC-2006 Summary: (Adapted from the Applicant's Abstract): Urinary tract infections (UTIs) are common infections that affect a large proportion of the world population and account for significant morbidity and medical expenditures. These infections are most commonly caused by Escherichia coli (E. coli). A long-term goal of this proposal is to understand the processes by which E. coli causes acute, recurrent and chronic UTIs and the sequelae of these infections. An integrated approach will be used that blends a powerful bacterial genetic system, a mouse UTI model, and x-ray crystallography with high-resolution electron microscopy (EM), protein chemistry, carbohydrate chemistry, and tissue culture systems in order to reveal the cellular, molecular, and structural basis for the pathogenesis of these infections. The FimH adhesin present at the tip of type 1 pili has been shown in animal models to mediate binding to the uroplakin-coated lumenal surface of the bladder. The uroplakin receptor complexes recognized by the
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FimH adhesin will be cloned and used to investigate the consequences of FimHuroplakin interactions. Also, the three dimensional structure of the FimH adhesin will be used to design a panel of site directed mutations to delineate the mannose binding pocket of the FimH adhesin and the structural basis of bacterial colonization of the urinary tract. The adaptive responses to bladder infections and the activation of signals that lead to the release of cytokines and recruitment of neutrophils will be dissected in detail. FimH-mediated attachment to the bladder epithelial cells activates a cascade of innate defenses that leads to rapid exfoliation and proliferation of underlying epithelial cells. The molecular basis of exfoliation will be investigated and its role in protecting the bladder from infection will be studied. The molecular mechanisms by which uropathogenic E. coli are able to invade bladder epithelial cells and evade the host response will be elucidated. Uropathogenic E. coli replicate intracellularly and form "bacterial factories" in the lumenal superficial facet cells of the bladder. The virulence factors required for this process will be identified and studied. Finally, the fluxing of E. coli out of the facet cells and colonization of underlying tissue will be investigated as a mechanism to cause persistent and recurrent infections. These studies will contribute to the development of adhesin-based vaccines to treat and prevent urinary tract infections and their sequelae. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MOLECULAR PATHOGENESIS OF PROTEUS MIRABILIS URINARY TRACT INFECTION Principal Investigator & Institution: Mobley, Harry L.; Professor; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2001 Summary: P. mirabilis is not a common cause of UTI in the normal host but does infect a high proportion of patients with complicated urinary tracts, i.e., those with functional or anatomic abnormalities or with chronic instrumentation such as long-term catheterization. In these patients, not only does this bacterium cause cystitis and acute pyelonephritis, but the production of urinary stones, a hallmark of infection with this organism, add another dimension to the already complicated urinary tract. Stone formation is caused by the expression of a highly active urease which hydrolyzes urea to ammonia, causing local pH to rise with subsequent precipitation of magnesium ammonium phosphate (struvite) and calcium phosphate (apatite) crystals. In addition to urease, we have also identified MR/P (mannose-resistant/Proteus-like) fimbriae, PMF (P. mirabilis fimbriae), and flagella as virulence factors that are essential for colonization of the urinary tract. Because we are beginning to understand the molecular mechanisms by which P. mirabilis establishes infection, evades the host defense, and damages host tissue, and because we can identify a large and well defined group of patients who are affected by this species, and because there is evidence that vaccination would prevent infections, we propose, as Specific Aims for the current proposal, 1) To identify and characterize new virulence and regulatory determinants of uropathogenic Proteus mirabilis; 2) To localize bacteria in relation to specific cell types during experimental UT1 and assess expression of virulence factors in different locations and phases of infection (e.g., PMF in bladder, flagella in ureter, MR/P in kidney); and 3) To investigate MR/P fimbrial adhesion structure and function and develop an adhesin- based vaccine to protect against Proteus UT1 and uroliathiasis. To accomplish these aims, signature tagged mutagenesis. To accomplish these aims, signature tagged mutagenesis and other molecular techniques, confocal laser scanning microscopy, and the CBA mouse model of ascending UT1 will be used.
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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MOLECULAR PROPERTIES AND MODULATION OF BACTERIAL PORINS Principal Investigator & Institution: Delcour, Anne H.; Associate Professor; Biology and Biochemistry; University of Houston 4800 Calhoun Rd Houston, Tx 77004 Timing: Fiscal Year 2001; Project Start 01-JUL-1994; Project End 30-JUN-2004 Summary: Porins are large channels of the outer membrane of Gram-negative bacteria, which represent the major entry pathway for hydrophilic solutes into these organisms. Porins have classically been considered as permanently open pores, and little is known about their regulation and mode of action. The objectives of this proposal are to study, at the molecular level, the function and modulation of these proteins in Escherichia coli. Bacteria are one of leading agents in human infectious diseases. Because of their abundance and location at the external surface of the bacterial cells, porins may play a role in the host- pathogen interactions involved in bacterial infection and have been shown to be targets for immune responses. Changes in porin expression patterns have also been observed in virulent strains of E. coli causing urinary tract infections. The significance of this project resides in the study of the control of the bacterial outer membrane permeability which plays an vital role in microorganism's survival. The disruption of the normal functional state of the outer membrane by drug-mediated modulation of porin activity can be conceived as a potential strategy for controlling bacterial infection. The patch clamp technique, widely used in the description of eukaryotic channels, will be applied for the real-time measurement, in the submillisecond range, of electrical fluctuations across the membrane during the course of activity of a single or small number of channels. Channel activities will be studied in giant spheroplast or giant cells of E.coli, and in outer membrane fractions reconstituted into giant liposomes. Experiments will be conducted to investigate the molecular mechanisms underlying voltage sensitivity and cooperativity of the major porins expressed by the ompF and ompC genes. OmpC activity can be regulated by membrane-derived oligosaccharides (MDOs), a family of piroplasmic sugar polymers synthesized at high osmolarity. The nature of the molecular events taking place at the level of the channel protein during regulation will be studied. We will also determine the class of MDOs which is responsible for the modulation and define the location of the binding site. A search for other regulatory substances will be conducted, in particular form molecules which promote channel opening and inhibition. Some of these should ultimately be relevant to therapeutic approaches. To fully understand the molecular mechanisms underlying the observed ion channels properties, the relationship between structure and function will be explored by the used of mutant channels. A variety of spontaneous mutants will be used first to map the general regions relevant to specific channels functions. Ultimately, site-directed mutagenesis will be implemented to refine these locations. This is an approach which is widely used in the structure/function relationship studies of eukaryotic channels. The advantages of the bacterial system are that mutant channels are to be studied in their natural environment without the need for injection into foreign expression systems, and porins are the first channels for which an X-ray crystallographic structure has been published. This information on the threedimensional structure of porins will be extremely valuable for the design of genetically engineered channels and the meaningful interpretation of the data. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: NEURAL PROSTHETIC CONTROL OF CONTINENCE AND MICTURITION Principal Investigator & Institution: Grill, Warren M.; Assistant Professor; Biomedical Engineering; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2001; Project Start 25-SEP-2001; Project End 31-AUG-2004 Summary: (provided by applicant): Loss of bladder control as a result of neurological disease or injury such as spinal cord injury (SCI) has devastating effects. SCI results in loss of voluntary control of bladder evacuation, bladder hyper-reflexia, and bladder sphincter dysynergia. These factors often lead to ureteric reflux and obstruction, infection of the kidneys, long-term renal damage, episodes of autonomic dysreflexia with dangerous rises in blood pressure, incontinence which contributes to skin breakdown, as well as frequent urinary tract infections. Loss of bladder control also has profound social impact and leads to decreased quality of life, as well as large direct medical costs from procedures, supplies, and medication. The long-term goal of this research is to develop a neural prosthesis to restore bladder function (continence and micturition) in persons with neurological disorders, particularly spinal cord injury. Restoration of bladder evacuation and continence in individuals with SCI by electrical stimulation of the sacral nerve roots and surgical transection of sacral sensory nerve roots (dorsal rhizotomy) has resulted in documented medical, quality of life, and financial benefits. However, the widespread application of existing technology is limited by the objection of potential candidates to the irreversible dorsal rhizotomy and the complex surgical implant procedure. The PIs propose an innovative approach to restoration of bladder function using a single multi-electrode nerve cuff implanted on the pudendal nerve to detect the onset of hyper-reflexive bladder contractions by electrical recording, to arrest nascent hyper-reflexive bladder contractions by electrical stimulation of pudendal genital afferent nerve fibers, and to produce on-demand bladder evacuation by electrical stimulation of pudendal urethral afferent nerve fibers. This innovative approach differs substantially from existing approaches using electrical stimulation of the spinal roots in that it does not require a spinal laminectomy, does not require irreversible surgical transection of the sacral sensory nerve roots, and stimulates the afferent rather than the efferent side of the system. This is expected to increase the population of individuals who can benefit from neural prosthetic technology, while mantaining the documented benefits. The objective of the proposed work is to demonstrate the feasibility of this approach using complementary experiments in an animal model and in persons with spinal cord injury. Successful completion of this project will lead to the development of an effective neural prosthetic system for restoration of bladder function. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: NITRIC OXIDE TRANSDUCTION MECHANISMS IN UTIS AND IC Principal Investigator & Institution: Weiss, Robert M.; Professor and Chief; Surgery; Yale University 47 College Street, Suite 203 New Haven, Ct 065208047 Timing: Fiscal Year 2001; Project Start 30-SEP-1993; Project End 28-FEB-2003 Summary: (Adapted from the Applicant's Abstract): Urinary tract infections (UTIs) and interstitial cystitis (IC) are two pathologic conditions of the urinary system which predominately affect women and which have medical, psychological, sociological and economic implications. The unifying hypothesis of this proposal is that nitric oxide (NO), a small lipophilic gaseous molecule, which is released from non-adrenergic, noncholinergic neurons and which is synthesized in a variety of mammalian tissues
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including macrophages and neutrophils, acts as a mediator in UTIs and IC. The applicants have: 1) shown that nitric oxide synthase (NOS) activity and cyclic GMP levels are elevated in the urine of patients with a UTI and decreased in the urine of patients with IC; 2) providing the first definitive molecular evidence for the presence of a biologically active inducible NOS (iNOS) in human neutrophils during an infectious process; and 3) shown that L-arginine administration to IC patients increases NOS activity and urinary cyclic GMP and Nox (nitrate plus nitrite) levels, and results in a decrease in IC related symptoms. To test their hypothesis they plan to: 1) determine factors, including cytokines and bacterial products, that mediate the production of nitric oxide in isolated human neutrophils, and to determine if and how neutrophil produced NO is involved in phagocytosis and bacterial killing; 2) identify the inflammatory agents, i.e., bacterial products and cytokines, enzymatic reactions, and cell types, that are involved in the induction of NOS during the initiation of and reparative response to inflammatory/infectious processes in the urinary tract; 3) characterize the subcellular localization and the post translational modifications that regulate human iNOS (hiNOS) expression using an in vitro heterologous system; and 4) determine the relationship between inflammatory cell identity, nitric oxide, prostaglandin and cytokine production, and IC related symptoms. The interpretation of the data obtained will not only pertain to infectious/inflammatory processes of he urinary tract, but also will facilitate the understanding of processes in humans which are less amenable to investigation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: OPTIMIZING ANTIBIOTIC USE IN LONG-TERM CARE Principal Investigator & Institution: Loeb, Mark B.; Mc Master University Hamilton L8s 4L8, Canada Hamilton, Timing: Fiscal Year 2003; Project Start 30-SEP-2000; Project End 31-AUG-2004 Summary: The primary aim of this study is to determine if an evidence-based clinical algorithm for managing urinary tract infections (UTIs) in older adults in residential long-term care facilities (LTCFs) can reduce the overall use of antibiotics in LTCFs. Three secondary objectives are: 1) to demonstrate the feasibility of implementing diagnostic and therapeutic evidence-based clinical algorithms in LTCFs; 2) to assess the safety of reducing the number of diagnostic tests and antibiotic use for UTIs in the target population; 3) to evaluate the process of adopting the algorithms in LTCFs. This study will use a combined quantitative and qualitative approach to evaluate the process and outcomes of implementing a clinical algorithm to optimize the use of antibiotics in residential LTCFs. For the quantitative component of the study, a randomized matchedpair design has been used where, within each of the 12 pairs of LTCFs, one was randomized to the intervention (clinical algorithm). The other half is providing "usual" management of presumptive urinary tract infections. Quantitative outcomes include 1) the proportion of antibiotic courses prescribed for urinary indications, 2) the total number of courses of antibiotics used, 3) rates of urine cultures ordered, 4) hospitalization rates for urinary tract infections, and 5) mortality rates. The qualitative component of the study will be a prospective case study evaluation of the clinical algorithms. This component of the study will exam the ease of implementation and health care provider satisfaction with the algorithms. This study was funded by AHRQ under the TRIP-II program in October 2000. The clinical trial is in progress and data collection is scheduled to be complete in May 2003. Additional funds are being requested to complete the data collection and qualitative components of the study. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: OUTCOME AND QUALITY OF LIFE AFTER DIABETIC STROKE Principal Investigator & Institution: Kissela, Brett M.; Neurology; University of Cincinnati 2624 Clifton Ave Cincinnati, Oh 45221 Timing: Fiscal Year 2003; Project Start 15-JAN-2003; Project End 31-DEC-2007 Summary: (provided by applicant): Individually, diabetes and stroke are among the most common causes of disability and result in substantial health care utilization and expense. Diabetic patients suffer stroke at a younger age and are disproportionately more likely to die or become disabled than non-diabetic patients. These poor functional outcomes have high costs for society. Previous studies, including our own, have demonstrated that diabetes and elevated serum glucose consistently predict poor functional outcome following stroke even after controlling for other significant variables. While multiple studies convincingly document that post-stroke outcomes are worse in patients with diabetes, the reasons for this disparity remain unclear. Previous stroke outcome studies have not taken post-stroke medical complications (pneumonia, urinary tract infections, etc.) or psychological complications such as depression into account. It is generally accepted that such complications impair recovery and perceived quality of life after stroke, and yet only one study has proven this with statistical rigor. Furthermore, it is not known if the rates of these complications differ between diabetic and non-diabetic patients. Until this information is available, we will be unable to develop optimal strategies for stroke prevention, acute stroke treatment, and post-stroke care in diabetic patients. Diabetes itself has a significant impact upon perceived quality of life, is commonly associated with depression, and usually has multiple medical comorbidities. Although health-related quality of life (HRQOL) measures such as the SF36 have been standardized for patients with diabetes, there are currently no data showing how HRQOL changes after stroke in patients with diabetes. To determine if HRQOL can be improved for diabetic stroke patients, baseline data regarding poststroke quality of life must be collected. We hypothesize that there will be an excess of post-stroke complications in diabetic patients, explaining the disparity in post-stroke outcomes and HRQOL. At the completion of this study, we will have determined the incidence of each complication and its impact on outcome and HRQOL. By explaining the disparity in post-stroke outcomes, we will have identified areas where future interventions could improve the quality of life for diabetic stroke patients. Given the enormous burden of stroke on patients with diabetes, the need for a specialist that can bridge the gap between neurology and diabetes care is evident. It is the goal of the Principal Investigator to become an expert in epidemiology and outcomes research and to use clinical research to improve the lives of diabetic patients with stroke. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: PATHOGENESIS OF CANDIDA GLABRATA IN THE URINARY TRACT Principal Investigator & Institution: Cormack, Brendan P.; Assistant Professor; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2001 Summary: The long term objective of this proposal is a comprehensive analysis of virulence factors in pathogenic yeast required for colonization and persistence in the urinary tract. Candida glabrata and Candida albicans are the two major organisms responsible for funguria, as well as vaginal, oropharyngeal and systemic candidiasis. Little is known about the factors that allow Candida to colonize or persist in the urinary tract. Here, we will take a genetic approach to understanding Candida infections of the
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urinary tract. Unlike C. albicans, C. glabrata is a genetic approach to understanding Candida infections of the urinary tract. Unlike C. albicans, C. glabrata is haploid making it an excellent model for genetic analysis of virulence using already established genetic tools. We propose first to identify genes specifically involved in colonization and persistence in the urinary tract. We will use two different complementary global approaches. First, a variation of signature-tagged mutagenesis that we have established in C. glabrata will be used to screen a bank of. glabrata mutants for those that are unable to colonize and replicate in the bladder. Second, a library of genomic fragments fused to GFP will be constructed and screened for promotes specifically induced in the bladder or kidney but not under laboratory conditions These two global approaches will yield overlapping sets of genes relevant to the host interaction. Lastly, we will analyze in detail the role of any identified genes in urinary tract infections. Identified genes will first be prioritized for further study based on sequence homology. Mutants will be characterized with a set of in vitro assays for different aspects of the host interaction, including adherence to host tissue, interaction with phagocytes and growth under in vitro conditions mimicking the bladder environment. Different genes are likely to have roles in different aspects of infection which can be assayed only if the dynamics of the infection are known. We will therefore also use our signature-tagged strains to analyze the dynamics of UTI infection for wild type and mutant strains of C. glabrata, distinguishing between initial colonization and outgrowth. These approaches will provide insight into diverse aspects of the yeast- host interaction and an improved understanding of the processes contributing to fungal UTI, ultimately permitting enhanced therapeutic intervention. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PATHOGENIC MECHANISMS IN URINARY TRACT INFECTIONS Principal Investigator & Institution: Stamm, Walter E.; Professor; Medicine; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2001; Project Start 24-FEB-1998; Project End 31-JAN-2003 Summary: An estimated 150 million UTIs occur annually on a global basis, accounting for direct health care costs of $6 billion. While no aggregate assessment of the morbidity, mortality and total costs related to UTIs can be calculated, these infections clearly represent a significant public health burden. This program project proposes studies that will improve our understanding of the epidemiology , risk factors, microbial ecology, molecular pathogenesis and prevention of UTIs. The objectives of the project will be met through the development of a multi-disciplinary research team that will collaborate to carry out four interrelated projects. Project 1 will delineate the protective role of hydrogen peroxide producing lactobacilli, the major microbial species of the normal vaginal flora, in preventing vaginal colonization with E. coli and UTI in young women. The project will ultimately test a novel approach to the prevention of UTI in women, namely, use of a highly adherent hydrogen peroxide producing lactobacillus strain administered as a vaginal suppository. In Project 2, the role and regulation of bladder epithelial cell glycosphingolipids as attachment sites for uropathogenic bacteria will be studied using primary cultures of bladder epithelial cells. Identification of specific interactions between bacterial adhesins and epithelial cell glycosphingolipid receptors may facilitate the development of novel means of prevention using topically applied comparative analogs. Project 3 will identify new virulence genes in two important uropathogens, E. coli and Pseudomonas aeruginosa by studying gene expression under conditions of actual infection. In Project 4, the epithelial cell responses and intracellular signaling pathways that are activated after Dr fimbria bearing E. coli attach to epithelial
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cells via Decay Accelerating Factor will be studied. A laboratory core will provide primary bladder epithelial cells, ribotyping, characterization of urovirulence genes and other resources to the projects. An Administrative/Biostatistical Core will coordinate the project and provide biostatistical expertise to project investigators. The proposed studies will result in new approaches to the prevention of UTIs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PEPTIDE DERIVATIVES TO TREAT URINARY TRACT INFECTIONS Principal Investigator & Institution: Otvos, Laszlo; Associate Professor; Chaperone Technologies, Inc. 801 Mockingbird Ln Audubon, Pa 19403 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 31-DEC-2003 Summary: (provided by applicant): The war between man and bacteria entered a new phase. With the rapid spread of antimicrobial resistant bacterial strains the currently used drug families start to fail and desperate calls for a new armory of agents are regularly voiced. Indeed, apart from the discovery of natural antibacterial peptides from plants and animals, there have been few new antibiotics developed in recent years. In this desperate situation the insect-derived cationic proline-rich antibacterial peptide family can come to the rescue. Unlike most other native antimicrobial peptides that interrupt the bacterial membrane permeability barrier, drosocin, pyrrhocoricin and apidaecin were shown to deactivate an intracellular bacteria-specific protein, and were shown to be completely non-toxic in vitro and in vivo to mammalian cells and live mice. We characterized the in vitro activity spectrum, in vivo efficacy and mode of action of these peptides, especially those of pyrrhocoricin, the most active member of this antimicrobial family against selected bacterial strains. Pyrrhocoricin and drosocin appear to kill bacteria by binding to the multihelical lid region of the 70 kDa heat shock protein DnaK and inhibit chaperone-assisted protein folding. Pyrrhocoricin and its designed analogs kill (-lactam-, tetracycline- and aminoglycoside-resistant Escherichia coli, Klebsiella pneumoniae, Salmonella typhimurium, and Haemophilus influenzae clinical isolates, among many others, in nanomolar or low micromolar concentrations. In addition, these peptides protect mice from experimental systemic E. coli or local H. influenzae lung infection when added intravenously (i.v.) or as an aerosol. Our multiply protected dimeric lead analogs retain all the high in vitro activities of the native compound, and show remarkable stabilities in mammalian sera. The activity spectrum of the pyrrhocoricin analogs, the urgent need for new antimicrobial compounds to treat human urinary tract infections (UTI) and the generally observable tissue distribution and renal clearance of peptidic drugs suggest that if appropriately developed, pyrrhocoricin derivatives will be suitable candidates for the treatment of UTI in the clinical setting. This grant application is concerned with the development of such a peptide-based drug candidate. In the Phase I stage of the studies, we will characterize the efficacy of the current dimeric lead pyrrhocoricin analog against a series of uropathogenic bacteria in vitro by using two different assay types. In addition, the in vivo potency, approximate dose and efficacious administration routes (i.v., subcutaneous or oral) will be characterized in a widely accepted mouse ascending UTI model, which uses an E. coli strain isolated from a human pyelonephritis case. If the lead compound shows promising in vitro and in vivo efficacy data, in Phase II, we will optimize the lead compound for further increased in vitro efficacy against uropathogenic bacterial strains, stability, oral bioavailability, lack of toxicity and reduced manufacturing costs. Four peptide analogs will be selected for further in vivo activity studies in mice. When all data are available, a final pyrrhocoricin derivative will be identified, and it will be investigated for its ability to treat experimental UTI in a
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rabbit model. In addition, the final drug candidate will be subjected to detailed toxicity studies in rats. Our hope is that by the end of the grant period, we will be able to provide a pyrrhocoricin-derived peptide for ensuing US Food and Drug Administration-approved preclinical and clinical evaluation against urinary tract infections. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PHOTODYNAMIC THERAPY OF LOCALIZED INFECTIONS Principal Investigator & Institution: Hamblin, Michael R.; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 31-DEC-2006 Summary: (provided by applicant): The overall goal of this proposal is to explore a novel photochemical method for killing antibiotic resistant pathogenic bacteria in localized models of infection. Photodynamic therapy (PDT) employs a non-toxic dye termed a photosensitizer (PS) and low intensity visible light, which in the presence of oxygen produce cytotoxic species. PDT has the advantage of dual selectivity in that the PS can be targeted to its destination cell or tissue, and in addition the illumination can be spatially directed to the lesion. PDT has previously been used to kill pathogenic microorganisms in vitro, but until now this has not been accomplished in animal models of infection. We have developed a novel method of targeting PS conjugates to both Gram (+) and Gram (-) pathogenic bacteria that can produce up to 6 logs of killing in vitro, while in vivo it increases the selectivity of the treatment for bacteria while sparing host tissue. This is based on the covalent attachment of the PS chlorin e6 to polycationic delivery vehicles such as poly-L-lysine, that increases the selective binding to bacteria and enables the PS to penetrate the cell walls of Gram (-) bacteria to gain access to sensitive intracellular sites. Multi-antibiotic resistant strains are as easily killed as wildtype strains. We have generated preliminary data using luminescent bacteria and a lowlight imaging camera, that PDT will kill both Gram (-) species (Escherichia coli and Pseudomonas aeruginosa) and Gram (+) species Staphylococcus aureus) in vivo in animal models of both early and established infections. In the case of the invasive P. aeruginosa mice are cured of an otherwise fatal infection. Localized PDT may have an additional advantage in that it is also possible to inactivate secreted extracellular virulence factors that pathogenic bacteria use to establish infections and invade tissue. This project will seek to explore the determinants of PDT for localized infections. Four specific aims will focus on optimizing the treatment in different mouse models of early, acute and chronic infections, comprising excisional wounds, established soft tissue infection, chronic abscesses, burns and urinary tract infections. Since one of the advantages of PDT is its rapidity compared to traditional antibiotic therapy, we will also study the use of PDT to quickly reduce the bacterial burden in the infection, followed by antibiotics to eliminate the residual bacteria. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: PHYTOTHERAPY FOR BENIGN PROSTATIC HYPERPLASIA Principal Investigator & Institution: Avins, Andrew L.; Assistant Clinical Professor; Kaiser Foundation Research Institute 1800 Harrison St, 16Th Fl Oakland, Ca 94612 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-MAR-2009 Summary: (provided by applicant): The use of herbal extracts for treatment of benign prostatic hyperplasia (BPH) is growing rapidly in the United States. Numerous small clinical studies, carried out primarily in Europe, suggest that some of these extracts have
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great potential for providing relief of symptoms and, possibly, altering the natural course of BPH. The size and quality of prior studies, however, make it impossible to provide firm evidence-based recommendations to patients; the need for higher-quality, longer-term studies is compelling. This proposal describes plans to establish a Clinical Evaluation and Treatment Center in response to RFA # DK-02-026. We plan to bring the substantial patient population and scientific resources of the Northern California KaiserPermanente (NCKP) Division of Research (DOR) to support the successful completion of this important multicenter randomized clinical trial. While the final details of the research protocol will be established by the trial's Steering and Planning Committee, the approach described in this proposal is based on prior successful trials of BPH therapeutics and an ongoing NIH-funded randomized, double-blind, placebo-controlled trial of saw palmetto currently being conducted by our group. Participants will be recruited from five NCKP clinical facilities, which serve over 100,000 men aged 50 and older who are unlikely to meet exclusion criteria. Entry criteria include male participants at least 50 years old with an American Urological Association Symptom Index (AUASI) Score >7, no prior history of prostate cancer or prostate surgery, PSA below the age-adjusted upper limit (or PSA<10 with negative prostate biopsy), and creatinine<2.0mg/dl. Patients on current medical therapy will undergo a wash-out phase prior to final eligibility determination. Eligible patients will undergo a one-month single-blind run-in period; those demonstrating adequate adherence will be randomized in equal proportions to saw palmetto, pygeum, or placebo. Patients will be followed at four-month intervals for a period of four-to-six years. Primary endpoints are those specified in the RFA (acute urinary retention, BPH-related renal insufficiency, recurrent urinary tract infections, incontinence, and an increase of at least 4 points in the AUASI); secondary endpoints include symptom scores, uroflow measurements, and adverse effects. A systematic, multifaceted approach will be used to promote participant adherence to the study protocol. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PREVENTION OF PSEUDOMONAS INFECTION WITH ANTI-PCRV Principal Investigator & Institution: Spack, Edward G.; Intermune Pharmaceuticals, Inc. 1710 Gilbreth Rd, #301 Burlingame, Ca 94010 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-MAR-2003 Summary: (provided by applicant): We propose an innovative approach to prevent Pseudomonas aeruginosa infection by blockade of a critical Type III secretory protein with monoclonal antibodies. Pseudomonas causes disease by the release of exotoxins which destroy host tissue and paralyze the phagocytic mechanism of macrophages. To be active, many toxins require translocation from the interior of the bacteria directly into the eukaryotic cell. This translocation (type Ill secretory mechanism) is accomplished by a group of proteins which form a channel from the interior of the bacterium to the interior of the host cell. Preliminary work has shown that one of the type Ill secretory proteins, PcrV, is critical for translocation of toxins into the host cell. Blockade of this protein with active immunization or passive immunization with polyclonal antibodies prevents infection with P. aeruginosa in a murine model of pneumonitis. The overall goal of this Phase I proposal is to develop a murine monoclonal antibody to PcrV to prevent infection with P. aeruginosa. This work should establish proof of principle that a monoclonal antibody to PcrV can prevent infection, thus supporting the development of human monoclonal antibodies as a preventive therapy in patients at high risk for P. aeruginosa infection. PROPOSED COMMERCIAL APPLICATION: Pseudomonas aeruginasa is a major cause of hospital-acquired infection, accounting for 20% of
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nosocomial pneumonias,10-15% of nosocomial urinary tract infections and 10% of sepsis. In addition, P. aeruginosa infection is the major cause of mortality in cystic fibrosis. Current treatment is associated with a high rate of antibiotic resistance and a 2550% failure rate. The proposed treatment provides a novel approach to the prevention of P. aervginosa infection in patients at high risk for this infection, including patients on ventilators, bum patients, patients with in-dwelling catheters, neutropenic patients, and patients with cystic fibrosis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PREVENTION OF UTI IN PERSONS WITH SPINAL CORD INJURY Principal Investigator & Institution: Darouiche, Rabih O.; Phys Med and Rehabilitation; Baylor College of Medicine 1 Baylor Plaza Houston, Tx 77030 Timing: Fiscal Year 2004; Project Start 01-FEB-2004; Project End 31-JAN-2008 Summary: (provided by applicant): People who have spinal cord injury (SCI) experience an increase in bacterial infections. These infections always interfere with quality of life of the patient, frequently result in lost productivity due to hospitalization and, in the long term, cause significant morbidity. Bacteria that cause symptomatic urinary tract infections (UTI) can usually be found in the urine beforehand. However, not all bacteria present in the bladder of people with SCI lead to UTI. Bacteria usually colonize the bladder of most SCI patients who rely upon indwelling catheterization, and of many others who use other methods for bladder management. Some of these bacteria result in UTI while other bacteria colonize the bladder without causing overt symptoms of infection. In the SCI patient group, seemingly benign bacterial colonization of the bladder is often left untreated as it may offer some protection against more harmful bacteria. One such seemingly benign bacterium, called E. coli 83972, was identified previously. Several studies revealed that E. coli 83972 was able to persist in the human bladder for extended periods, up to four years (8 to 12 months on average), after it was experimentally implanted. SCI test subjects who maintained bladder colonization with E. coli 83972 remained essentially free from symptoms of bladder infection for as long as E. coli 83972 was present. They remained essentially free of symptoms even when other bacteria were present in the urine together with E. coli 83972. UTI is an almost universal occurrence among persons with SCI. It is associated with large personal and monetary cost to the patient and to society. As a consequence, study of the impact of deliberate bladder colonization with E. coil 83972 on the occurrence of symptomatic UTI has the potential for improving the quality of life of SCI patients and decreasing the cost of health care. The proposed study consists of a single aim that deals with the efficacy of this method in SCI patients. The PIs propose a prospective, randomized, double-blind placebo-controlled multicenter trial to evaluate the clinical efficacy of this innovative therapeutic protocol. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: PROGRESSION OF BPH ON MEDICAL THERAPY Principal Investigator & Institution: Kaplan, Steven A.; Urology; Columbia University Health Sciences New York, Ny 10032 Timing: Fiscal Year 2001; Project Start 27-APR-1995; Project End 31-MAR-2003 Summary: Benign prostatic hyperplasia (BPH) is the most common affliction of men over the age of 50. Traditionally associated symptoms are felt to be secondary to bladder outlet obstruction, dynamic tone of the smooth muscle of the prostate or inherent bladder dysfunction. A host of alternative therapeutic options have been described in
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the literature over the past 5 years. However, these studies have focused on the relative efficacy and side effect profile of these therapies. There have been few long term studies of the natural history of BPH progression in those who are either treated or in those who are followed by watchful waiting. Moreover, the natural history of BPH in various age and ethnic groups have been poorly characterized. Finally, to date, there have been no long term studies of the association between bladder function, prostatic obstruction, prostate size, symptoms and therapy employed. This full scale, 7 year trial, will provide enormous insight into the progression of prostate enlargement and symptoms in both an untreated population and one treated with medication. This is of particular importance because efficacy of medical therapy can be truly determined only with an understanding of the untreated natural history of BPH. The effects of pharmacologic reduction in the size of the prostate utilizing the 5alpha reductase inhibitor, finasteride, and/or physiologic reduction of urethral outlet resistance using the alpha1 receptor antagonist, doxazosin, on symptoms, voiding parameters and reversibility of bladder dysfunction will be assessed. Four treatment groups will be studied, l) placebo, 2) 5 mg of finasteride (PROSCAR), 3) 8 mg of doxazosin (CARDURA) and, 4) 5 mg finasteride and 8 mg of doxazosin. Progression of disease will be measured by either a rise in baseline AUA Symptom Score of 4 points, development of urinary retention, incontinence or recurrent urinary tract infections or a rise in baseline serum creatinine of 50%. Through this full scale BPH trial, we hope to ascertain: A) the optimal temporal intervention in the treatment of BPH, B) whether reduction in the size of the prostate result in true regression of the disease process? C) a priori prostate tissue characteristics which predict severity of disease or preferential response to medical therapy, D) whether specific ethnic groups manifest various forms of BPH resulting in different rates of progression and differential response to therapy? and, E) whether concomitant prostate conditions such as cancer or prostatitis are effected by pharmacologic intervention for BPH? Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PROPHYLAXIS OF URINARY TRACT INFECTIONS AFTER STRESS URINARY INCONTINENCE SURGER Principal Investigator & Institution: Rogers, Rebecca; University of New Mexico Albuquerque Controller's Office Albuquerque, Nm 87131 Timing: Fiscal Year 2001 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: INFECTIONS
QUINOLONE
RESISTANCE
IN
NOSOCOMIAL
URINARY
Principal Investigator & Institution: Lautenbach, Ebbing; Medicine; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2001; Project Start 30-SEP-2000; Project End 30-JUN-2005 Summary: (adapted from the application) This award will prepare Ebbing Lautenbach M.D., M.P.H., for a career as an independent investigator in Infectious Diseases epidemiology with a particular focus on the proper use of antimicrobial agents and the emergence of antimicrobial resistance. He proposes a comprehensive, interdisciplinary program that will provide him with the skills and experience necessary for independent patient-oriented research. The training component includes advanced education in clinical epidemiology and biostatistics, training in Hospital Epidemiology, and dual
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mentorship from an internationally recognized pharmacoepidemiologist and a highly experienced Infectious Diseases clinical researcher. The research component of the Award will focus on resistance to the fluoroquinolone (FQ) antibiotics among nosocomial urinary tract infections (UTIs). UTIs are by far the most common of nosocomial infections and are responsible for significant morbidity, mortality, and cost associated with hospitalization. FQ antibiotics have played an increasingly important role in the treatment of nosocomial UTIs particularly as resistance to other first line antibiotics has become widespread. The utility of FQ antibiotics in this setting is, however, seriously threatened by the emergence of resistance to these agents in recent years. Causes of FQ resistance in nosocomial UTIs are unclear and whether risk factors for FQ resistance vary across different infecting organisms has not been studied. This proposal will investigate risk factors for FQ resistance for individual pathogens as well as for gram-positive and gram-negative pathogens as distinct groups. These data will then be used to develop clinical prediction rules for FQ resistance in patients with UTI. Finally, the impact of FQ resistance will be investigated by comparing the outcomes of patients with FQ-resistant and FQ-susceptible infections. This work will provide a basis for the control of the emergence of FQ resistance. Future studies will be planned to evaluate the effect of interventions designed to decrease the emergence of resistance as well as the effect of the prediction rules in selecting more effective empiric antimicrobial therapy for patients with nosocomial UTI. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: REDUCING INFECTION IN INDWELLING MEDICAL DEVICES Principal Investigator & Institution: Lin, Tung-Liang; Ast Products, Inc. 9 Linnell Cir Billerica, Ma 01821 Timing: Fiscal Year 2001; Project Start 01-JUN-2001; Project End 30-NOV-2001 Summary: (Verbatim from the Applicant's Abstract): Urethral catheters are essential in the management of many diseases and conditions yet often result in catheter associated urinary tract infections. The use of sterile closed systems, advanced infection control protocols, and antimicrobial parts has not prevented infection or the associated morbidity increase. Additionally, direct patient care costs for these infections exceed $0.5billion annually. Our novel ironically bonded antimicrobial coating shows promise for the long-term prevention of infection in urethral catheters. This research will establish that unlike conventional systems where the antimicrobial agent is entrapped in a matrix and acts through diffusion, our antimicrobial agents are ionically bonded to a polymeric backbone. The release mechanism is one of ion exchange and is not purely diffusional. The effectiveness is thus sustainable for a long period. Initial work will establish antimicrobial activity as a function of time against four organisms characteristic of nosocomial urinary tract infections. The method of release will be established by comparing the results of three different measures of antimicrobial activity, namely, the zone of inhibition and bacterial adherence tests. Preliminary biocompatibility tests and coating integrity will be conducted as well. Coating effectiveness greater than 1 week will justify further in vivo investigations. PROPOSED COMMERCIAL APPLICATION: Urethral catheters that effectively reduce the incidence of infection in long-term use have great market potential due to the reduction in mortality, morbidity, and direct patient costs. For instance, the direct patient costs associated with the treatment of catheter associated urinary tract infections exceeds $0.5 billion annually. The success of Bard's hydrogel/silver Foley catheter demonstrates that the medical and insurance communities would be highly receptive to reasonably priced products that significantly reduces the incidence of nosocomial urinary tract infections.
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While advances in infection control procedures and medical devices have reduced the overall incidence of catheter associated urinary tract infections, in long term (> one week) catheterizations there is a greater than 50% chance that those patients will acquire a sometimes anti-biotic resistant infection. There are no products that are effective for more than 1 week. Preliminary results have shown that our antimicrobial coating is effective for as long as 30 days, a four-fold increase over any other commercially available product. Since our coating does not alter the physical characteristics of the base material or product, acceptance by the medical device community once safety and efficacy is established should be achievable with appropriate business development efforts. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: REGULATION OF PSEUDOMONAS AERUGINOSA TYPE III SECRETION Principal Investigator & Institution: Yahr, Timothy L.; Microbiology; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2003; Project Start 15-MAY-2003; Project End 30-APR-2008 Summary: (provided by applicant): Pseudomonas aeruginosa is an opportunistic pathogen of humans commonly isolated from patients with cystic fibrosis, nosocomial pneumonias, urinary tract infections, or severe burns. One of the many virulence determinants of P. aeruginosa is a type III secretion system. The type III system is required for pathogenesis in infection models of lung, cornea, and burned epithelia and functions to deliver the ExoS, ExoT, ExoU, and ExoY cytotoxins to the cytoplasm of eukaryotic host cells. Translocation of these toxins promotes evasion of host immune responses and dissemination of P. aeruginosa from sites of colonization. Expression of the type III system is highly regulated and induced through contact of P. aeruqinosa with eukaryotic cells, growth in the presence of serum, or tow Ca2+ concentrations. The mechanism of coupling these environmental cues to expression of the regulon are unclear. The long-term goal of these studies is to identify and characterize the mechanisms involved in regulation of the P. aeruginosa type III regulon. We have identified ExsD as a negative regulator of the type III regulon. ExsD is unique to P. aeruginosa, lacks a DNA-binding motif, and is coordinately regulated with the type III regulon. In an exsD mutant expression of the regulon is derepressed and overexpression of ExsD leads to repression of the regulon. We hypothesize that ExsD functions as a sensor of the type III translocase. Prior to contact of P. aeruginosa with eukaryotic host cells the type Ill secretion channel is closed and ExsD prevents expression of the type III system. Contact with host cells opens the type III translocase and triggers a mechanism for suppressing the negative regulatory activity of ExsD. Therefore, we hypothesize that the negative regulatory activity of ExsD is reflective of the secretion state of the bacterial cell. This would provide a simple and specific mechanism for induction of the type III system in response to contact of P. aeruginosa with eukaryotic cells. To test these hypotheses we propose the following specific aims; (1) Identify ExsD domains and residues important for negative regulation, (2) Identify and characterize ExsD interaction partners, and (3) Determine the regulatory role of ExsD in response to alternative environmental cues. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: REGULATION OF THE (POLY) SIALIC ACID VIRULENCE FACTOR Principal Investigator & Institution: Vimr, Eric R.; Associate Professor; Animal Sciences; University of Illinois Urbana-Champaign Henry Administration Bldg Champaign, Il 61820 Timing: Fiscal Year 2001; Project Start 01-JUL-1998; Project End 31-MAY-2003 Summary: The broad objective of this proposal is to increase our understanding of bacterial polysaccharide synthesis in pathogenic microorganisms. The K1 antigen, or polysialic acid capsule is a homopolymer of alpha2,8- linked sialyl residues. Synthesis of the capsule depends on about 15 genes of the kps pathogenicity locus that is organized into at least two convergently transcribed operons, one of which is controlled by the thermoregulated kpsF promoter. The anti-recognition functions of sialic acids (antiphagocytosis; inhibition of antibody-independent complement fixation; molecular mimicry of host antigens) make these unique nine- carbon carboxy sugar acids important determinants of virulence in diverse human and animal pathogens. Escherichia coli K1 is a leading cause of neonatal meningitis and a frequent cause of urinary tract infections in children and bacteremia in adults. Vaccination against these diseases may not always be practical, and conventional drug therapy is problematic. Alternative or improved therapies may emerge from a better understanding of capsular polysaccharide expression. Objectives of the application are to understand the molecular mechanisms of capsule thermoregulation and sialic acid precursor biosynthesis. This information is necessary for construction of defined mutants that will allow us to unambiguously determine the association between capsule and lipopolysaccharide O antigen during disease. To accomplish these objectives, we will pursue three specific aims. First, thermoregulation will be investigated with an in vitro transcription system designed to determine the intrinsic sensitivity of the kpsF promoter to temperature. The role of a positive regulator will be determined by isolation and characterization of mutants that no longer regulate the kpsF promoter. Second, the origin of sialic acid biosynthetic precursor, N- acetylmannosamine, will be determined by genetic and biochemical approaches. Finally, the role of the capsule and its association with O antigen will be determined using defined mutants in an animal model of E. coli K1 meningitis and bacteremia. At the completion of this research, we expect to have clearly delineated the relative contributions of cell surface polysaccharides to pathogenesis. We also expect to have identified specific new targets for potential therapeutic developments aimed at blocking capsule expression in vivo. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: RHO-MODIFYING CYTOTOXIC NECROTIZING FACTOR OF E. COLI Principal Investigator & Institution: O'brien, Alison D.; Professor of Microbiology & Immunol; Henry M. Jackson Fdn for the Adv Mil/Med Rockville, Md 20852 Timing: Fiscal Year 2002; Project Start 30-SEP-1995; Project End 30-APR-2007 Summary: Cytotoxic necrotizing factor type 1 (CNF1) is a member of a family of bacterial toxins that target the Rho family of small GTP-binding proteins in mammalian cells. CNF1 deamidates a single glutamine residue in RhoA, Cdc42, and Rac1 but not in Ras. This deamidation results in the constitutive activation of these GTPases which can trigger actin stress fiber formation, multinucleation, or cell death, depending on the target cell and dose of toxin. CNF1 is frequently produced by Escherichia coli strains that cause urinary tract infections (UTIs), such as cystitis, prostatitis, and pyelonephritis. In support of this epidemiological connection, we recently showed that
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CNF1 not only induces apoptosis in 5637 human uroepithelial cells but also provides a growth advantage to uropathogenic E. coli (UPEC) in a mouse model of ascending UTI when compared to CNF1-negative isogenic mutants. Additionally, we found that CNF1 enhances the degree of inflammation and resulting tissue damage in bladders of infected mice and in prostates of rats challenged intraurethrally with CNF1-producing UPEC. Finally, we discovered that CNF1- producing UPEC survive better than CNF1negative isogenic mutants in the presence of human polymorphonuclear leukocytes (PMNs). Taken together, these findings have led us to propose the following hypothesis. CNF1 enhances the pathogenicity of UPEC by: i.) promoting uroepithelial cell shedding; ii.) evoking a large influx of PMNs while providing toxin-producing E. coli protection against PMN-mediated killing, and; iii.) facilitating deeper invasion of the bladder or prostate by the infecting strain. The specific aims designed to test this theory are to: 1.) further define the role that CNF1 plays in the pathogenesis of UPEC-mediated cystitis in the mouse and prostatitis in the rat by analyzing the interaction of CNF1 or CNF1expressing UPEC with PMNs from these animals and by defining the CNF1-mediated cytokine response that evokes PMN influx; 2) investigate the cellular and cytokine responses of a human bladder organoid to CNF1 or a CNF1-producing UPEC strain; 3.) identify the functional receptor for CNF1 by sequential biochemical and molecular approaches, and; 4.) continue to evaluate CNF1 structure and function by characterizing the CNF1 epitopes recognized by neutralizing monoclonal antibodies and by analyzing chimeric molecules comprised of portions of CNF1 and the related toxins CNF2, Pasteurella multocida toxin, and the Bordetella dermonecrotic toxin. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ROLE OF CD14 AND TLR4 IN UROTHELIAL RESPONSE TO LPS. Principal Investigator & Institution: Bjorling, Dale E.; Professor and Chair; Surgical Sciences; University of Wisconsin Madison 750 University Ave Madison, Wi 53706 Timing: Fiscal Year 2003; Project Start 10-AUG-2003; Project End 30-JUN-2005 Summary: (provided by applicant): Urinary tract infections result in approximately 9.6 million doctor visits annually, and 20% of women will develop a urinary tract infection during their lifetime. A majority (70-90%) of urinary tract infections are the result of gram-negative bacteria that produce lipopolysaccharide (LPS), and LPS is the component of the cell wall of gram-negative bacteria responsible for cellular response resulting in pain and inflammation. The mucosa of a variety of organ systems (GI, respiratory, urinary) functions as the first line of innate defense against infection by gram-negative bacteria; however, cellular processes that regulate the response of urothelial cells to LPS remain unknown. Although other investigators have reported that urothelial cells do not express CD14 (the primary cognate cellular receptor for LPS), a recent report described the presence of message for CD14 in human bladder mucosa, and preliminary investigations in our laboratory demonstrated the presence of message and protein in human urothelial cells. These cells also express Toll-Like Receptor 4 (TLR4), which appears to provide the transmembrane pathway for signaling in response to LPS. Urothelial cells have the capacity to produce cytokines which recruit and activate leukocytes. The goal of this research is to test the hypothesis that CD14 and TLR4 play a crucial role in the response of the urothelium to LPS. Using cultures of human urothelial cells and mice with genetic disruption of either CD14 or TLR4, we will investigate the response of the urothelium in vitro and in vivo to LPS in the presence or absence of functional CD14 and TLR4. Further, we will determine whether or not the soluble form of CD14 amplifies the response of urothelial cells to LPS. The proposed experiments will better define participation of these receptors in the response of
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urothelial cells to LPS in the presence (in vivo) and absence (in vitro) of other components of innate immunity. We anticipate that these studies will provide the foundation for continued investigations to identify additional proteins that may participate in this process and dissect signaling pathways which translate LPS binding by urothelial cells into cellular response. The long-range goal of this research is to identify strategies to minimize pain and harmful cellular effects associated with cystitis due to LPS-producing gram-negative bacteria. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ROLE OF ENTEROCOCCUS FAECALIS BIOFILMS DURING INFECTION Principal Investigator & Institution: Kristich, Christopher J.; Microbiology; University of Minnesota Twin Cities 200 Oak Street Se Minneapolis, Mn 554552070 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JUL-2005 Summary: (provided by applicant): Epidemiological evidence indicates that microbial biofilms play a role in indwelling device-associated bloodstream and urinary tract infections. However, direct evidence supporting this claim is lacking in most cases. The Gram-positive opportunistic pathogen Enterococcus faecalis is frequently implicated as a causative agent of urinary tract infections, bacteremia, and bacterial endocarditis. Each of these types of infections has been associated with organisms growing as a biofilm. E. faecalis is often isolated from biofilms on various indwelling devices. These observations lead to the hypothesis that biofilm growth is an important mechanism by which E. faecalis is able to persist in vivo and cause infection. The goal of this proposal is to evaluate the contribution of biofilm growth to E. faecalis persistence and proliferation in animal models of infection. The following approaches will be taken: identify the genes involved in biofilm formation, examine the regulation of those genes during biofilm development, analyze gene expression in biofilms grown in vivo, and assess mutants impaired in biofilm formation in in vivo models of infection. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: ROLE OF TAMM-HORSFALL PROTEIN IN URINARY TRACT DEFENSE Principal Investigator & Institution: Wu, Xue-Ru; Professor; Urology; New York University School of Medicine 550 1St Ave New York, Ny 10016 Timing: Fiscal Year 2001; Project Start 15-SEP-2000; Project End 30-JUN-2005 Summary: (Adapted from the Applicant's Abstract): Urinary tract infection (UTI) is a major clinical problem caused primarily by E. coli. Most uropathogenic E. coli strains express type 1 fimbriae, an important urovirulence factor that mediate E. coli adhesion to specific urothelial receptors. Recent data from the investigators' laboratory and others showed that uroplakins Ia and Ib, two major protein subunits for urothelial plaques that cover >80% of the urothelial surface, are the major urothelial receptors of the type 1fimbriated E. coli. It has been suggested, however, that the binding of the bacteria to urothelial receptors can be blocked by soluble receptors present in the host urine. One soluble receptor candidate is Tamm-Horsfall protein (THP), the most abundant protein in human urine. Their preliminary data indicate that THP can bind via its high-mannose moiety to type 1-fimbriated E. coli, and block the binding of type 1-fimbriated E. coli to urothelial receptors in vitro. These results strongly suggest a possible defensive role of THP against E. coli infection. The main goal of this study is to evaluate the in vivo function of THP, first focusing on its role in host urinary defense against type 1-
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fimbriated E. coli infection. Toward this end, they will perform three series of experiments: (1) ablate the THP gene by conventional in vivo knockout in which THP gene will be ablated during embryonic development, as well as by inducible knockout in which THP gene will be ablated in adult mice, and examine the susceptibility of transgenic mice to E. coli-induced UTIs; (2) map and characterize the E. coli-binding, high mannose-type glycosylation site(s) of THP isolated from human and mouse urine, and recombinant THP expressed in cultured epithelial cells; and (3) selectively mutate the high-mannose glycosylation site(s) of THP in transgenic mice and test the effects of the absence of this unique glycosylation of THP on urinary defense. These studies should lead to a better understanding of the physiological function of THP, the molecular pathogenesis of urinary tract infections, and the host defense mechanisms of the urinary tract. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: STRUCTURE AND DYNAMICS OF MAMMALIAN UROTHELIAL PLAQUES Principal Investigator & Institution: Sun, Tung-Tien H.; Professor; Dermatology; New York University School of Medicine 550 1St Ave New York, Ny 10016 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 31-AUG-2004 Summary: The long-term goal of this project is to better understand the assembly and regulation of the urothelial plaques that cover almost the entire apical surface of mammalian urothelium. These plaques represent two dimensional crystals of hexagonally arranged 16-nm particles, that are composed of four major integral membrane proteins called uroplakins. It has been assumed that urothelial plaques are rigid structures that are overlaid by a glyco-calyx or mucin layer which plays a role in forming the permeability barrier and/or in inhibiting the attachment of uropathogenic E. coli. Recent negative staining and quick-freeze deep-etch (QFDE) data suggest that each 16-nm particle is a mushroom-like structure consisting of a 16-nm propeller-like head anchored into the lipid bilayer of the plaque via a narrower 9-nm tail; that the plaque structure is in dynamic flux undergoing breakage and reformation; and that the apical surface of the mouse urothelial plaques are not covered by an extensive glycocalyx. This project will perform four series of experiments to determine (i) whether the apical urothelial surface of mammalian bladder exhibits species-dependent variations; (ii) how the uroplakin particles are delivered to the apical surface during wound healing; (iii) whether the size of the urothelial plaques are adjusted reversibly during different phases of the micturition cycle; and (iv) whether urothelial plaques are heterogeneous in their uroplakin composition. These studies will shed light on the heterogeneity of urothelia, the appropriateness of some of the animal models for studying urinary tract infections, the mechanism of permeability barrier and selfdefense against infections, the mode by which the cytoplasmic AUM vesicles are assembled and regulated during normal and hyperplastic urothelial differentiation, the dynamic nature of urothelial plaques, and the uroplakin composition of individual urothelial plaques. The data may also have implications on the pathophysiological bases of important bladder diseases including interstitial cystitis and urinary tract infections. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: SYNTHESIS AND BENZOXAZOLYL)FLUOROOUINOLONES
ACTIVITY
OF
SOME
7-(2-
Principal Investigator & Institution: Richardson, Thomas O.; Bethune-Cookman College Daytona Beach, Fl 321143099
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Urinary Tract Infections
Timing: Fiscal Year 2001 Summary: Fluoroquinolones are orally administered and well tolerated drugs and are increasingly used affectively to combat various systemic infections as well as urinary tract infections. However, the fluoroquinolones are not as useful as desired in some therapeutic applications particularly respiratory infections due to low activity against streptococci and enterococci. More active and broader spectrum drugs are greatly needed. The effect of the imidazo [1,2-a] pyridin-2-yl group and 6-substituted imidazo [1,2-a] pyridin-2-yl groups at the C7 position upon the activity of fluoroquinolones will be investigated. The groups substituted at the six position of the imidazo [1,2-a] pyridine ring will be chloro, bromo, cyano, carbamoyl, methyl, carboxyl, acetamido and amino groups. Structure- activity anti-bacterial relationships will be determined. This study will aid in defining the optimum C7 group necessary for the design of more active and broader spectrum fluoroquinolone drugs for the treatment of various kinds of bacterial infections. The synthesis of the proposed fluoroquinolones will be accomplished by us of the Gould-Jacobs synthetic path to quinolones. In vitro tests will be accomplished by a broth dilution method versus norfloxacin, a clinically used fluoroquinole, as reference. Antibacterial potency will be measured in terms of the minimum inhibitory concentration (MIC). The bacteria which will be used for in vitro tests are Escherichia coli, Pseudomonas aeruginosa, Proteus mirabilis, Klebsiella pneumoniae and Staphylococcus aureus. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: THE SIGNIFICANCE OF FUNGURIA IN HOSPITALIZED PATIENTS Principal Investigator & Institution: Miller, Loren G.; Harbor-Ucla Research & Educ Inst 1124 W Carson St Torrance, Ca 90502 Timing: Fiscal Year 2001; Project Start 30-SEP-2000; Project End 31-JUL-2005 Summary: (adapted from applicant's abstract): The incidence of fungal urinary tract infections, largely caused by Candida species, is rapidly increasing in hospitalized patients. In just one decade, the proportion of fungal urinary isolates from medical intensive care units has increased from 22% to 39%. The significance of isolated fungi from the urinary tract remains a subject of considerable debate. Nevertheless, many patients with funguria receive antifungal drugs, which is expensive and may be contribute to selection of drug resistant fungi. Since there is an urgent need to understand the significance of fungal urinary tract isolates, the applicant plans to perform a series of 5 patient-oriented research projects. Project 1 is a prospective observational study of >600 patients with funguria from 2 centers over 24 months. The patients will be followed longitudinally for persistence of infection and complications, and they will be compared to similar numbers of control patients without funguria (to be identified in Project 2, a hospital-based prospective surveillance project) to create models to address whether funguria is independently associated with mortality and whether funguria is associated with or predicts fungemia. The robust size of these models will allow the applicant to control for known risks of mortality and fungemia and to ask whether subpopulations (e.g., critically ill patients) are at higher risk for morbidity or mortality from fungemia. Project 3 will be to follow patients with funguria up to 1 year after hospital discharge to define long-term outcomes and complications. Project 4 will employ molecular typing methods to investigate strain relatedness between blood and urine fungal isolates in patients who have both funguria and fungemia. Project 5 will estimate the incidence of funguria among hospitalized patients and the impact of funguria on resource utilization nationwide using various health care databases. From the above studies, the applicant expects to generate information that
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will help clinicians employ focused strategies toward the patient with funguria and may result in cost savings while contributing to the effort to avoid a shift towards azoleresistant fungi. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: THERAPY AND PREVENTION FOR BACTERIAL VAGINOSIS Principal Investigator & Institution: Schwebke, Jane R.; Professor; Medicine; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2002; Project Start 01-JAN-2002; Project End 31-DEC-2007 Summary: Bacterial vaginosis (BV) is a sexually associated disease caused by a complex mixture or anaerobic bacteria. BV is the most prevalent cause of symptomatic vaginal discharge in the U.S. and is associated with numerous complications including pre term delivery of infants, pelvic inflammatory disease, urinary tract infections and acquisition/transmission of sexually transmitted diseases including human immunodeficiency virus. Widespread control of BV has been suggested as a possible means for decreasing the incidence of HIV in the developing world, however, current achievable cure rates combined with high recurrence rates makes this solution impractical. Further, half of all women who meet the clinical diagnostic criteria for BV are asymptomatic and the appropriate management of these women is unknown. Although the microbiological changes which occur in women with symptomatic and asymptomatic BV appear by culture techniques to be identical, the clinical significance of asymptomatic BV is unclear. The current therapy for BV consists of seven days of oral or topical metronidazole or clindamycin. However, there is a growing concern that eradication of organisms from the lower genital tract may be inadequate to prevent recurrences or complications and that more intensive therapy may be required for eradication of upper tract infection/colonization. Further, some of the key organisms associated with BV such as Mobiluncus and mycoplasmas are resistant to the standard therapies. Lastly, although BV has epidemiological characteristics of an STD, the role of the male partner in its pathogenesis remains unknown. We propose to conduct clinical trials which will assess enhanced therapy for BV, including longer duration of therapy and combination therapy as well as increased use of condoms to improve initial cure rates and decrease recurrences. We will also utilize specimens from these prospective studies to further study the association of Mobiluncus, an organism strongly associated with BV using sensitive PCR technology. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: TLR4 IN HOST RESPONSES TO URINARY TRACT INFECTIONS Principal Investigator & Institution: Martin, Steven M.; Pathology and Immunology; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2003; Project Start 01-FEB-2003; Project End 31-JAN-2004 Summary: (provided by applicant): Urinary tract infections (UTIs) are a significant health problem in the United States infecting 20% of the female population. The gramnegative bacteria E. coli causes the majority of UTIs and mouse models of UTIs have been established using clinical isolates of uropathogenic E. Coli (UPEC). One question that needs to be addressed in the pathogenesis of UTIs is how does the host recognize the UPEC and initiate an inflammatory response. The protein Toll Like Receptor (TLR) 4 has been shown to mediate recognition of lippopolysaccharide (LPS), produced by Gram-negative bacteria, on macrophages and dendritic cells. While the role of TLR4 on bone marrow derived cells in the immune system has been extensively studied, TLR4
64
Urinary Tract Infections
function on epithelial cells has not been addressed. In fact, it is the epithelial cell that first encounters bacteria in UTIs. C3H/HeJ mice have a mutation in the TLR4 gene that renders the molecule unable to signal in response to LPS. Wild type C3H/HeN mice express functional TLR4 and produce a robust inflammatory response to UPEC. C3H/HeJ mice do not initiate this inflammatory response. Utilizing a reciprocal bone marrow reconstitution approach, the relative roles of TLR4 expression on the bone marrow derived cells and stromal/epithelial cells will be investigated. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: TYPE 1 FIMBRIAE AND URINARY TRACT INFECTIONS Principal Investigator & Institution: Hasty, David L.; Professor; Anatomy and Neurobiology; University of Tennessee Health Sci Ctr Memphis, Tn 38163 Timing: Fiscal Year 2001; Project Start 01-DEC-1998; Project End 30-NOV-2003 Summary: (Adapted from the Applicant's Abstract): Type I fimbriae are important for the urovirulence of E. coli, because they mediate adhesion, stimulate a mucosal immune response and mediate interactions with phagocytes. Experimental studies indicate the importance of type 1 fimbriae, but previous epidemiological studies found no correlation, perhaps because of the virtual ubiquity of the fim (type 1) gene cluster. Allelic variants of the gene for the FimH adhesin subunit that significantly alter the receptor-binding phenotype of E. coli have recently been discovered. Their distribution suggests that certain phenotypes offer a selective advantage in the urinary tract. This hypothesis is supported by preliminary animal studies. The effects of the expression of different fimH allelic variants on the ability of E. coli to colonize the mouse urinary tract will be studied. Isogenic E. coli strains will be inoculated into mouse bladders and infection studied by quantitative cultures and histopathology. We will identify the murine uroepithelial cell receptor(s) for E. coli expressing different fimH alleles. Preliminary studies lead us to focus on the asymmetrical unit membrane plaques (AUMs) of transitional epithelium and their constituent proteins, the uroplakins. In vitro and in vivo adhesion and adhesion inhibition assays (using uroplakin-specific antibodies) will be performed to confirm whether these molecules are the type 1 receptors. We will study the recruitment of leukocytes into the urinary tract mucosa of infected mice. The adhesion, ingestion and calling of E. coli by human and mouse peripheral blood PMN will be quantified and extracellular and intracellular release of oxygen metabolites will be measured. We will characterize the induction of cytokine production in urinary tract mucosa of mice infected with a recombinant E. coli strain exhibiting an M\H type 1 fimbrial phenotype typical of UTI isolates. When the basic responses have been characterized, we will determine whether qualitatively or quantitatively different responses are elicited by E. coli expressing different "fimH alleles. Production of inflammatory and regulatory cytokines will be measured by ELISAs and/or message will be measured by. RT-PCR. Cellular source(s) of cytokines will be determined by immunocytochemistry. The long-term goal of this research is to understand the role of type 1 fimbriae in the pathogenesis of UTIs to eventually enhance procedures for treatment or prevention. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: URINARY INCONTINENCE: REPRODUCTIVE/HORMONAL RISK FACTORS Principal Investigator & Institution: Thom, David H.; Assistant Professor; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122
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65
Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2007 Summary: Urinary incominence (UI) is a common problem in middle aged and older women that substantiMly impacts quality of life, increases caregiver burden and risk of institutionalization, and results in biUiom of dollars in health care expenditures annuaUy. Our studies, and those of other investigators, have identified several established and potential risk factors for incominence, including childbirth, hormone use, diabetes, obesity and surgery, urinary tract infections, pelvic organ prolapse, and physical activity. Dr. Lue, another UCSF SCOR investigator, have used animal models to investigate several major risk factors identified epidemiologically, including vaginal birth (normal and traumatic), obesity, hysterectomy, menopause, and oral estrogen therapy. In vitro studies of hormone receptors using tissue cultures from the lower urinary tract of laboratory animals and humans by investigators at UCSF and elsewhere have advanced our understanding of the complex interaction between exogenous and endogenous hormones and urogenital physiology. The primary objective for the proposed study is to increase our understanding of risk factors for incontinence by identifying risk factors for incident UI, assessing biologic markers as risk factors for prevalent UI, and integratmg our investigations with laboratory investigation in this area. We will accomplish this by prospectively following a population-based, ethically diverse cohort of 2100 middle-aged and older women over 5 years to: (1)determine the incidence of and risk factors for new urinary incontinence; (2) determine the incidence of and risk factors for major changes in incominence frequency; and (3) investigate serum 17-13-cstradiol and progesterone as risk factors for prevalent incontinence. A major strength of this study is our retrospective cohort of 2100 women for who we have detailed data on lifetime reproductive events from abstraction of up to 50 years of medical records, detailed interviews, and linkage to excellent pharmacy, laboratory, outpatient and hospital databases. Another strength is our established relationships with laboratory investigators in this area. Combining a prospective epidemiologic study of our unique cohort with laboratory studies will help translate findings into new preventive and theraocutic aooroaches to reduce the individual and social burden of urinary incontinence. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: URINARY SUSCEPTIBILITY
TRACT
INFECTIONS--IMMUNE
BASIS
OF
Principal Investigator & Institution: Hopkins, Walter J.; Senior Research Scientist; Surgery; University of Wisconsin Madison 750 University Ave Madison, Wi 53706 Timing: Fiscal Year 2001; Project Start 01-MAY-1992; Project End 30-JUN-2003 Summary: (Adapted from the Applicant's Abstract): Urinary tract infections (UTI) are estimated to occur in up to 50% of all women in their lifetimes. Approximately seven million women per year develop acute infections that account for an estimated one billion dollars in health care costs. Recurrent infections develop in 10-15% of adult women and require ongoing medical care and use of antibiotics both acutely and prophylactically. In addition, lower tract infections can ascend to the kidneys, possibly leading to kidney damage or bacteremia. Host resistance to UTI's is comprised of several different mechanisms that include innate immunity, inflammatory responses, and adaptive immune responses. Cytokines, phagocytes, natural killer cells, and T cells are active in host defense to infections. Our preliminary results have shown that functional deficiencies in any of these components leads to increased severity of infections in the bladder and kidneys of experimental animals. There is also evidence that innate and early cellular defenses can act to prevent bladder infections from ascending to the
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Urinary Tract Infections
kidneys. Preliminary genetic studies have indicated that increased host susceptibility to UTI's has a heritable component. Therefore, the overall objective is to more clearly define the host responses that are active during a UTI and to identify genetic factors that increase susceptibility. The specific aims are: 1) to identify the role of cellular host defense mechanisms that are active during a UTI and, in particular those that are most important in preventing lower tract infections from ascending to the kidneys; 2) to evaluate the hypothesis that antibody-mediated hyporesponsiveness to E. coli antigens in UTI-susceptible women is associated with T cell regulation or induction of antibody responses; 3) to evaluate the hypothesis that a heritable trait increases the susceptibility to some women to recurrent UTIs by analysis of familial inheritance patterns; 4) to evaluate the hypothesis that a genetic locus (or loci) in mice will increase susceptibilityto an induced UTI. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: UROPATHOGENIC E COLI VIRULENCE GENES--COMPREHENSIVE ANALYSIS Principal Investigator & Institution: Donnenberg, Michael S.; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2001 Summary: Uropathogenic E. coli (UPEC) are the leading cause of all types of urinary tract infections (UTIs): cystitis and pyelonephritis, community- acquired and nosocomial, complicated and uncomplicated, symptomatic and asymptomatic. Despite many of study, a clear understanding of the pathogenesis of UPEC infections has not emerged. With the exception of type-1 and P fimbriae, heretofore suspected virulence factors have not been confirmed to be essential for UT in animal models. Meanwhile, the discovery the pathogenicity islands in UPEC strains has awakened our appreciation that vast stretches of the genomes of these organisms have yet to be scrutinized. We propose a trifaceted approach to accomplish signature-tagged mutagenesis to identify genetic loci required for colonization in our murine model of ascending UTI. Our success thus far in isolating 12 such mutants portends well for the achievement of this aim. Our second specific aim is to identify fragments of E. coli mutants portends well for the achievement of this aim. Our second specific aim is to identify fragments of E. coli CFT073 genome that are not present in E. coli K-12. Our second specific aim is to identify fragments of E. coli CFT073 genome that are not present in E. coli K-12. We have used a PCR-based genome subtraction approach to clone fragments enriched for such sequences and, using this approach have identified a gene encoding the usher from a previously unknown fimbria. Our third specific aim is to use a green fluorescent protein promoter trap and a fluorescence activated cell sorter to identify promoters from E. coli CFT073 that are expressed specifically in the murine urinary tract. Finally, we will prioritize the loci identified in the first three specific aims and select the most promising for further study in vivo and in vitro to determine the mechanisms by which the products these genes contribute to the pathogenesis of UTI. We believe that this comprehensive analysis of the virulence determinants of UPEC will greatly advance our understanding of the pathogenesis of UTI. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: USING PROSPECTIVE MDS DATA TO ENHANCE RESIDENT SAFETY Principal Investigator & Institution: Teigland, Christie L.; Foundation for Long Term Care 150 State St, Ste 301 Albany, Ny 12207
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Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-MAR-2005 Summary: The goal of the proposed research is to determine whether preventable adverse outcomes for the frail elderly population in long term care settings can be reduced by providing prospective computerized information alerting nursing and other staff to the likelihood of the problem occurring, and further providing resident specific risk factors likely to cause the adverse outcome so that preventive actions can be taken. Through the use of prospective clinical data, we hope to shift the focus from using Minimum Data Set (MDS) assessment data for investigating adverse outcomes after they occur, to one centering on the safety of individual residents before an adverse event occurs. We plan to test three specific outcomes of care that are directly related to patient safety and are known to be preventable adverse events -- falls, pressure ulcers and urinary tract infections (UTIs). These clinical outcomes represent major socio-economic problems in health care. Thespecific aims of the project are to: (1) Support the use of clinical informatics by 'front line' staff that are in daily contact with residents. (2) Utilize predictive logistic regression models that identify the critical risk factors and calculate the likelihood of an adverse outcome occurring with a high degree of accuracy. (3) Encourage the day-to-day use of targeted clinical information through development of a web based application that will flag residents by predicted probability of the event occurring--high, moderate or low--and report the residents' risk factors based on the most recent assessment data so that interventions can be initiated before a negative outcome occurs, thereby improving the processes and outcomes of care. (4) Test the feasibility of accessing the web based application using 'bedside' electronic technology vs. hard copy reports. (S) Educate nursing staff about how to use the technology. (6) Conduct special training aimed at providing a basic understanding of the relevance and practical application of statistical and clinical information in avoiding errors and improving resident safety. (7) Measure statistically significant improvements in facility rates for the adverse outcomes following implementation of the information. (8) Identify 'best practices' in implementing the use of clinical informatics, as well as barriers to implementation. (9) Extend the collection and use of this data to the entire continuum of long term care providers. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: VACCINIUM ANTIADHERENTS
MACROCARPON
COMPOUNDS
AS
E.COLI
Principal Investigator & Institution: Turner, Allison; Prog/Collab Res/Pharmactl Scis; University of Illinois at Chicago 1737 West Polk Street Chicago, Il 60612 Timing: Fiscal Year 2001; Project Start 15-JUN-2001 Summary: The precise structure of active compounds in Vaccinium macrocarpon Ait. (VM; cranberry) that prevent urinary tract infections, and the active metabolites found in urine of subjects who have ingested VM, have not been determined to date, and are a primary focus of this research. Another important focus is the thorough training and education of the applicant in research methods for botanical dietary supplements, through an extensive study of VM, that will include the following: a) Botanical characterization of VM as determined by electron and light microscopy; genetic identification of VM and related botanicals will be determined via polymerase chain reaction techniques. b) Chemical characterization: VM will be incubated with bacteria, and active (bound) compounds isolated using an ultrafiltration-Mass Spec. technique; this is a unique and timesaving approach for determining VM active compounds. Active metabolites will be isolated by incubating bacteria with urine from subjects who have ingested VM, followed by the same technique. Larger quantities of active compounds
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Urinary Tract Infections
will be isolated using bioactivity guided fractionation and may include reverse phase HPLC. NMR and MS data will be used for structure ID. c) Biochemical characterization will include bioassay of the above 'active' compounds to confirm anti- adherence activity. The numerous techniques involved in this characterization of VM will give the trainee excellent understanding of VM's biochemical targets and mechanism of action, including, but not necessarily limited to, inhibition of bacterial adhesion. Following this comprehensive characterization, a chemically and biologically standardized product, based on HPLC analysis, bioactive fractionation, and stability studies of the active constituents within will be developed for use in clinical studies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: VIRUL FACTORS OF UROPATH ESCHERICHIA COLI Principal Investigator & Institution: Redford, Peter; Medical Microbiol & Immunology; University of Wisconsin Madison 750 University Ave Madison, Wi 53706 Timing: Fiscal Year 2001; Project Start 01-APR-1999; Project End 31-MAR-2004 Summary: Escherichia coli is the most common cause of community-acquired urinary tract infections, resulting in an estimated eight million physician visits a year in the United States. It is also a leading cause of nosocomial infections. Pathogenic E. coli strains carry groupings of genes which are absent in strains that do not cause infection of the urinary tract. These clusters of extra genes have been termed "pathogenicity islands (PAI's)", and the hypothesis to be tested is that they code for the factors necessary in the development of cystitis, pyelonephritis and sepsis. The basis for this hypothesis is the homology of some PAI sequences to virulence genes recognized in other pathogens such as Salmonella, Shigella, Yersinia, Serratia, Vibrio, Bordetella and Streptococcus. Putative virulence genes will be identified on the basis of homologies to sequences of known virulence genes. They also will be found by signature-tagged mutagenesis of a wild-type uropathogenic strain and negative selection of avirulent mutants in a murine model of ascending urinary tract infection. The mouse model will be used to confirm the loss of virulence of signature- tagged mutants as well as test specific allelic knock-outs of candidate virulence genes identified by sequence homologies. New virulence genes will be further examined at the molecular level with analysis of expression conditions and characterization of translation products. The goal of this project is to further the understanding of the mechanisms that underlie the ability of these uropathogenic E. coli to cause disease. The information will promote the development of new chemotherapies and vaccines. The performance of this research plan requires an investigator with a background in basic research. The candidate for this award has worked a year at the NIH and a year so far in the laboratory of the sponsor. The sponsor has more than two decades of research experience in this field and has trained eight Ph.D.'s and six postdoctoral fellows. He heads a fully-equipped and expertly- staffed laboratory at a large university with a distinguished record of research success. The combination of the experience gained in this research, the mentorship given by the sponsor and the educational opportunities offered by the university will accomplish the second goal of this project and meet the ambition of the award candidate: to launch a career as an independent academic investigator. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “urinary tract infections” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for urinary tract infections in the PubMed Central database: •
"Actinobaculum massiliae," a New Species Causing Chronic Urinary Tract Infection. by Greub G, Raoult D.; 2002 Nov; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=139656
•
3-day course of ofloxacin versus cefalexin in the treatment of urinary tract infections in postmenopausal women. by Raz R, Rozenfeld S.; 1996 Sep; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=163499
•
A nurse led education and direct access service for the management of urinary tract infections in children: prospective controlled trial. by Coulthard MG, Vernon SJ, Lambert HJ, Matthews JN.; 2003 Sep 20; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=196395
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Activities of a Nitrofurazone-Containing Urinary Catheter and a Silver Hydrogel Catheter against Multidrug-Resistant Bacteria Characteristic of Catheter-Associated Urinary Tract Infection. by Johnson JR, Delavari P, Azar M.; 1999 Dec; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=89599
•
Activities of oral antibiotics on Providencia strains isolated from institutionalized elderly patients with urinary tract infections. by Cornaglia G, Frugoni S, Mazzariol A, Piacentini E, Berlusconi A, Fontana R.; 1995 Dec; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=163040
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Aerococcus urinae in Urinary Tract Infections. by Zhang Q, Kwoh C, Attorri S, Clarridge JE III.; 2000 Apr; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=86536
•
Antimicrobial Activity of Intraurethrally Administered Probiotic Lactobacillus casei in a Murine Model of Escherichia coli Urinary Tract Infection. by Asahara T, Nomoto K, Watanuki M, Yokokura T.; 2001 Jun; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=90542
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Carumonam (Ro 17-2301; AMA-1080) compared with gentamicin for treatment of complicated urinary tract infections. by Hoepelman AI, Bakker LJ, Verhoef J.; 1988 Apr; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=172204
3 4
Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.
With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.
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Carumonam versus ceftazidime for urinary tract infections. by Edelstein H, Oster S, Cassano K, McCabe R.; 1988 Jul; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=172338
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Characterization of Tn1546 in Vancomycin-Resistant Enterococcus faecium Isolated from Canine Urinary Tract Infections: Evidence of Gene Exchange between Human and Animal Enterococci. by Simjee S, White DG, McDermott PF, Wagner DD, Zervos MJ, Donabedian SM, English LL, Hayes JR, Walker RD.; 2002 Dec; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=154613
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Chronic Urinary Tract Infection Due to Candida utilis. by Hazen KC, Theisz GW, Howell SA.; 1999 Mar; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=84571
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Cluster randomised controlled trial of tailored interventions to improve the management of urinary tract infections in women and sore throat. by Flottorp S, Oxman AD, Havelsrud K, Treweek S, Herrin J.; 2002 Aug 17; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=117890
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Cohort study of bacterial species causing urinary tract infection and urinary tract abnormalities in children. by Honkinen O, Lehtonen OP, Ruuskanen O, Huovinen P, Mertsola J.; 1999 Mar 20; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27791
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Comparative in vitro activities of 13 antimicrobial agents against Morganella-ProteusProvidencia group bacteria from urinary tract infections. by Piccolomini R, Cellini L, Allocati N, Di Girolamo A, Ravagnan G.; 1987 Oct; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=175007
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Comparative study of cephradine and amoxicillin-clavulanate in the treatment of recurrent urinary tract infections. by Brumfitt W, Hamilton-Miller JM.; 1990 Sep; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=171931
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Comparative trial of cefuroxime axetil in recurrent urinary tract infections illustrating importance of 6-week follow-up. by Brumfitt W, Hamilton-Miller JM, Smith GW.; 1987 Sep; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=174961
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Comparative, double-blind, prospective, multicenter trial of temafloxacin versus trimethoprim-sulfamethoxazole in uncomplicated urinary tract infections in women. by Iravani A.; 1991 Sep; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=245267
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Comparison of cefprozil and cefaclor for treatment of acute urinary tract infections in women. by Iravani A.; 1991 Sep; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=245300
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Comparison of single-dose administration and three-day course of amoxicillin with those of clavulanic acid for treatment of uncomplicated urinary tract infection in women. by Raz R, Rottensterich E, Boger S, Potasman I.; 1991 Aug; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=245246
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Construction of a flagellum-negative mutant of Proteus mirabilis: effect on internalization by human renal epithelial cells and virulence in a mouse model of ascending urinary tract infection. by Mobley HL, Belas R, Lockatell V, Chippendale G, Trifillis AL, Johnson DE, Warren JW.; 1996 Dec; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=174527
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Corynebacterium riegelii sp. nov., an Unusual Species Isolated from Female Patients with Urinary Tract Infections. by Funke G, Lawson PA, Collins MD.; 1998 Mar; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=104597
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Development of a Long-Term Ascending Urinary Tract Infection Mouse Model for Antibiotic Treatment Studies. by Hvidberg H, Struve C, Krogfelt KA, Christensen N, Rasmussen SN, Frimodt-Moller N.; 2000 Jan; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=89643
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Development of a rapid assay for detecting gyrA mutations in Escherichia coli and determination of incidence of gyrA mutations in clinical strains isolated from patients with complicated urinary tract infections. by Ozeki S, Deguchi T, Yasuda M, Nakano M, Kawamura T, Nishino Y, Kawada Y.; 1997 Sep; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=229961
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Direct antimicrobial susceptibility testing for acute urinary tract infections in women. by Johnson JR, Tiu FS, Stamm WE.; 1995 Sep; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=228402
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Double-blind, dose-range-finding study of fleroxacin (RO 23-6240; AM-833) for treatment of complicated urinary tract infections. by Wolfhagen MJ, Hoepelman AI, Verhoef J.; 1990 Mar; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=171606
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Double-blind, randomized comparison of 24 weeks of norfloxacin and 12 weeks of norfloxacin followed by 12 weeks of placebo in the therapy of complicated urinary tract infection. by Sheehan GJ, Harding GK, Haase DA, Thomson MJ, Urias B, Kennedy JK, Hoban DJ, Ronald AR.; 1988 Aug; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=172398
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Effects of Sulfamethizole and Amdinocillin against Escherichia coli Strains (with Various Susceptibilities) in an Ascending Urinary Tract Infection Mouse Model. by Kerrn MB, Frimodt-Moller N, Espersen F.; 2003 Mar; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=149286
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Efficacy and safety of oral ciprofloxacin for treatment of serious urinary tract infections. by Fass RJ.; 1987 Feb; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=174680
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Ertapenem versus Ceftriaxone Followed by Appropriate Oral Therapy for Treatment of Complicated Urinary Tract Infections in Adults: Results of a Prospective, Randomized, Double-Blind Multicenter Study. by Tomera KM, Burdmann EA, Pamo Reyna OG, Jiang Q, Wimmer WM, Woods GL, Gesser RM.; 2002 Sep; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=127417
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Evaluating the benefits of antimicrobial prophylaxis to prevent urinary tract infections in children: a systematic review. by Le Saux N, Pham B, Moher D.; 2000 Sep 5; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=80458
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Evaluation of the Leukocyte Esterase and Nitrite Urine Dipstick Screening Tests for Detection of Bacteriuria in Women with Suspected Uncomplicated Urinary Tract Infections. by Semeniuk H, Church D.; 1999 Sep; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=85454
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Evaluation of the Usefulness of a Novel Injectable Cephalosporin, E1040, and Ceftazidime for Management of Complicated Urinary Tract Infections Caused by Pseudomonas aeruginosa and Proteus mirabilis by Using the Rat Urolithiasis Model. by Satoh M, Munakata KI, Takeuchi H, Yoshida O.; 1992 Jul; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=191627
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Fluorescent Amplified Fragment Length Polymorphism Probabilistic Database for Identification of Bacterial Isolates from Urinary Tract Infections. by Kassama Y, Rooney PJ, Goodacre R.; 2002 Aug; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=120626
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Frequency of Isolation of Staphylococcus lugdunensis in Consecutive Urine Cultures and Relationship to Urinary Tract Infection. by Haile DT, Hughes J, Vetter E, Kohner P, Snyder R, Patel R, Cockerill III FR.; 2002 Feb; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=153380
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Human Lactoferrin and Peptides Derived from a Surface-Exposed Helical Region Reduce Experimental Escherichia coli Urinary Tract Infection in Mice. by Haversen LA, Engberg I, Baltzer L, Dolphin G, Hanson LA, Mattsby-Baltzer I.; 2000 Oct; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=101542
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Identification of a Gene Encoding Heat-Resistant Agglutinin in Escherichia coli as a Putative Virulence Factor in Urinary Tract Infection. by Srinivasan U, Foxman B, Marrs CF.; 2003 Jan; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=149612
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Identification of a Klebsiella pneumoniae strain associated with nosocomial urinary tract infection. by Kil KS, Darouiche RO, Hull RA, Mansouri MD, Musher DM.; 1997 Sep; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=229970
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Identification of Urovirulence Traits in Escherichia coli by Comparison of Urinary and Rectal E. coli Isolates from Dogs with Urinary Tract Infection. by Johnson JR, Kaster N, Kuskowski MA, Ling GV.; 2003 Jan; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=149618
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Identifying barriers and tailoring interventions to improve the management of urinary tract infections and sore throat: a pragmatic study using qualitative methods. by Flottorp S, Oxman AD.; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=150569
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In vitro Binding of Type 1-Fimbriated Escherichia coli to Uroplakins Ia and Ib: Relation to Urinary Tract Infections. by Wu X, Sun T, Medina JJ.; 1996 Sep 3; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=38479
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In Vivo Dynamics of Type 1 Fimbria Regulation in Uropathogenic Escherichia coli during Experimental Urinary Tract Infection. by Gunther NW IV, Lockatell V, Johnson DE, Mobley HL.; 2001 May; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=98232
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In Vivo Phase Variation of Escherichia coli Type 1 Fimbrial Genes in Women with Urinary Tract Infection. by Lim JK, Gunther NW IV, Zhao H, Johnson DE, Keay SK, Mobley HL.; 1998 Jul; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=108346
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In vivo selection of Klebsiella pneumoniae strains with enhanced quinolone resistance during fluoroquinolone treatment of urinary tract infections. by Deguchi T, Kawamura T, Yasuda M, Nakano M, Fukuda H, Kato H, Kato N, Okano Y, Kawada Y.; 1997 Jul; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=163971
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Isolation of an SHV-12 [beta]-Lactamase-Producing Escherichia coli Strain from a Dog with Recurrent Urinary Tract Infections. by Teshager T, Dominguez L, Moreno MA.; 2000 Dec; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=90231
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Leuconostoc pseudomesenteroides as a Cause of Nosocomial Urinary Tract Infections. by Cappelli EA, Barros RR, Camello TC, Teixeira LM, Merquior VL.; 1999 Dec; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=85896
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Lipopolysaccharide-responder and nonresponder C3H mouse strains are equally susceptible to an induced Escherichia coli urinary tract infection. by Hopkins W, Gendron-Fitzpatrick A, McCarthy DO, Haine JE, Uehling DT.; 1996 Apr; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=173927
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Loracarbef versus cefaclor in the treatment of urinary tract infections in women. by Iravani A.; 1991 Apr; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=245091
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Measurement of Urinary Lactoferrin as a Marker of Urinary Tract Infection. by Arao S, Matsuura S, Nonomura M, Miki K, Kabasawa K, Nakanishi H.; 1999 Mar; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=84465
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Molecular Epidemiologic Approaches to Urinary Tract Infection Gene Discovery in Uropathogenic Escherichia coli. by Zhang L, Foxman B, Manning SD, Tallman P, Marrs CF.; 2000 Apr; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=97380
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Pharmacodynamic parameters and toxicity of netilmicin (6 milligrams/kilogram/day) given once daily or in three divided doses to cancer patients with urinary tract infection. by Van der Auwera P, Meunier F, Ibrahim S, Kaufman L, Derde MP, Tulkens PM.; 1991 Apr; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=245072
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Pharmacokinetics and bioavailability of intravenous-to-oral enoxacin in elderly patients with complicated urinary tract infections. by Marchbanks CR, Mikolich DJ, Mayer KH, Zinner SH, Dudley MN.; 1990 Oct; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=171973
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Pharmacokinetics of [18F]fleroxacin in patients with acute exacerbations of chronic bronchitis and complicated urinary tract infection studied by positron emission tomography. by Fischman AJ, Livni E, Babich JW, Alpert NM, Bonab A, Chodosh S, McGovern F, Kamitsuka P, Liu YY, Cleeland R, Prosser BL, Correia JA, Rubin RH.; 1996 Mar; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=163176
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Prospective, randomized, placebo-controlled trial of norfloxacin for the prophylaxis of recurrent urinary tract infection in women. by Nicolle LE, Harding GK, Thompson M, Kennedy J, Urias B, Ronald AR.; 1989 Jul; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=176057
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Randomised trial of cranberry-lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women. by Kontiokari T, Sundqvist K, Nuutinen M, Pokka T, Koskela M, Uhari M.; 2001 Jun 30; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=33514
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Randomized clinical trial of rifampin-trimethoprim and sulfamethoxazoletrimethoprim in the treatment of localized urinary tract infections. by Stein GE, Gurwith D, Gurwith M.; 1988 Jun; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=172286
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Randomized comparison of cefepime and ceftazidime for treatment of skin, surgical wound, and complicated urinary tract infections in hospitalized subjects. by Gentry LO, Rodriguez-Gomez G.; 1991 Nov; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=245387
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Randomized, controlled trial of a 10-day course of amifloxacin versus trimethoprimsulfamethoxazole in the treatment of acute, uncomplicated urinary tract infection. Amifloxacin Multi-Center Trial Group. by Boyko EJ, Iravani A, Silverman MH, Schelling DJ, Wright RA.; 1990 Apr; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=171664
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Randomized, double-blind comparison of ciprofloxacin and trimethoprimsulfamethoxazole for complicated urinary tract infections. by Allais JM, Preheim LC, Cuevas TA, Roccaforte JS, Mellencamp MA, Bittner MJ.; 1988 Sep; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=175861
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Reflux in the Mouse Model of Urinary Tract Infection. by Johnson JR.; 1998 Dec; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=108775
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Risk Factors for Antibiotic-Resistant Escherichia coli Isolated from Hospitalized Patients with Urinary Tract Infections: a Prospective Study. by Sotto A, De Boever CM, Fabbro-Peray P, Gouby A, Sirot D, Jourdan J.; 2001 Feb; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=87756
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Role of Enterococcus faecalis Surface Protein Esp in the Pathogenesis of Ascending Urinary Tract Infection. by Shankar N, Lockatell CV, Baghdayan AS, Drachenberg C, Gilmore MS, Johnson DE.; 2001 Jul; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=98508
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Serum Immunoglobulin Response and Protection from Homologous Challenge by Proteus mirabilis in a Mouse Model of Ascending Urinary Tract Infection. by Johnson DE, Bahrani FK, Lockatell CV, Drachenberg CB, Hebel JR, Belas R, Warren JW, Mobley HL.; 1999 Dec; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=97083
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Serum response of Escherichia coli strains causing dyspepsia and urinary tract infection: relation to alpha-hemolysin production and O type. by Siegfried L, Kmetova M, Janigova V, Sasinka M, Takacova V.; 1995 Nov; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=173650
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Single-dose cefuroxime axetil versus multiple-dose cefaclor in the treatment of acute urinary tract infections. by Iravani A, Richard GA.; 1989 Aug; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=172627
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Single-dose ciprofloxacin at 100 versus 250 mg for treatment of uncomplicated urinary tract infections in women. by Garlando F, Rietiker S, Tauber MG, Flepp M, Meier B, Luthy R.; 1987 Feb; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=174727
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Sustained in vitro activity of human albumin microspheres containing chlorhexidine dihydrochloride against bacteria from cultures of organisms that cause urinary tract infections. by Egbaria K, Friedman M.; 1990 Nov; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=172009
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Symptomatic Shigella sonnei urinary tract infection. by Papasian CJ, Enna-Kifer S, Garrison B.; 1995 Aug; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=228374
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Time Course and Host Responses to Escherichia coli Urinary Tract Infection in Genetically Distinct Mouse Strains. by Hopkins WJ, Gendron-Fitzpatrick A, Balish E, Uehling DT.; 1998 Jun; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=108272
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Treatment duration for urinary tract infections in adults. by Gleckman RA.; 1987 Jan; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=174640
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Treatment of acute uncomplicated urinary tract infections with 3 days of lomefloxacin compared with treatment with 3 days of norfloxacin. by Nicolle LE, DuBois J, Martel AY, Harding GK, Shafran SD, Conly JM.; 1993 Mar; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=187709
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Treatment of Community-Acquired Acute Uncomplicated Urinary Tract Infection with Sparfloxacin versus Ofloxacin. by Henry D, Ellison W, Sullivan J, Mansfield DL, Magner DJ, Dorr MB, Talbot GH, Group FT.; 1998 Sep; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=105806
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Treatment of genitourinary tract infections with fluoroquinolones: activity in vitro, pharmacokinetics, and clinical efficacy in urinary tract infections and prostatitis. by Wolfson JS, Hooper DC.; 1989 Oct; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=172733
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Treatment of genitourinary tract infections with fluoroquinolones: clinical efficacy in genital infections and adverse effects. by Hooper DC, Wolfson JS.; 1989 Oct; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=172734
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Treatment of Mice with Staphylococcal Enterotoxin B Enhances Resolution of an Induced Escherichia coli Urinary Tract Infection and Stimulates Production of Proinflammatory Cytokines. by Morin MD, Hopkins WJ.; 1998 Jun; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=108226
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Trends in Antimicrobial Resistance among Urinary Tract Infection Isolates of Escherichia coli from Female Outpatients in the United States. by Karlowsky JA, Kelly LJ, Thornsberry C, Jones ME, Sahm DF.; 2002 Aug; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=127340
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Ultrasonography and abdominal radiography versus intravenous urography in investigation of urinary tract infection in men: prospective incident cohort study. by Andrews SJ, Brooks PT, Hanbury DC, King CM, Prendergast CM, Boustead GB, McNicholas TA.; 2002 Feb 23; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=65665
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UreR, the Transcriptional Activator of the Proteus mirabilis Urease Gene Cluster, Is Required for Urease Activity and Virulence in Experimental Urinary Tract Infections. by Dattelbaum JD, Lockatell CV, Johnson DE, Mobley HL.; 2003 Feb; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=145398
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Urinary Tract Infections Associated with Nontyphoidal Salmonella Serogroups. by Abbott SL, Portoni BA, Janda JM.; 1999 Dec; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=85919
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Use of ciprofloxacin versus use of aminoglycosides for therapy of complicated urinary tract infection: prospective, randomized clinical and pharmacokinetic study. by Fang GD, Brennen C, Wagener M, Swanson D, Hilf M, Zadecky L, DeVine J, Yu VL.; 1991 Sep; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=245279
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Use of Green Fluorescent Protein To Assess Urease Gene Expression by Uropathogenic Proteus mirabilis during Experimental Ascending Urinary Tract Infection. by Zhao H, Thompson RB, Lockatell V, Johnson DE, Mobley HL.; 1998 Jan; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=107894
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Visualization of Proteus mirabilis Morphotypes in the Urinary Tract: the Elongated Swarmer Cell Is Rarely Observed in Ascending Urinary Tract Infection. by Jansen AM, Lockatell CV, Johnson DE, Mobley HL.; 2003 Jun; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=155743
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Visualization of Proteus mirabilis within the Matrix of Urease-Induced Bladder Stones during Experimental Urinary Tract Infection. by Li X, Zhao H, Lockatell CV, Drachenberg CB, Johnson DE, Mobley HL.; 2002 Jan; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=127628
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with urinary tract infections, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “urinary tract infections” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for urinary tract infections (hyperlinks lead to article summaries): •
A multicenter study on clinical efficacy of ofloxacin in respiratory and urinary tract infections. Author(s): Grassi GG. Source: Infection. 1986; 14 Suppl 4: S300-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3546149&dopt=Abstract
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A nurse led education and direct access service for the management of urinary tract infections in children: prospective controlled trial. Author(s): Coulthard MG, Vernon SJ, Lambert HJ, Matthews JN. Source: Bmj (Clinical Research Ed.). 2003 September 20; 327(7416): 656. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14500439&dopt=Abstract
6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
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A prospective, multicenter, randomized, double-blind study comparing ertapenem and ceftriaxone followed by appropriate oral therapy for complicated urinary tract infections in adults. Author(s): Jimenez-Cruz F, Jasovich A, Cajigas J, Jiang Q, Imbeault D, Woods GL, Gesser RM; Protocol 021 Study Group. Source: Urology. 2002 July; 60(1): 16-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12100914&dopt=Abstract
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A study of urinary tract infections at Ile-Ife, Nigeria. Author(s): Ako-Nai AK, Kassim OO, Adeniran MO, Taiwo O. Source: East Afr Med J. 1993 January; 70(1): 10-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8513719&dopt=Abstract
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Acupuncture treatment in the prevention of uncomplicated recurrent lower urinary tract infections in adult women. Author(s): Alraek T, Soedal LI, Fagerheim SU, Digranes A, Baerheim A. Source: American Journal of Public Health. 2002 October; 92(10): 1609-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12356607&dopt=Abstract
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Amoxicillin-clavulanic acid versus cefaclor in the treatment of urinary tract infections and their effects on the urogenital and rectal flora. Author(s): Iravani A, Richard GA. Source: Antimicrobial Agents and Chemotherapy. 1986 January; 29(1): 107-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3524418&dopt=Abstract
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An Escherichia coli-based oral vaccine against urinary tract infections potently activates human dendritic cells. Author(s): Schmidhammer S, Ramoner R, Holtl L, Bartsch G, Thurnher M, Zelle-Rieser C. Source: Urology. 2002 September; 60(3): 521-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12350510&dopt=Abstract
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An international survey of the antimicrobial susceptibility of pathogens from uncomplicated urinary tract infections: the ECO.SENS Project. Author(s): Kahlmeter G; ECO.SENS. Source: The Journal of Antimicrobial Chemotherapy. 2003 January; 51(1): 69-76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12493789&dopt=Abstract
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Antibiotic duration for treating uncomplicated, symptomatic lower urinary tract infections in elderly women. Author(s): Lutters M, Vogt N. Source: Cochrane Database Syst Rev. 2002; (3): Cd001535. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12137628&dopt=Abstract
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Antibiotic prescribing patterns in Italian hospital inpatients with pneumonia, chronic obstructive pulmonary disease, and urinary tract infections. Author(s): Guglielmo L, Leone R, Moretti U, Conforti A, Spolaor A, Velo G. Source: The Annals of Pharmacotherapy. 1993 January; 27(1): 18-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8431612&dopt=Abstract
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Antibiotic resistance of bacteria associated with community-acquired urinary tract infections in the southern area of the Gaza Strip. Author(s): Astal Z, El-Manama A, Sharif FA. Source: Journal of Chemotherapy (Florence, Italy). 2002 June; 14(3): 259-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12120880&dopt=Abstract
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Antibiotic sensitivities of common bacterial pathogens in urinary tract infections at Gondar Hospital, Ethiopia. Author(s): Moges AF, Genetu A, Mengistu G. Source: East Afr Med J. 2002 March; 79(3): 140-2. Erratum In: East Afr Med J. 2002 August; 79(8): 426. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12389960&dopt=Abstract
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Antibiotic treatment for urinary tract infections does not follow guidelines, study says. Author(s): Rollins G. Source: Rep Med Guidel Outcomes Res. 2002 February 22; 13(4): 1-2, 5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12434774&dopt=Abstract
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Antibiotic treatment of urinary tract infections at a skilled nursing facility in Hawaii. Author(s): Cafege AL. Source: Hawaii Med J. 2002 July; 61(7): 138-41. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12192998&dopt=Abstract
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Antibiotic use as an inducer of resistant urinary tract infections. Author(s): Ball P. Source: Scand J Infect Dis Suppl. 1986; 49: 146-53. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3029858&dopt=Abstract
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Antimicrobial activity of imipenem against isolates from complicated urinary tract infections. Author(s): Ishihara S, Yamada T, Yokoi S, Ito M, Yasuda M, Nakano M, Kawada Y, Deguchi T. Source: International Journal of Antimicrobial Agents. 2002 June; 19(6): 565-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12135849&dopt=Abstract
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Antimicrobial activity of norfloxacin in enteric and urinary tract infections: combined effect of norfloxacin with aminoglycosides, tetracycline and chloramphenicol. Author(s): Mascellino MT, Lorenzi A, Bonanni M, Iegri F. Source: Drugs Exp Clin Res. 1986; 12(4): 319-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3720519&dopt=Abstract
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Antimicrobial resistance among uropathogens that cause community-acquired urinary tract infections in Bangui, Central African Republic. Author(s): Hima-Lerible H, Menard D, Talarmin A. Source: The Journal of Antimicrobial Chemotherapy. 2003 January; 51(1): 192-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12493816&dopt=Abstract
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Antimicrobial resistance in Escherichia coli causing urinary tract infections in Costa Rica: a clinical dilemma. Author(s): Williams DN, Sannes MR, Eckhoff AA, Peterson PK, Johnson JR, Sannes MR, San Roman M, Mora N, Moya J. Source: International Journal of Antimicrobial Agents. 2003 January; 21(1): 79-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12507843&dopt=Abstract
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Antimicrobial resistance pattern of Escherichia coli causing urinary tract infections, and that of human fecal flora, in the southeast of Iran. Author(s): Mansouri S, Shareifi S. Source: Microbial Drug Resistance (Larchmont, N.Y.). 2002 Summer; 8(2): 123-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12118516&dopt=Abstract
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Bacteremia and meningitis among infants with urinary tract infections. Author(s): Bachur R, Caputo GL. Source: Pediatric Emergency Care. 1995 October; 11(5): 280-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8570449&dopt=Abstract
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Bacteremia and urinary tract infections in young febrile children with bronchiolitis. Author(s): Dhaliwal HS. Source: Archives of Pediatrics & Adolescent Medicine. 1998 August; 152(8): 818-9; Author Reply 820. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9701146&dopt=Abstract
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Bacterial adherence in urinary tract infections caused by Escherichia coli. Author(s): Svanborg Eden C. Source: Scandinavian Journal of Urology and Nephrology. 1986; 20(2): 81-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2875519&dopt=Abstract
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Bacterial biofilms: influence on the pathogenesis, diagnosis and treatment of urinary tract infections. Author(s): Nickel JC, Costerton JW, McLean RJ, Olson M. Source: The Journal of Antimicrobial Chemotherapy. 1994 May; 33 Suppl A: 31-41. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7928835&dopt=Abstract
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Bacterial resistance in urinary tract infections: how to stem the tide. Author(s): Fluit AC, Schmitz FJ. Source: Expert Opinion on Pharmacotherapy. 2001 May; 2(5): 813-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11336624&dopt=Abstract
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Bacterial urinary tract infections in diabetes. Author(s): Patterson JE, Andriole VT. Source: Infectious Disease Clinics of North America. 1995 March; 9(1): 25-51. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7769219&dopt=Abstract
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Bacterial urinary tract infections in diabetes. Author(s): Schaeffer AJ. Source: The Journal of Urology. 1998 July; 160(1): 293. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9628663&dopt=Abstract
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Bacterial urinary tract infections in diabetes. Author(s): Patterson JE, Andriole VT. Source: Infectious Disease Clinics of North America. 1997 September; 11(3): 735-50. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9378933&dopt=Abstract
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Bay o 9867 (ciprofloxacin) in the treatment of urinary tract infections in elderly patients. Author(s): Vellucci A, De Rosa F, Bernardini G, Di Vico B. Source: Riv Eur Sci Med Farmacol. 1988 August; 10(4): 333-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3274909&dopt=Abstract
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Behavioral and functional abnormalities linked with recurrent urinary tract infections in girls. Author(s): Mazzola BL, von Vigier RO, Marchand S, Tonz M, Bianchetti MG. Source: Journal of Nephrology. 2003 January-February; 16(1): 133-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12649544&dopt=Abstract
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Behaviour modification group-treatment of children with recurrent lower urinary tract infections. Author(s): Lindstrom TC, Baerheim A, Flataas AS. Source: Scandinavian Journal of Caring Sciences. 2000; 14(4): 259-67. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12035217&dopt=Abstract
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Best pharmacological practice: urinary tract infections. Author(s): Nicolle L. Source: Expert Opinion on Pharmacotherapy. 2003 May; 4(5): 693-704. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12739995&dopt=Abstract
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Beta-D-Glucuronidase activity among prototrophic and auxotrophic variants of Escherichia coli and other Enterobacteriaceae commonly implicated in urinary tract infections. Author(s): Tapsall JW, McIver CJ. Source: Diagnostic Microbiology and Infectious Disease. 1995 July; 22(3): 261-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8565414&dopt=Abstract
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Betaines and urinary tract infections. Author(s): Chambers ST, Lever M. Source: Nephron. 1996; 74(1): 1-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8883013&dopt=Abstract
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Biochemical and serological patterns of Escherichia coli O2 strains isolated from patients with urinary tract infections. Author(s): Zingler G, Reissbrodt R, Falkenhagen U, Naumann G. Source: Zentralbl Bakteriol. 1992 January; 276(2): 288-96. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1373094&dopt=Abstract
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Bladder irrigation with amphotericin B for treatment of fungal urinary tract infections. Author(s): Jacobs LG, Skidmore EA, Cardoso LA, Ziv F. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 1994 March; 18(3): 313-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8011810&dopt=Abstract
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Bladder management and urinary tract infections in Danish hospitals, nursing homes, and home care: a national prevalence study. Author(s): Zimakoff J, Stickler DJ, Pontoppidan B, Larsen SO. Source: Infection Control and Hospital Epidemiology : the Official Journal of the Society of Hospital Epidemiologists of America. 1996 April; 17(4): 215-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8935728&dopt=Abstract
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Blood group antigen expression on vaginal cells and mucus in women with and without a history of urinary tract infections. Author(s): Navas EL, Venegas MF, Duncan JL, Anderson BE, Kanerva C, Chmiel JS, Schaeffer AJ. Source: The Journal of Urology. 1994 August; 152(2 Pt 1): 345-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8015068&dopt=Abstract
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Breast-feeding and urinary tract infections. Author(s): Schlager TA, Dudley SM, Dunn ML, Lohr JA. Source: The Journal of Pediatrics. 1992 August; 121(2): 331-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1640311&dopt=Abstract
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Brief overview of single-dose therapy for uncomplicated urinary tract infections. Author(s): Bailey RR. Source: Chemotherapy. 1990; 36 Suppl 1: 27-30. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2085985&dopt=Abstract
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Candidal urinary tract infections caused by non-albicans Candida species. Author(s): Dorko E, Pilipcinec E, Tkacikova L. Source: Folia Microbiol (Praha). 2002; 47(2): 182-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12058399&dopt=Abstract
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Case report: an unusual intravesical foreign body: cause of recurrent urinary tract infections. Author(s): Rafique M. Source: International Urology and Nephrology. 2002; 34(2): 205-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12775096&dopt=Abstract
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Catheter associated urinary tract infections in neurology and neurosurgical units. Author(s): Puri J, Mishra B, Mal A, Murthy NS, Thakur A, Dogra V, Singh D. Source: The Journal of Infection. 2002 April; 44(3): 171-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12099744&dopt=Abstract
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Catheter-associated urinary tract infections. Author(s): Rea H, Mills T, Kemp R. Source: The Medical Journal of Australia. 1992 June 1; 156(11): 813-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1630358&dopt=Abstract
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Catheter-associated urinary tract infections: prevalence of uropathogens and pattern of antimicrobial resistance in a UK hospital (1996-2001). Author(s): Wazait HD, Patel HR, Veer V, Kelsey M, Van Der Meulen JH, Miller RA, Emberton M. Source: Bju International. 2003 June; 91(9): 806-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12780837&dopt=Abstract
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Cefixime for the prophylaxis of urinary tract infections in children with malformative uropathies: an open study. Author(s): Stranieri G, Zampogna S, Ielapi V, Defilippo RG, Defilippo V, Cristofaro G, Galiano R, Capillo S, Madonna L, Cifala S, Ferro V, Rubino R. Source: Eur Rev Med Pharmacol Sci. 2003 March-April; 7(2): 57-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12911120&dopt=Abstract
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Cefuroxime axetil versus ofloxacin for short-term therapy of acute uncomplicated lower urinary tract infections in women. Author(s): Naber KG, Koch EM. Source: Infection. 1993 January-February; 21(1): 34-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8449579&dopt=Abstract
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Characterization of Escherichia coli strains causing urinary tract infections in patients with transposed intestinal segments. Author(s): Keegan SJ, Graham C, Neal DE, Blum-Oehler G, N'Dow J, Pearson JP, Gally DL. Source: The Journal of Urology. 2003 June; 169(6): 2382-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12771802&dopt=Abstract
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Characterization of Tn1546 in vancomycin-resistant Enterococcus faecium isolated from canine urinary tract infections: evidence of gene exchange between human and animal enterococci. Author(s): Simjee S, White DG, McDermott PF, Wagner DD, Zervos MJ, Donabedian SM, English LL, Hayes JR, Walker RD. Source: Journal of Clinical Microbiology. 2002 December; 40(12): 4659-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12454168&dopt=Abstract
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Ciprofloxacin and co-trimoxazole resistance and extended spectrum beta-lactamase production in Escherichia coli strains isolated from urinary tract infections. Author(s): Ozden M, Kalkan A, Demirdag K, Kilic SS, Ozdarendeli A. Source: International Journal of Antimicrobial Agents. 2003 May; 21(5): 492-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12727086&dopt=Abstract
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Ciprofloxacin versus trimethoprim-sulfamethoxazole: treatment of communityacquired urinary tract infections in a prospective, controlled, double-blind comparison. Author(s): Grubbs NC, Schultz HJ, Henry NK, Ilstrup DM, Muller SM, Wilson WR. Source: Mayo Clinic Proceedings. 1992 December; 67(12): 1163-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1469927&dopt=Abstract
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Circumcision and urinary tract infections. Author(s): Cunningham N. Source: Pediatrics. 1986 February; 77(2): 267-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3945544&dopt=Abstract
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Clinical evaluation of ofloxacin versus ciprofloxacin in complicated urinary tract infections. Author(s): Kromann-Andersen B, Sommer P, Pers C, Larsen V, Rasmussen F. Source: Infection. 1986; 14 Suppl 4: S305-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3546151&dopt=Abstract
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Cluster randomised controlled trial of tailored interventions to improve the management of urinary tract infections in women and sore throat. Author(s): Flottorp S, Oxman AD, Havelsrud K, Treweek S, Herrin J. Source: Bmj (Clinical Research Ed.). 2002 August 17; 325(7360): 367. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12183309&dopt=Abstract
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Combination of cefmenoxime and cefsulodin in the treatment of complicated urinary tract infections caused by Pseudomonas aeruginosa. Author(s): Doi T, Nishiura T, Deguchi K, Kondo M. Source: Chemotherapy. 1986; 32(3): 299-304. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3458567&dopt=Abstract
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Community acquired urinary tract infections in Singapore: a microbiological study. Author(s): Chan RK, Lye WC, Lee EJ, Kumarasinghe G, Lim HY. Source: Ann Acad Med Singapore. 1992 May; 21(3): 361-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1416785&dopt=Abstract
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Correlation of drug utilization data for trimethoprim in a defined population with patterns of resistance among bacteria causing urinary tract infections. Author(s): Skold O, Boethius G, Steen R. Source: Scandinavian Journal of Infectious Diseases. 1986; 18(5): 451-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3775272&dopt=Abstract
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Cost-effectiveness comparison of single and multiple-dose antibiotic treatment of lower uncomplicated urinary tract infections. Author(s): Capri S, Del Bono GP, Dellamano R. Source: Journal of Chemotherapy (Florence, Italy). 1992 June; 4(3): 171-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1517811&dopt=Abstract
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Cross-resistance and associated resistance in 2478 Escherichia coli isolates from the Pan-European ECO.SENS Project surveying the antimicrobial susceptibility of pathogens from uncomplicated urinary tract infections. Author(s): Kahlmeter G, Menday P. Source: The Journal of Antimicrobial Chemotherapy. 2003 July; 52(1): 128-31. Epub 2003 June 12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12805266&dopt=Abstract
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Current diagnosis and treatment of urinary tract infections. Author(s): Childs S. Source: Urology. 1992 October; 40(4): 295-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1413346&dopt=Abstract
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Declining frequency of circumcision: implications for changes in the absolute incidence and male to female sex ratio of urinary tract infections in early infancy. Author(s): Wiswell TE, Enzenauer RW, Holton ME, Cornish JD, Hankins CT. Source: Pediatrics. 1987 March; 79(3): 338-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3822633&dopt=Abstract
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Decreased invasive capacity of quinolone-resistant Escherichia coli in patients with urinary tract infections. Author(s): Velasco M, Horcajada JP, Mensa J, Moreno-Martinez A, Vila J, Martinez JA, Ruiz J, Barranco M, Roig G, Soriano E. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2001 November 15; 33(10): 1682-6. Epub 2001 October 10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11595990&dopt=Abstract
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Defining and monitoring indwelling catheter-related urinary tract infections. Author(s): Long CO, Anderson C, Greenberg EA, Woomer N. Source: Home Healthcare Nurse. 2002 April; 20(4): 255-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11984194&dopt=Abstract
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Detection of the icaADBC gene cluster and biofilm formation in Staphylococcus epidermidis isolates from catheter-related urinary tract infections. Author(s): Cho SH, Naber K, Hacker J, Ziebuhr W. Source: International Journal of Antimicrobial Agents. 2002 June; 19(6): 570-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12135850&dopt=Abstract
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Detection of urinary tract infections by reduction of nitroblue tetrazolium. Author(s): Smith SD, Wheeler MA, Weiss RM. Source: Kidney International. 1998 October; 54(4): 1331-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9767552&dopt=Abstract
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Determination of cut-off values for leucocytes and bacteria for urine flow cytometer (UF-100) in urinary tract infections. Author(s): Koken T, Aktepe OC, Serteser M, Samli M, Kahraman A, Dogan N. Source: International Urology and Nephrology. 2002; 34(2): 175-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12775087&dopt=Abstract
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Detrusor instability; day and night time wetting, urinary tract infections. Author(s): Fisher R, Frank D. Source: Archives of Disease in Childhood. 2000 August; 83(2): 135-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10906020&dopt=Abstract
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Diagnosis and imaging in urinary tract infections. Author(s): Bjerklund Johansen TE. Source: Current Opinion in Urology. 2002 January; 12(1): 39-43. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11753132&dopt=Abstract
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Diagnosis of histoplasmosis in urine cytology: reactive urothelial changes, a diagnostic pitfall. Case report and literature review of urinary tract infections. Author(s): Mukunyadzi P, Johnson M, Wyble JG, Scott M. Source: Diagnostic Cytopathology. 2002 April; 26(4): 243-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11933270&dopt=Abstract
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Diagnosis, treatment and registration of urinary tract infections in geriatric patients. Author(s): Friis-Moller A, Luneborg-Nielsen M. Source: Ann Univ Mariae Curie Sklodowska [med]. 2002; 57(1): 540-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12898972&dopt=Abstract
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Diagnostic role of ultrasounds in urinary tract infections. Author(s): Agostiniani R, Fanos V, Cataldi L. Source: Pediatr Med Chir. 2002 March-April; 24(2): 123-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11987512&dopt=Abstract
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Diagnostic testing strategies in childhood urinary tract infections. Author(s): Downs SM. Source: Pediatric Annals. 1999 November; 28(11): 670-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10578495&dopt=Abstract
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Diagnostic value of a P-fimbriation test in determining duration of therapy in children with urinary tract infections. Author(s): Tambic T, Oberiter V, Delmis J, Tambic A. Source: Clinical Therapeutics. 1992 September-October; 14(5): 667-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1361423&dopt=Abstract
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Dipstick examination for urinary tract infections. Author(s): Thayyil-Sudhan S, Gupta S. Source: Archives of Disease in Childhood. 2000 March; 82(3): 271-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10722406&dopt=Abstract
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Distribution and susceptibility of bacterial urinary tract infections in Dakar, Senegal. Author(s): Dromigny JA, Nabeth P, Perrier Gros Claude JD. Source: International Journal of Antimicrobial Agents. 2002 November; 20(5): 339-47. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12431869&dopt=Abstract
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Diversity of plasmids in Staphylococcus saprophyticus isolated from urinary tract infections in women. Author(s): Cristino JA, Pereira AT, Andrade LG. Source: Epidemiology and Infection. 1989 June; 102(3): 413-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2737253&dopt=Abstract
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Do cranberries aid in the treatment of urinary tract infections? Author(s): Cunningham E. Source: Journal of the American Dietetic Association. 2002 August; 102(8): 1118. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12171456&dopt=Abstract
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Does postcoital voiding prevent urinary tract infections in young women? Author(s): Beisel B, Hale W, Graves RS, Moreland J. Source: The Journal of Family Practice. 2002 November; 51(11): 977. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12485556&dopt=Abstract
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DUE of ciprofloxacin in the treatment of urinary tract infections in hospitalized patients. Author(s): Dydek GJ, Souney PF, Matthews SJ. Source: Hospital Formulary. 1992 February; 27(2): 185-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10116716&dopt=Abstract
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Dynamic interactions between host and pathogen during acute urinary tract infections. Author(s): Schilling JD, Mulvey MA, Hultgren SJ. Source: Urology. 2001 June; 57(6 Suppl 1): 56-61. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11378051&dopt=Abstract
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Effect of external urinary collection system on colonization and urinary tract infections with Pseudomonas and Klebsiella in men with spinal cord injury. Author(s): Gilmore DS, Schick DG, Young MN, Montgomerie JZ. Source: J Am Paraplegia Soc. 1992 July; 15(3): 155-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1500940&dopt=Abstract
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Effective prophylaxis for recurrent urinary tract infections during pregnancy. Author(s): Pfau A, Sacks TG. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 1992 April; 14(4): 810-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1576275&dopt=Abstract
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Efficacy of an enzyme-linked immunosorbent assay for detection of urinary tract immunoglobulins for diagnosis of urinary tract infections. Author(s): Kellogg JA, Manzella JP, Seiple JW, Fortna SJ, Cook JW, Levisky JS. Source: Journal of Clinical Microbiology. 1992 July; 30(7): 1711-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1629325&dopt=Abstract
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Empiric antimicrobial therapy of serious urinary tract infections. Author(s): File TM Jr, Tan JS. Source: Urology. 1986 January; 27(1): 80-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3510503&dopt=Abstract
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Empiric use of trimethoprim-sulfamethoxazole (TMP-SMX) in the treatment of women with uncomplicated urinary tract infections, in a geographical area with a high prevalence of TMP-SMX-resistant uropathogens. Author(s): Raz R, Chazan B, Kennes Y, Colodner R, Rottensterich E, Dan M, Lavi I, Stamm W; Israeli Urinary Tract Infection Group. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2002 May 1; 34(9): 1165-9. Epub 2002 April 04. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11941541&dopt=Abstract
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Empirical management of urinary tract infections complicating transrectal ultrasound guided prostate biopsy. Author(s): Tal R, Livne PM, Lask DM, Baniel J. Source: The Journal of Urology. 2003 May; 169(5): 1762-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12686828&dopt=Abstract
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Empowering female residents: alternative approaches to urinary tract infections (UTIs) in nursing homes. Author(s): Ritchie BF. Source: Aust J Holist Nurs. 2000 April; 7(1): 26-30. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11898217&dopt=Abstract
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Enterococcal urinary tract infections: eight years experience at a regional hospital in Trinidad, West Indies. Author(s): Orrett FA, Connors E. Source: Chinese Medical Journal. 2001 January; 114(1): 90-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11779446&dopt=Abstract
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Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Author(s): Foxman B. Source: Disease-A-Month : Dm. 2003 February; 49(2): 53-70. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12601337&dopt=Abstract
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Ertapenem versus ceftriaxone followed by appropriate oral therapy for treatment of complicated urinary tract infections in adults: results of a prospective, randomized, double-blind multicenter study. Author(s): Tomera KM, Burdmann EA, Reyna OG, Jiang Q, Wimmer WM, Woods GL, Gesser RM; Protocol 014 Study Group. Source: Antimicrobial Agents and Chemotherapy. 2002 September; 46(9): 2895-900. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12183244&dopt=Abstract
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Evaluation of a familial predisposition to recurrent urinary tract infections in women. Author(s): Hopkins WJ, Uehling DT, Wargowski DS. Source: American Journal of Medical Genetics. 1999 April 23; 83(5): 422-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10232756&dopt=Abstract
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Evaluation of antibacterial efficacy of drugs for urinary tract infections by genotyping based on pulsed-field gel electrophoresis (PFGE). Author(s): Osawa K, Nakajima M, Kataoka N, Arakawa S, Kamidono S. Source: Journal of Infection and Chemotherapy : Official Journal of the Japan Society of Chemotherapy. 2002 December; 8(4): 353-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12525898&dopt=Abstract
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Evaluation of humoral and cellular immunity in patients with urinary tract infections. Author(s): Oliveira EF, Suassuna I, Marques EA, Campos-Neto A. Source: Brazilian Journal of Medical and Biological Research = Revista Brasileira De Pesquisas Medicas E Biologicas / Sociedade Brasileira De Biofisica. [et Al.]. 1986; 19(2): 189-97. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3548856&dopt=Abstract
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Evaluation of the diagnostic workup in young women referred for recurrent lower urinary tract infections. Author(s): van Haarst EP, van Andel G, Heldeweg EA, Schlatmann TJ, van der Horst HJ. Source: Urology. 2001 June; 57(6): 1068-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11377307&dopt=Abstract
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Factors contributing to susceptibility of postmenopausal women to recurrent urinary tract infections. Author(s): Stamm WE, Raz R. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 1999 April; 28(4): 723-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10825026&dopt=Abstract
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Factors influencing early urinary tract infections in kidney transplant recipients. Author(s): Renoult E, Aouragh F, Mayeux D, Hestin D, Lataste A, Hubert J, L'Hermite J, Weber M, Kessler M. Source: Transplantation Proceedings. 1994 August; 26(4): 2056-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8066669&dopt=Abstract
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Factors predisposing to urinary tract infections in children. Author(s): Roberts JA. Source: Pediatric Nephrology (Berlin, Germany). 1996 August; 10(4): 517-22. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8865259&dopt=Abstract
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Feedback to nursing staff as an intervention to reduce catheter-associated urinary tract infections. Author(s): Goetz AM, Kedzuf S, Wagener M, Muder RR. Source: American Journal of Infection Control. 1999 October; 27(5): 402-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10511486&dopt=Abstract
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Field evaluation of a second-generation cytometer UF-100 in diagnosis of acute urinary tract infections in adult patients. Author(s): Manoni F, Valverde S, Antico F, Salvadego MM, Giacomini A, Gessoni G. Source: Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases. 2002 October; 8(10): 662-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12390285&dopt=Abstract
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First urinary tract infections in Swedish children. Author(s): Edmonson MB. Source: Pediatrics. 2000 September; 106(3): 620-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11012337&dopt=Abstract
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Fluconazole in the management of fungal urinary tract infections. Author(s): Voss A, Meis JF, Hoogkamp-Korstanje JA. Source: Infection. 1994 July-August; 22(4): 247-51. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8002084&dopt=Abstract
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Fluconazole therapy for Candida albicans urinary tract infections in infants. Author(s): Triolo V, Gari-Toussaint M, Casagrande F, Garraffo R, Dageville C, Boutte P, Berard E. Source: Pediatric Nephrology (Berlin, Germany). 2002 July; 17(7): 550-3. Epub 2002 June 21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12172774&dopt=Abstract
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Fluorescent amplified fragment length polymorphism probabilistic database for identification of bacterial isolates from urinary tract infections. Author(s): Kassama Y, Rooney PJ, Goodacre R. Source: Journal of Clinical Microbiology. 2002 August; 40(8): 2795-800. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12149332&dopt=Abstract
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Fluoroquinolones in the treatment of acute uncomplicated urinary tract infections in adult women. Author(s): Garrison J, Hooton TM. Source: Expert Opinion on Pharmacotherapy. 2001 August; 2(8): 1227-37. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11584990&dopt=Abstract
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Formula to help select rational antimicrobial therapy (FRAT): its application to community- and hospital-acquired urinary tract infections. Author(s): Blondeau JM, Tillotson GS. Source: International Journal of Antimicrobial Agents. 1999 July; 12(2): 145-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10418760&dopt=Abstract
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Fosfomycin trometamol in a single dose versus seven days nitrofurantoin in the treatment of acute uncomplicated urinary tract infections in women. Author(s): Van Pienbroek E, Hermans J, Kaptein AA, Mulder JD. Source: Pharmacy World & Science : Pws. 1993 December 17; 15(6): 257-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8298585&dopt=Abstract
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Fosfomycin tromethamine. A review of its antibacterial activity, pharmacokinetic properties and therapeutic efficacy as a single-dose oral treatment for acute uncomplicated lower urinary tract infections. Author(s): Patel SS, Balfour JA, Bryson HM. Source: Drugs. 1997 April; 53(4): 637-56. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9098664&dopt=Abstract
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Frequency and clinical characteristics of mycoplasma urinary tract infections in the early post-transplantation period in renal allograft patients. Author(s): Dimitrakov D, Dimitrakov J, Beleva R. Source: Folia Med (Plovdiv). 1999; 41(4): 59-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10786206&dopt=Abstract
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Frequency of Escherichia coli strains producing the cytotoxic necrotizing factor (CNF1) in nosocomial urinary tract infections. Author(s): Landraud L, Gauthier M, Fosse T, Boquet P. Source: Letters in Applied Microbiology. 2000 March; 30(3): 213-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10747253&dopt=Abstract
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Frequency of isolation of pathogens from bloodstream, nosocomial pneumonia, skin and soft tissue, and urinary tract infections occurring in European patients. Author(s): Fluit AC, Schmitz FJ, Verhoef J; European SENTRY Participant Group. Source: European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology. 2001 March; 20(3): 188-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11347669&dopt=Abstract
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Fungal urinary tract infections in patients at risk. Author(s): Krcmery S, Dubrava M, Krcmery V Jr. Source: International Journal of Antimicrobial Agents. 1999 May; 11(3-4): 289-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10394985&dopt=Abstract
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Fungal urinary tract infections in the elderly: treatment guidelines. Author(s): Jacobs LG. Source: Drugs & Aging. 1996 February; 8(2): 89-96. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8845590&dopt=Abstract
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Gardnerella vaginalis in urinary tract infections of renal allograft patients. Author(s): von der Lippe E, Midtvedt T. Source: European Journal of Clinical Microbiology. 1986 February; 5(1): 54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3516684&dopt=Abstract
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Gene clusters governing the production of hemolysin and mannose-resistant hemagglutination are closely linked in Escherichia coli serotype O4 and O6 isolates from urinary tract infections. Author(s): Low D, David V, Lark D, Schoolnik G, Falkow S. Source: Infection and Immunity. 1984 January; 43(1): 353-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6317570&dopt=Abstract
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General practitioner study: fosfomycin trometamol versus amoxycillin clavulanate in acute urinary tract infections. Author(s): Cooper J, Raeburn AL, Brumfitt W, Hamilton-Miller JM. Source: Chemotherapy. 1990; 36 Suppl 1: 24-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2085984&dopt=Abstract
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Genetic relationships among Escherichia coli isolates causing urinary tract infections in humans and animals. Author(s): Whittam TS, Wolfe ML, Wilson RA. Source: Epidemiology and Infection. 1989 February; 102(1): 37-46. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2645153&dopt=Abstract
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GPs' treatment of uncomplicated urinary tract infections--a clinical judgement analysis in four European countries. DEP group. Drug Education Project. Author(s): Hummers-Pradier E, Denig P, Oke T, Lagerlov P, Wahlstrom R, HaaijerRuskamp FM. Source: Family Practice. 1999 December; 16(6): 605-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10625136&dopt=Abstract
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Group B streptococcal urinary tract infections. Author(s): Lohr JA. Source: The Pediatric Infectious Disease Journal. 1990 February; 9(2): 150-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2179843&dopt=Abstract
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Guidelines and evaluation of new anti-infective drugs for treatment of urinary tract infections. Author(s): Kunin CM. Source: International Journal of Antimicrobial Agents. 1999 May; 11(3-4): 197-9; Discussion 213-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10394970&dopt=Abstract
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Guidelines for antimicrobial therapy of urinary tract infections in Taiwan. Author(s): Infectious Diseases Society of the Republic of China.; Medical Foundation in Memory of Dr. Deh-Lin Cheng.; Foundation of Professor Wei-Chuan Hsieh for Infectious Diseases Research and Education.; Lee CY's Research Foundation for Pediatric Infectious Diseases and Vaccine. Source: J Microbiol Immunol Infect. 2000 December; 33(4): 271-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11269375&dopt=Abstract
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Guidelines for urinary tract infections. Rationale for a separate strata for patients with “low-count” bacteriuria. Author(s): Kunin CM. Source: Infection. 1994; 22 Suppl 1: S38-40; Discussion S41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8050790&dopt=Abstract
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Haemagglutinins & enterotoxins in Escherichia coli strains from human urinary tract infections. Author(s): Saxena VK, Yadava JN. Source: The Indian Journal of Medical Research. 1985 January; 81: 35-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3886540&dopt=Abstract
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Hemophilus influenzae as a cause of urinary tract infections in men. Author(s): Gabre-Kidan T, Lipsky BA, Plorde JJ. Source: Archives of Internal Medicine. 1984 August; 144(8): 1623-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6331807&dopt=Abstract
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Hospital urinary tract infections in surgical patients. Author(s): Sakwa W, Polkowski W, Chmurzynski M, Wallner G. Source: Ann Univ Mariae Curie Sklodowska [med]. 2002; 57(2): 535-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12898892&dopt=Abstract
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Hospital-acquired urinary tract infections associated with the indwelling catheter. Author(s): Sedor J, Mulholland SG. Source: The Urologic Clinics of North America. 1999 November; 26(4): 821-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10584622&dopt=Abstract
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Hospital-acquired urinary tract infections in the pediatric patient: a prospective study. Author(s): Lohr JA, Downs SM, Dudley S, Donowitz LG. Source: The Pediatric Infectious Disease Journal. 1994 January; 13(1): 8-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8170742&dopt=Abstract
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Hospital-acquired urinary tract infections in Turkey: a nationwide multicenter point prevalence study. Author(s): Leblebicioglu H, Esen S; Turkish Nosocomial Urinary Tract Infection Study Group. Source: The Journal of Hospital Infection. 2003 March; 53(3): 207-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12623322&dopt=Abstract
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Hospital-acquired urinary tract infections. Author(s): Wagenlehner FM, Naber KG. Source: The Journal of Hospital Infection. 2000 November; 46(3): 171-81. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11073725&dopt=Abstract
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Host defense mechanisms in urinary tract infections. Author(s): Neal DE Jr. Source: The Urologic Clinics of North America. 1999 November; 26(4): 677-86, Vii. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10584610&dopt=Abstract
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Host factors in susceptibility to urinary tract infections. Author(s): Stapleton A. Source: Advances in Experimental Medicine and Biology. 1999; 462: 351-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10599438&dopt=Abstract
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Host factors in the pathogenesis of urinary tract infections. Author(s): Sobel JD, Kaye D. Source: The American Journal of Medicine. 1984 May 15; 76(5A): 122-30. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6372461&dopt=Abstract
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Host pathogenesis in urinary tract infections. Author(s): Schaeffer AJ, Rajan N, Cao Q, Anderson BE, Pruden DL, Sensibar J, Duncan JL. Source: International Journal of Antimicrobial Agents. 2001 April; 17(4): 245-51. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11295403&dopt=Abstract
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How physicians diagnose urinary tract infections: the potential influence of laboratory regulations on test availability and use. Author(s): Flach SD, Wigton RS, Longenecker JC, Parenti C, Bryan TJ, Tape TG. Source: The Journal of Family Practice. 2001 July; 50(7): 613. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11485711&dopt=Abstract
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Hydration monitoring in the prevention of recurrent idiopathic urinary tract infections in pre-menopausal women. Author(s): Eckford SD, Keane DP, Lamond E, Jackson SR, Abrams P. Source: British Journal of Urology. 1995 July; 76(1): 90-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7648069&dopt=Abstract
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Identification of coagulase-negative Staphylococci isolated from urinary tract infections. Author(s): Leighton PM, Little JA. Source: American Journal of Clinical Pathology. 1986 January; 85(1): 92-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3940428&dopt=Abstract
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Identifying barriers and tailoring interventions to improve the management of urinary tract infections and sore throat: a pragmatic study using qualitative methods. Author(s): Flottorp S, Oxman AD. Source: Bmc Health Services Research [electronic Resource]. 2003 February 4; 3(1): 3. Epub 2003 Feb 04. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12622873&dopt=Abstract
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Imipenem resistance in nonfermenters causing nosocomial urinary tract infections. Author(s): Taneja N, Maharwal S, Sharma M. Source: Indian Journal of Medical Sciences. 2003 July; 57(7): 294-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12928556&dopt=Abstract
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In vitro activity of gatifloxacin compared with gemifloxacin, moxifloxacin, trovafloxacin, ciprofloxacin and ofloxacin against uropathogens cultured from patients with complicated urinary tract infections. Author(s): Naber KG, Hollauer K, Kirchbauer D, Witte W. Source: International Journal of Antimicrobial Agents. 2000 November; 16(3): 239-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11091042&dopt=Abstract
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In vitro activity of linezolid against Gram-positive uropathogens of hospitalized patients with complicated urinary tract infections. Author(s): Onda H, Wagenlehner FM, Lehn N, Naber KG. Source: International Journal of Antimicrobial Agents. 2001 September; 18(3): 263-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11673040&dopt=Abstract
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In vitro activity of quinolones against isolates from paediatric urinary tract infections from three Venezuelan centres. Author(s): Rodriguez AJ, Rodriguez CN, Meijomil P, Garcia A, Duque C, Molina N, Barbella R, Lakatos M, Bellorin E, Mendoza M. Source: International Journal of Antimicrobial Agents. 2001 June; 17(6): 531-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11397626&dopt=Abstract
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In vitro activity, pharmacokinetics, clinical safety and therapeutic efficacy of enoxacin in the treatment of patients with complicated urinary tract infections. Author(s): Naber KG, Sorgel F, Gutzler F, Bartosik-Wich B. Source: Infection. 1986; 14 Suppl 3: S203-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3463543&dopt=Abstract
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In vitro antibacterial activity of S-4661, a new parenteral carbapenem, against urological pathogens isolated from patients with complicated urinary tract infections. Author(s): Nomura S, Nagayama A. Source: Journal of Chemotherapy (Florence, Italy). 2002 April; 14(2): 155-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12017370&dopt=Abstract
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Incidence of urinary tract infections and vesicorenal reflux: a comparison between conventional and antirefluxive technique of ureter implantation. Author(s): Franz M, Klaar U, Hofbauer H, Hobarth K, Steininger R, Klauser R, Muhlbacher F, Kovarik J, Pohanka E. Source: Transplantation Proceedings. 1992 December; 24(6): 2773-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1465935&dopt=Abstract
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Incidence of urinary tract infections in patients with short-term indwelling urethral catheters: a comparison between a 3-day urinary drainage bag change and no change regimens. Author(s): Keerasuntonpong A, Thearawiboon W, Panthawanan A, Judaeng T, Kachintorn K, Jintanotaitavorn D, Suddhisanont L, Waitayapiches S, Tiangrim S, Thamlikitkul V. Source: American Journal of Infection Control. 2003 February; 31(1): 9-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12548251&dopt=Abstract
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Increased incidence of urinary tract infections in patients with coeliac disease. Author(s): Fanos V, Verlato G, Matti P, Pizzini C, Maffeis C. Source: Pediatric Nephrology (Berlin, Germany). 2002 July; 17(7): 570-1. Epub 2002 June 07. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12172778&dopt=Abstract
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Increasing antimicrobial resistance and the management of uncomplicated community-acquired urinary tract infections. Author(s): Gupta K, Hooton TM, Stamm WE. Source: Annals of Internal Medicine. 2001 July 3; 135(1): 41-50. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11434731&dopt=Abstract
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Indwelling catheter-associated urinary tract infections. Author(s): Parkin J, Keeley FX. Source: British Journal of Community Nursing. 2003 April; 8(4): 166-7, 170-1. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12732832&dopt=Abstract
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Influence of circumcision technique on frequency of urinary tract infections in neonates. Author(s): Harel L, Straussbergr R, Jackson S, Amir J, Tiqwa P. Source: The Pediatric Infectious Disease Journal. 2002 September; 21(9): 879-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12380588&dopt=Abstract
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Influence of hormones on urinary tract infections. Author(s): Landes RR. Source: Urology. 1977 October; 10(4): 403. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11394416&dopt=Abstract
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Intravenous versus oral antibiotics for urinary tract infections. Author(s): Hopp L. Source: Pediatrics. 2000 October; 106(4): 865. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11183178&dopt=Abstract
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Involvement of Gardnerella vaginalis in urinary tract infections in men. Author(s): Smith SM, Ogbara T, Eng RH. Source: Journal of Clinical Microbiology. 1992 June; 30(6): 1575-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1624577&dopt=Abstract
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Is endoscopic decompression of the neonatal extravesical upper pole ureterocele necessary for prevention of urinary tract infections or bladder neck obstruction? Author(s): Husmann DA, Strand WR, Ewalt DH, Kramer SA. Source: The Journal of Urology. 2002 March; 167(3): 1440-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11832766&dopt=Abstract
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Is there need for both intravenous urography and voiding cystography in the evaluation of children with recurrent urinary tract infections? Author(s): Nielsen KK, Qvist N, Jensen KM, Kristensen ES, Krarup T, Dalsgaard J, Pedersen D. Source: Urological Research. 1986; 14(4): 187-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3787884&dopt=Abstract
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Isolation of an SHV-12 beta-lactamase-producing Escherichia coli strain from a dog with recurrent urinary tract infections. Author(s): Teshager T, Dominguez L, Moreno MA, Saenz Y, Torres C, Cardenosa S. Source: Antimicrobial Agents and Chemotherapy. 2000 December; 44(12): 3483-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11185493&dopt=Abstract
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Journal of Infection Control Nursing. Catheter toilet and urinary tract infections. Author(s): Gibbs H. Source: Nurs Times. 1986 June 4-10; 82(23): 75-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3637812&dopt=Abstract
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K-antigen identification, hemolysin production, and hemagglutination types of Escherichia coli O6 strains isolated from patients with urinary tract infections. Author(s): Zingler G, Schmidt G, Orskov I, Orskov F, Falkenhagen U, Naumann G. Source: Zentralbl Bakteriol. 1990 December; 274(3): 372-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2090152&dopt=Abstract
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Kelfiprim versus co-trimoxazole in recurrent and persistent urinary tract infections: multicenter double-blind trial. Author(s): Graziani G, Chiarini C, Limido D, Cantaluppi A, Marai P, Pincella G, Piaia F, Zucchelli P, Locatelli F, Ponticelli C. Source: Urology. 1987 September; 30(3): 293-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3307097&dopt=Abstract
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Kelfiprim. A new sulfa-trimethoprim combination in urinary tract infections. Author(s): Tanphaichitra D. Source: J Med Assoc Thai. 1985 July; 68(7): 342-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3903021&dopt=Abstract
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Laboratory evaluation of urinary tract infections in an ambulatory clinic. Author(s): Carroll KC, Hale DC, Von Boerum DH, Reich GC, Hamilton LT, Matsen JM. Source: American Journal of Clinical Pathology. 1994 January; 101(1): 100-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7506476&dopt=Abstract
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Laboratory in the diagnosis and management of urinary tract infections. Author(s): Pappas PG. Source: The Medical Clinics of North America. 1991 March; 75(2): 313-25. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1996036&dopt=Abstract
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Laboratory management of neonatal sepsis and urinary tract infections: new perspectives. Author(s): Mussap M, Plebani M. Source: Pediatr Med Chir. 2002 March-April; 24(2): 119-21. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11987511&dopt=Abstract
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Lactulose may help prevent urinary tract infections. Author(s): Battle M, Martin T, Fulton J. Source: Bmj (Clinical Research Ed.). 2001 October 20; 323(7318): 936. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11668146&dopt=Abstract
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Leuconostoc pseudomesenteroides as a cause of nosocomial urinary tract infections. Author(s): Cappelli EA, Barros RR, Camello TC, Teixeira LM, Merquior VL. Source: Journal of Clinical Microbiology. 1999 December; 37(12): 4124-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10565942&dopt=Abstract
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Limited clinical usefulness of tests for P-fimbriated Escherichia coli in patients with urinary tract infections. Author(s): Sandberg T, Hansson S. Source: Scandinavian Journal of Infectious Diseases. 1992; 24(2): 253-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1353634&dopt=Abstract
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Liposomal amphotericin B: an effective, nontoxic preparation for the treatment of urinary tract infections caused by Candida albicans. Author(s): Ralph ED, Barber KR, Grant CW. Source: American Journal of Nephrology. 1991; 11(2): 118-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1951471&dopt=Abstract
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Lomefloxacin versus ciprofloxacin in the treatment of complicated urinary tract infections: a multicenter study. Author(s): Pisani E, Bartoletti R, Trinchieri A, Rizzo M. Source: Journal of Chemotherapy (Florence, Italy). 1996 June; 8(3): 210-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8808718&dopt=Abstract
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Lomefloxacin versus norfloxacin in the treatment of uncomplicated urinary tract infections: three-day versus seven-day treatment. The South Swedish Lolex Study Group. Author(s): Neringer R, Forsgren A, Hansson C, Ode B. Source: Scandinavian Journal of Infectious Diseases. 1992; 24(6): 773-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1337623&dopt=Abstract
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Long term follow up to determine the prognostic value of imaging after urinary tract infections. Author(s): Robson WL, Kelley R. Source: Archives of Disease in Childhood. 1996 January; 74(1): 89. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8660064&dopt=Abstract
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Long term follow up to determine the prognostic value of imaging after urinary tract infections. Author(s): Jadresic L. Source: Archives of Disease in Childhood. 1996 January; 74(1): 89. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8660063&dopt=Abstract
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Long-term consequences of urinary tract infections. Author(s): Hellerstein S. Source: Current Opinion in Pediatrics. 2000 April; 12(2): 125-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10763761&dopt=Abstract
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Long-term follow up to determine the prognostic value of imaging after urinary tract infections. Part 1: Reflux. Author(s): Merrick MV, Notghi A, Chalmers N, Wilkinson AG, Uttley WS. Source: Archives of Disease in Childhood. 1995 May; 72(5): 388-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7618902&dopt=Abstract
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Long-term follow up to determine the prognostic value of imaging after urinary tract infections. Part 2: Scarring. Author(s): Merrick MV, Notghi A, Chalmers N, Wilkinson AG, Uttley WS. Source: Archives of Disease in Childhood. 1995 May; 72(5): 393-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7618903&dopt=Abstract
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Long-term followup of 158 young adults surgically treated for vesicoureteral reflux in childhood: the ongoing risk of urinary tract infections. Author(s): Beetz R, Mannhardt W, Fisch M, Stein R, Thuroff JW. Source: The Journal of Urology. 2002 August; 168(2): 704-7; Discussion 707. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12131355&dopt=Abstract
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Long-term follow-up of children with surgically treated vesicorenal reflux: postoperative incidence of urinary tract infections, renal scars and arterial hypertension. Author(s): Beetz R, Schulte-Wissermann H, Troger J, Riedmiller H, Mannhardt W, Schofer O, Hohenfellner R. Source: European Urology. 1989; 16(5): 366-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2789137&dopt=Abstract
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Loracarbef versus cefaclor in the treatment of urinary tract infections in women. Author(s): Iravani A. Source: Antimicrobial Agents and Chemotherapy. 1991 April; 35(4): 750-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2069382&dopt=Abstract
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Low dose oestrogen prophylaxis for recurrent urinary tract infections in elderly women. Author(s): Cardozo L, Benness C, Abbott D. Source: British Journal of Obstetrics and Gynaecology. 1998 April; 105(4): 403-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9609266&dopt=Abstract
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Low urinary tract infections in simultaneous pancreas and kidney transplantation: comparison between bladder and enteric drainage of exocrine secretions. Author(s): Baldi A, Mourad M, Malaise J, Squifflet JP. Source: Transplantation Proceedings. 1995 December; 27(6): 3116-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8539870&dopt=Abstract
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Lower urinary tract infections in women. Author(s): Parsons CL. Source: The Urologic Clinics of North America. 1987 May; 14(2): 247-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3576849&dopt=Abstract
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Management of acute uncomplicated urinary tract infections in general practice in the south of The Netherlands. Author(s): Verest LF, van Esch WM, van Ree JW, Stobberingh EE. Source: The British Journal of General Practice : the Journal of the Royal College of General Practitioners. 2000 April; 50(453): 309-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10897517&dopt=Abstract
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Management of bacterial urinary tract infections in adult patients with diabetes mellitus. Author(s): Meiland R, Geerlings SE, Hoepelman AI. Source: Drugs. 2002; 62(13): 1859-68. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12215057&dopt=Abstract
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Management of lower urinary tract infections and cystitis. Author(s): Anderson RU. Source: The Urologic Clinics of North America. 1999 November; 26(4): 729-35, Viii. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10584614&dopt=Abstract
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Management of lower urinary tract infections. Author(s): Bailey RR. Source: Drugs. 1993; 45 Suppl 3: 139-44. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7689445&dopt=Abstract
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Management of pyelonephritis and upper urinary tract infections. Author(s): Roberts JA. Source: The Urologic Clinics of North America. 1999 November; 26(4): 753-63. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10584616&dopt=Abstract
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Management of uncomplicated urinary tract infections. Author(s): Jancel T, Dudas V. Source: The Western Journal of Medicine. 2002 January; 176(1): 51-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11788540&dopt=Abstract
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Management of urinary tract infections and lymphocele in renal transplant recipients. Author(s): Munoz P. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2001 July 1; 33 Suppl 1: S53-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11389523&dopt=Abstract
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Management of urinary tract infections in the elderly. Author(s): Beyer I, Mergam A, Benoit F, Theunissen C, Pepersack T. Source: Zeitschrift Fur Gerontologie Und Geriatrie : Organ Der Deutschen Gesellschaft Fur Gerontologie Und Geriatrie. 2001 April; 34(2): 153-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11393008&dopt=Abstract
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Management of Urinary tract infections in the nursing home elderly: a proposed algorithmic approach. Author(s): Beier MT. Source: International Journal of Antimicrobial Agents. 1999 May; 11(3-4): 275-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10394983&dopt=Abstract
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Management of urinary tract infections in women. Author(s): Fang LS. Source: Compr Ther. 1987 February; 13(2): 3-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3816135&dopt=Abstract
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Management of urinary tract infections. Author(s): Hari P, Mantan M, Bagga A. Source: Indian J Pediatr. 2003 March; 70(3): 235-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12785296&dopt=Abstract
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Management of urinary tract infections. Author(s): Nassar NT. Source: J Med Liban. 2000 July-August; 48(4): 278-82. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11214201&dopt=Abstract
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Managing lower urinary tract infections. What is the best approach? Author(s): Hickey J. Source: Can Fam Physician. 2000 August; 46: 1577-8. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10955175&dopt=Abstract
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Managing urinary tract infections in men. Author(s): Lipsky BA. Source: Hosp Pract (Off Ed). 2000 January 15; 35(1): 53-9; Discussion 59-60; Quiz 144. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10645989&dopt=Abstract
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Maternal health in sudden intrauterine unexplained death: do urinary tract infections protect the fetus? Author(s): Froen JF, Moyland RA, Saugstad OD, Stray-Pedersen B. Source: Obstetrics and Gynecology. 2002 November; 100(5 Pt 1): 909-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12423852&dopt=Abstract
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Methenamine hippurate for preventing urinary tract infections. Author(s): Lee B, Bhuta T, Craig J, Simpson J. Source: Cochrane Database Syst Rev. 2002; (1): Cd003265. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11869659&dopt=Abstract
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Modern concept of antibiotic therapy of urinary tract infections. Author(s): Auckenthaler R. Source: Advances in Experimental Medicine and Biology. 2000; 485: 279-87. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11109117&dopt=Abstract
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Molecular typing of Myroides odoratimimus (Flavobacterium odoratum) urinary tract infections in a Turkish hospital. Author(s): Yagci A, Cerikcioglu N, Kaufmann ME, Malnick H, Soyletir G, Babacan F, Pitt TL. Source: European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology. 2000 September; 19(9): 731-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11057514&dopt=Abstract
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Multiresistant Escherichia coli isolated from women with community-acquired urinary tract infections in the Gaza Strip. Author(s): Astal Z, Sharif FA, Abdallah SA, Fahd MI. Source: Journal of Chemotherapy (Florence, Italy). 2002 December; 14(6): 637-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12583559&dopt=Abstract
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Myths & facts. about urinary tract infections. Author(s): Pinkerman ML. Source: Nursing. 1992 September; 22(9): 86. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1528517&dopt=Abstract
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Neonatal jaundice and urinary tract infections. Author(s): Maisels MJ, Newman TB. Source: Pediatrics. 2003 November; 112(5): 1213-4; Author Reply 1213-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14595074&dopt=Abstract
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Neonatal jaundice coinciding with or resulting from urinary tract infections? Author(s): Sarici SU, Kul M, Alpay F. Source: Pediatrics. 2003 November; 112(5): 1212-3; Author Reply 1212-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14595073&dopt=Abstract
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New 4-quinolones in the treatment of urinary tract infections. Author(s): Boerema JB. Source: Pharm Weekbl Sci. 1986 February 21; 8(1): 46-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2938070&dopt=Abstract
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New concepts in the pathogenesis of urinary tract infections. Author(s): Schaeffer AJ. Source: The Urologic Clinics of North America. 2002 February; 29(1): 241-50, Xii. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12109352&dopt=Abstract
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N-nitrosamine generation by urinary tract infections in spine injured patients. Author(s): Stickler DJ, Chawla JC, Tricker AR, Preussmann R. Source: Paraplegia. 1992 December; 30(12): 855-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1287539&dopt=Abstract
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Norfloxacin versus co-trimoxazole in the treatment of recurring urinary tract infections in men. Author(s): Sabbaj J, Hoagland VL, Cook T. Source: Scand J Infect Dis Suppl. 1986; 48: 48-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3490684&dopt=Abstract
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Norfloxacin versus parenteral therapy in the treatment of complicated urinary tract infections and resistant organisms. Author(s): Cherubin C, Stilwell S. Source: Scand J Infect Dis Suppl. 1986; 48: 32-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3535053&dopt=Abstract
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Nosocomial urinary tract infections at a pediatric hospital. Author(s): Davies HD, Jones EL, Sheng RY, Leslie B, Matlow AG, Gold R. Source: The Pediatric Infectious Disease Journal. 1992 May; 11(5): 349-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1630854&dopt=Abstract
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Nosocomial urinary tract infections in children in a pediatric intensive care unit: a follow-up after 10 years. Author(s): Matlow AG, Wray RD, Cox PN. Source: Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2003 January; 4(1): 74-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12656548&dopt=Abstract
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Nosocomial urinary tract infections in urologic patients: assessment of a prospective surveillance program including 10,000 patients. Author(s): Merle V, Germain JM, Bugel H, Nouvellon M, Lemeland JF, Czernichow P, Grise P. Source: European Urology. 2002 May; 41(5): 483-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12074789&dopt=Abstract
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Nosocomial urinary tract infections: etiology and prevention. Author(s): Bruhl P, Widmann T, Sokeland J, Reybrouck G. Source: Urologia Internationalis. 1986; 41(6): 437-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3824702&dopt=Abstract
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Occurrence and antibiotic sensitivity of Enterobacteriaceae isolated from a group of Jordanian patients with community acquired urinary tract infections. Author(s): Abu Shaqra Q. Source: Cytobios. 2000; 101(396): 15-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10697742&dopt=Abstract
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Occurrence of single-point gyrA mutations among ciprofloxacin-susceptible Escherichia coli isolates causing urinary tract infections in Latin America. Author(s): Gales AC, Gordon KA, Wilke WW, Pfaller MA, Jones RN. Source: Diagnostic Microbiology and Infectious Disease. 2000 January; 36(1): 61-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10744370&dopt=Abstract
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Oestriol in the prophylactic treatment of recurrent urinary tract infections in postmenopausal women. Author(s): Kirkengen AL, Andersen P, Gjersoe E, Johannessen GR, Johnsen N, Bodd E. Source: Scandinavian Journal of Primary Health Care. 1992 June; 10(2): 139-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1641524&dopt=Abstract
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Ofloxacin for the treatment of urinary tract infections and biofilms in spinal cord injury. Author(s): Reid G, Potter P, Delaney G, Hsieh J, Nicosia S, Hayes K. Source: International Journal of Antimicrobial Agents. 2000 February; 13(4): 305-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10755246&dopt=Abstract
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Ofloxacin vs. cotrimoxazole in patients with complicated urinary tract infections. Author(s): Vellucci A, Bernardini G, Battaglia AM, Battaglia P. Source: Int J Clin Pharmacol Ther Toxicol. 1987 May; 25(5): 279-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3496284&dopt=Abstract
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Once daily isepamicin treatment in complicated urinary tract infections. Author(s): Lee SS, Liu YC, Wann SR, Lin WR, Tsai TH, Lin HH, Chen YS, Yen MY. Source: J Microbiol Immunol Infect. 1999 June; 32(2): 105-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11561574&dopt=Abstract
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Oral cephalosporins in uncomplicated urinary tract infections. Author(s): Garcia-Rodriguez JA, Munoz Bellido JL. Source: Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases. 2000; 6 Suppl 3: 73-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11449659&dopt=Abstract
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Oral ciprofloxacin in resistant urinary tract infections. Author(s): Ryan JL, Berenson CS, Greco TP, Mangi RJ, Sims M, Thornton GF, Andriole VT. Source: The American Journal of Medicine. 1987 April 27; 82(4A): 303-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3555052&dopt=Abstract
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Oral ciprofloxacin in the treatment of elderly patients with complicated urinary tract infections due to trimethoprim/sulfamethoxazole-resistant bacteria. Author(s): Preheim LC, Cuevas TA, Roccaforte JS, Mellencamp MA, Bittner MJ. Source: The American Journal of Medicine. 1987 April 27; 82(4A): 295-300. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3555051&dopt=Abstract
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Oral treatment of Pseudomonas-induced urinary tract infections with ciprofloxacin. Author(s): Van Poppel H, Wegge M, Dammekens H, Chysky V. Source: Chemotherapy. 1986; 32(1): 83-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2936583&dopt=Abstract
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Pathogenesis of urinary tract infections: a review. Author(s): Moore KN, Day RA, Albers M. Source: Journal of Clinical Nursing. 2002 September; 11(5): 568-74. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12201883&dopt=Abstract
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Pediatric urinary tract infections. Author(s): Chon CH, Lai FC, Shortliffe LM. Source: Pediatric Clinics of North America. 2001 December; 48(6): 1441-59. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11732124&dopt=Abstract
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Phase 2 clinical trial of a vaginal mucosal vaccine for urinary tract infections. Author(s): Uehling DT, Hopkins WJ, Elkahwaji JE, Schmidt DM, Leverson GE. Source: The Journal of Urology. 2003 September; 170(3): 867-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12913718&dopt=Abstract
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Piperacillin 2 g/tazobactam 0.5 g is as effective as imipenem 0.5 g/cilastatin 0.5 g for the treatment of acute uncomplicated pyelonephritis and complicated urinary tract infections. Author(s): Naber KG, Savov O, Salmen HC. Source: International Journal of Antimicrobial Agents. 2002 February; 19(2): 95-103. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11850161&dopt=Abstract
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Possible maternal inheritance of a common obstructive urinary tract anomaly. Report of a case of a woman with multiple urinary tract infections and two sons with posterior urethral valves. Author(s): Trembath DG, Rijhsinghani A. Source: J Reprod Med. 2002 November; 47(11): 962-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12497693&dopt=Abstract
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Postoperative Pseudomonas urinary tract infections as a source of bacterial contamination of an autogenous vein graft. Author(s): Campbell DR, Bartlett FF. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 1987 March; 5(3): 492-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3509604&dopt=Abstract
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Prevention of recurrent urinary tract infections with immuno-active E. coli fractions: a meta-analysis of five placebo-controlled double-blind studies. Author(s): Bauer HW, Rahlfs VW, Lauener PA, Blessmann GS. Source: International Journal of Antimicrobial Agents. 2002 June; 19(6): 451-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12135831&dopt=Abstract
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Prior antimicrobial drug exposure: a risk factor for trimethoprim-sulfamethoxazoleresistant urinary tract infections. Author(s): Metlay JP, Strom BL, Asch DA. Source: The Journal of Antimicrobial Chemotherapy. 2003 April; 51(4): 963-70. Epub 2003 February 25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12654756&dopt=Abstract
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Prospective study of urinary tract infections and urinary antibodies after radical prostatectomy and cystoprostatectomy. Author(s): Iwakiri J, Freiha FS, Shortliffe LM. Source: The Urologic Clinics of North America. 2002 February; 29(1): 251-8, Xii. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12109353&dopt=Abstract
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Prostaglandin E2 production and cyclooxygenase-2 induction in human urinary tract infections and bladder cancer. Author(s): Wheeler MA, Hausladen DA, Yoon JH, Weiss RM. Source: The Journal of Urology. 2002 October; 168(4 Pt 1): 1568-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12352459&dopt=Abstract
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Quality of life in women with urinary tract infections: is benign disease a misnomer? Author(s): Ellis AK, Verma S. Source: The Journal of the American Board of Family Practice / American Board of Family Practice. 2000 November-December; 13(6): 392-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11117334&dopt=Abstract
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Questions and answers. I am a 65-year-old woman who gets frequent urinary tract infections. What can I do to prevent recurrences? Author(s): Fihn SD. Source: Health News. 2003 September; 9(9): 12. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14584477&dopt=Abstract
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Recent advances into the pathogenesis of recurrent urinary tract infections: the bladder as a reservoir for uropathogenic Escherichia coli. Author(s): Schilling JD, Hultgren SJ. Source: International Journal of Antimicrobial Agents. 2002 June; 19(6): 457-60. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12135832&dopt=Abstract
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Recurrent urinary tract infections in female patients: an overview of management and treatment. Author(s): Stamey TA. Source: Reviews of Infectious Diseases. 1987 March-April; 9 Suppl 2: S195-210. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3554458&dopt=Abstract
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Recurrent urinary tract infections in infancy: relapses or reinfections? Author(s): Jantunen ME, Saxen H, Salo E, Siitonen A. Source: The Journal of Infectious Diseases. 2002 February 1; 185(3): 375-9. Epub 2002 January 09. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11807720&dopt=Abstract
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Recurrent urinary tract infections in women. Author(s): Sotelo T, Westney OL. Source: Curr Womens Health Rep. 2003 August; 3(4): 313-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12844456&dopt=Abstract
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Recurrent urinary tract infections in women. Pathogenesis and management. Author(s): Schaeffer AJ. Source: Postgraduate Medicine. 1987 February 15; 81(3): 51-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3809068&dopt=Abstract
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Recurrent urinary tract infections: relapses or reinfections? Author(s): Arya SC. Source: The Journal of Infectious Diseases. 2002 September 15; 186(6): 876. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12198630&dopt=Abstract
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Reducing nosocomial urinary tract infections in geriatric patients. Author(s): Roe B. Source: Todays or Nurse. 1992 April; 14(4): 4-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1570643&dopt=Abstract
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Renal pelvic wall thickening in childhood urinary tract infections--evidence of acute pyelitis or vesicoureteral reflux? Author(s): Tain YL. Source: Scandinavian Journal of Urology and Nephrology. 2003; 37(1): 28-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12745739&dopt=Abstract
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Resistant pathogens in urinary tract infections. Author(s): Nicolle LE. Source: Journal of the American Geriatrics Society. 2002 July; 50(7 Suppl): S230-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12121518&dopt=Abstract
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Risk of urinary tract infections in adults surgically treated for vesicoureteral reflux in childhood. Author(s): Snow BW. Source: The Journal of Urology. 2002 August; 168(2): 708. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12131356&dopt=Abstract
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Scientific and clinical challenges in the management of urinary tract infections. Author(s): Stamm WE. Source: The American Journal of Medicine. 2002 July 8; 113 Suppl 1A: 1S-4S. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12113865&dopt=Abstract
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Screening of urinary tract infections by ELISA. Author(s): Thakker B, Michie JR, Tait IB, McCartney AC. Source: Journal of Clinical Pathology. 1992 October; 45(10): 941. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1430272&dopt=Abstract
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Severe urinary tract infections. Author(s): Zagar Z, Vranes J, Beader N. Source: Journal of Chemotherapy (Florence, Italy). 1991 January; 3 Suppl 1: 19-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12041762&dopt=Abstract
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Single-dose antibiotic therapy for urinary tract infections and type II error. Author(s): Jordan NS. Source: Archives of Internal Medicine. 1986 February; 146(2): 413-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3484941&dopt=Abstract
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Single-dose antimicrobial therapy for urinary tract infections: “less is more”? or “Reductio ad absurdum”? Author(s): Fihn SD. Source: Journal of General Internal Medicine : Official Journal of the Society for Research and Education in Primary Care Internal Medicine. 1986 January-February; 1(1): 62-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3772569&dopt=Abstract
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Single-dose therapy in the management of urinary tract infections. Author(s): Whitworth JA. Source: The Medical Journal of Australia. 1986 February 3; 144(3): 136-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3511354&dopt=Abstract
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Spectrum and antibiotic resistance of uropathogens from hospitalized patients with urinary tract infections: 1994-2000. Author(s): Wagenlehner FM, Niemetz A, Dalhoff A, Naber KG. Source: International Journal of Antimicrobial Agents. 2002 June; 19(6): 557-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12135848&dopt=Abstract
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Staphylococcus saprophyticus urinary tract infections in children. Author(s): Abrahamsson K, Hansson S, Jodal U, Lincoln K. Source: European Journal of Pediatrics. 1993 January; 152(1): 69-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8444210&dopt=Abstract
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Surveillance of antibiotic resistance in urinary tract infections--are we misleading prescribers? Author(s): Oppenheim BA. Source: Commun Dis Public Health. 2002 September; 5(3): 181-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12434686&dopt=Abstract
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Susceptibility of Danish Escherichia coli strains isolated from urinary tract infections and bacteraemia, and distribution of sul genes conferring sulphonamide resistance. Author(s): Kerrn MB, Klemmensen T, Frimodt-Moller N, Espersen F. Source: The Journal of Antimicrobial Chemotherapy. 2002 October; 50(4): 513-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12356795&dopt=Abstract
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Terms used to describe urinary tract infections--the importance of conceptual clarification. Author(s): Liss PE, Aspevall O, Karlsson D, Forsum U. Source: Apmis : Acta Pathologica, Microbiologica, Et Immunologica Scandinavica. 2003 February; 111(2): 291-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12716385&dopt=Abstract
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Tetrazolium reduction test in diagnosis of urinary tract infections. Author(s): Agrawal SK, Das R, Goel MM, Kumar M. Source: Indian J Pathol Microbiol. 1986 January; 29(1): 61-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3536737&dopt=Abstract
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The effect of the prophylactic use of absorbable and non-absorbable antibiotics on the incidence of urinary tract infections in recipients of cadaveric kidney transplants. Author(s): Tegzess AM, Van Eck HA, Van Saene HK, Meijer-Vogt RA, Meijer S, Van Son WJ, Slooff MJ. Source: The Netherlands Journal of Medicine. 1986; 29(11): 352-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3543705&dopt=Abstract
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The management of childhood urinary tract infections. Author(s): Reddy PP, Redman JF. Source: J Ark Med Soc. 2002 November; 99(5): 156-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12434626&dopt=Abstract
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The PIC cystogram: a novel approach to identify “occult” vesicoureteral reflux in children with febrile urinary tract infections. Author(s): Rubenstein JN, Maizels M, Kim SC, Houston JT. Source: The Journal of Urology. 2003 June; 169(6): 2339-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12771795&dopt=Abstract
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The relationship between treatment objectives and practice patterns in the management of urinary tract infections. Author(s): Flach SD, Longenecker JC, Tape TG, Bryan TJ, Parenti C, Wigton RS. Source: Medical Decision Making : an International Journal of the Society for Medical Decision Making. 2003 March-April; 23(2): 131-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12693875&dopt=Abstract
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Therapeutic efficacy and renal effects of cefonicid in the treatment of difficult urinary tract infections. Author(s): Donadio C, Tramonti G, Garcea G, Costagli M, Lucchetti A, Giordani R, Paizis G, Pierotti R, Falcone G, Bianchi C. Source: Journal of Chemotherapy (Florence, Italy). 1991 January; 3 Suppl 1: 233-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12041774&dopt=Abstract
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Therapy of uncomplicated urinary tract infections. Author(s): Ribeiro RM, Rossi P, Pacetta AM, Haddad JM, Pinotti JA. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2002; 13(3): 190-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12140716&dopt=Abstract
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Treatment failures after antibiotic therapy of uncomplicated urinary tract infections. A prescription database study. Author(s): Bjerrum L, Dessau RB, Hallas J. Source: Scandinavian Journal of Primary Health Care. 2002 June; 20(2): 97-101. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12184721&dopt=Abstract
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Treatment of recurrent urinary tract infections: efficacy of an orally administered biological response modifier. Author(s): Frey C, Obolensky W, Wyss H. Source: Urologia Internationalis. 1986; 41(6): 444-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3547993&dopt=Abstract
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Urinary tract infections and acupuncture. Author(s): Katz AR. Source: American Journal of Public Health. 2003 May; 93(5): 702; Author Reply 702-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12721123&dopt=Abstract
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Urinary tract infections are a common bacterial infection in children. Author(s): Bagga A, Srivastava RN. Source: Indian J Pediatr. 2003 March; 70(3): 233. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12785295&dopt=Abstract
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Urinary tract infections beyond the early post-transplant period in pediatric renal graft recipients. Author(s): Mueller T, Resinger C, Ruffingshofer D, Arbeiter K, Balzar E, Aufricht C. Source: Wiener Klinische Wochenschrift. 2003 June 24; 115(11): 385-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12879736&dopt=Abstract
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Urinary tract infections caused by endemic multi-resistant Enterobacter cloacae in a dialysis and transplantation unit. Author(s): Kaminska W, Patzer J, Dzierzanowska D. Source: The Journal of Hospital Infection. 2002 July; 51(3): 215-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12144801&dopt=Abstract
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Urinary tract infections in adult and adolescent males of a developing community: pattern, bacteriology and genito-urinary predisposing factors. Author(s): Murshidi MS, Farah NB. Source: Arch Esp Urol. 2002 December; 55(10): 288-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12611232&dopt=Abstract
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Urinary tract infections in pregnant women. Author(s): Santos JF, Ribeiro RM, Rossi P, Haddad JM, Guidi HG, Pacetta AM, Pinotti JA. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2002; 13(3): 204-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12140719&dopt=Abstract
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Urinary tract infections in women. Author(s): Ribeiro RM, Rossi P, Guidi HG, Pinotti JA. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2002; 13(3): 198-203. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12140718&dopt=Abstract
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Urinary tract infections. Author(s): Bass PF 3rd, Jarvis JA, Mitchell CK. Source: Primary Care. 2003 March; 30(1): 41-61, V-Vi. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12838910&dopt=Abstract
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Urinary tract infections. Treatment and prevention. Author(s): Randrup E, Baum N. Source: Diabetes Self Manag. 2002 July-August; 19(4): 45-6, 49. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12533848&dopt=Abstract
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Urinary tract infections: pathogenesis and related conditions. Author(s): Herrmann V, Palma P, Geo MS, Lima RS. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2002; 13(3): 210-3. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12140720&dopt=Abstract
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Vaccination utilizing the FimCH complex as a strategy to prevent Escherichia coli urinary tract infections. Author(s): Langermann S, Ballou WR Jr. Source: The Journal of Infectious Diseases. 2001 March 1; 183 Suppl 1: S84-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11171023&dopt=Abstract
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Value of urologic investigation in a targeted group of women with recurrent urinary tract infections. Author(s): Nickel JC, Wilson J, Morales A, Heaton J. Source: Canadian Journal of Surgery. Journal Canadien De Chirurgie. 1991 December; 34(6): 591-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1747838&dopt=Abstract
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Vesico ureteric reflux and urinary tract infections in children. Author(s): Woodward A. Source: Aust Fam Physician. 1998 December; 27(12): 1095-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9919731&dopt=Abstract
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Vesicoureteral reflux and urinary tract infections. Author(s): Agarwal S. Source: Current Opinion in Urology. 2000 November; 10(6): 587-92. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11148730&dopt=Abstract
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Vesicoureteral reflux diagnosed in adulthood. Incidence of urinary tract infections, hypertension, proteinuria, back pain and renal calculi. Author(s): Kohler J, Tencer J, Thysell H, Forsberg L. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 1997 December; 12(12): 2580-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9430855&dopt=Abstract
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Virulence determinants in Pseudomonas aeruginosa strains from urinary tract infections. Author(s): Visca P, Chiarini F, Mansi A, Vetriani C, Serino L, Orsi N. Source: Epidemiology and Infection. 1992 April; 108(2): 323-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1582473&dopt=Abstract
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Virulence factors in Escherichia coli from urinary tract infections in patients with spinal injuries. Author(s): Benton J, Chawla J, Parry S, Stickler D. Source: The Journal of Hospital Infection. 1992 October; 22(2): 117-27. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1358953&dopt=Abstract
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Virulence-associated factors in Escherichia coli strains isolated from children with urinary tract infections. Author(s): Siegfried L, Kmetova M, Puzova H, Molokacova M, Filka J. Source: Journal of Medical Microbiology. 1994 August; 41(2): 127-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7913974&dopt=Abstract
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Voiding cystourethrograms and urinary tract infections: how long to wait? Author(s): McDonald A, Scranton M, Gillespie R, Mahajan V, Edwards GA. Source: Pediatrics. 2000 April; 105(4): E50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10742371&dopt=Abstract
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Voiding dysfunction associated with incontinence, vesicoureteral reflux and recurrent urinary tract infections. Author(s): McKenna PH, Herndon CD. Source: Current Opinion in Urology. 2000 November; 10(6): 599-606. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11148732&dopt=Abstract
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Walter E Stamm--towards control of urinary tract infections. Interview by Pam Das. Author(s): Stamm WE. Source: The Lancet Infectious Diseases. 2002 February; 2(2): 120-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11901644&dopt=Abstract
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Wegener's granulomatosis: prostatic involvement and recurrent urinary tract infections. Author(s): Khattak AQ, Nair M, Haqqani MT, Williamson EP. Source: Bju International. 1999 September; 84(4): 531-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10468778&dopt=Abstract
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What do general practitioners do when patients present with symptoms indicative of urinary tract infections? Author(s): McLeod D, Kljakovic M. Source: N Z Med J. 1998 May 22; 111(1066): 189-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9640319&dopt=Abstract
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What practical strategies can nurses utilize to assess, treat, and prevent urinary tract infections among persons with SCI/D? Author(s): Kelley B. Source: Sci Nurs. 1997 December; 14(4): 129. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9510834&dopt=Abstract
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When to do culture in urinary tract infections. Author(s): Andriole VT. Source: International Journal of Antimicrobial Agents. 1999 May; 11(3-4): 253-5; Discussion 261-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10394979&dopt=Abstract
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Which bacteria are found in Belgian women with uncomplicated urinary tract infections in primary health care, and what is their susceptibility pattern anno 95-96? Author(s): Christiaens TH, Heytens S, Verschraegen G, De Meyere M, De Maeseneer J. Source: Acta Clin Belg. 1998 June; 53(3): 184-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9701853&dopt=Abstract
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Which fluoroquinolones are suitable for the treatment of urinary tract infections? Author(s): Naber KG. Source: International Journal of Antimicrobial Agents. 2001 April; 17(4): 331-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11295418&dopt=Abstract
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Why do cranberries reduce incidence of urinary tract infections? Author(s): Dearing MD, Appel HM, Schultz JC. Source: Journal of Ethnopharmacology. 2002 May; 80(2-3): 211. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12007714&dopt=Abstract
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Why the resistance to diagnostic imaging in childhood urinary tract infections. Author(s): Dudley J, Chambers T. Source: Lancet. 1996 July 13; 348(9020): 71-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8676716&dopt=Abstract
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Widespread distribution of urinary tract infections caused by a multidrug-resistant Escherichia coli clonal group. Author(s): Manges AR, Johnson JR, Foxman B, O'Bryan TT, Fullerton KE, Riley LW. Source: The New England Journal of Medicine. 2001 October 4; 345(14): 1007-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11586952&dopt=Abstract
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CHAPTER 2. INFECTIONS
NUTRITION
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URINARY
TRACT
Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and urinary tract infections.
Finding Nutrition Studies on Urinary Tract Infections The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail:
[email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “urinary tract infections” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.
7 Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.
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The following information is typical of that found when using the “Full IBIDS Database” to search for “urinary tract infections” (or a synonym): •
Reducing the risk of urinary tract infections in breeding sows. Source: Hoehler, D. Lindermeayer, H. Wolffram, S. Kraftfutter (Germany). (2000). (no. 78) page 293-296.
Additional physician-oriented references include: •
A comparative study of pipemidic acid and nitrofurantoin in the treatment of uncomplicated urinary tract infections. Author(s): Department of Pharmacology, University of Pretoria. Source: Meyer, E C Schoeman, H S S-Afr-Med-J. 1987 November 21; 72(10): 663-5 00382469
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A prospective, controlled, randomized study of the effect of a slow-release silver device on the frequency of urinary tract infection in newly catheterized patients. Author(s): Maersk Medical A/S, Lynge, Denmark. Source: Reiche, T Lisby, G Jorgensen, S Christensen, A B Nordling, J BJU-Int. 2000 January; 85(1): 54-9 1464-4096
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A randomized trial to evaluate effectiveness and cost effectiveness of naturopathic cranberry products as prophylaxis against urinary tract infection in women. Author(s): Department of Surgery, Division of Urology, University of British Columbia, Vancouver, BC, Canada. Source: Stothers, L Can-J-Urol. 2002 June; 9(3): 1558-62 1195-9479
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A systematic review of estrogens for recurrent urinary tract infections: third report of the hormones and urogenital therapy (HUT) committee. Author(s): King's College School of Medicine and Dentistry, London, UK.
[email protected] Source: Cardozo, L Lose, G McClish, D Versi, E de Koning Gans, H Int-Urogynecol-JPelvic-Floor-Dysfunct. 2001; 12(1): 15-20
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Are cranberry juice or cranberry products effective in the prevention or management of urinary tract infection? Author(s): Department of Urology and School of Nursing, University of Virginia, Charlottesville 22908, USA.
[email protected] Source: Gray, M J-Wound-Ostomy-Continence-Nurs. 2002 May; 29(3): 122-6 1071-5754
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Catheter induced urethral inflammatory reaction and urinary tract infection. An experimental and clinical study. Author(s): Department of Urology, Karolinska Hospital and Institute, Stockholm, Sweden. Source: Liedberg, H Scand-J-Urol-Nephrol-Suppl. 1989; 1241-43 0300-8886
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Cranberries for preventing urinary tract infections (Cochrane Review). Author(s): 1F1, 130 Portobello High Street, Edinburgh, UK, EH15 1AH.
[email protected] Source: Jepson, R G Mihaljevic, L Craig, J Cochrane-Database-Syst-Revolume 2001; 3: CD001321 1469-493X
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Cranberries for treating urinary tract infections. Author(s): 15 Blackwood Crescent, Edinburgh, UK, EH9 1QZ.
[email protected] Source: Jepson, R G Mihaljevic, L Craig, J Cochrane-Database-Syst-Revolume 2000; (2): CD001322 1469-493X
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Cranberry juice and urinary tract infections: what is the evidence? Author(s): Department of Urology, St. Luke's-Roosevelt Hospital Center and Columbia University College of Physicians and Surgeons, New York, New York, USA Source: Lowe, F C Fagelman, E Urology. 2001 March; 57(3): 407-13 1527-9995
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Empowering female residents: alternative approaches to urinary tract infections (UTIs) in nursing homes. Source: Ritchie, B F Aust-J-Holist-Nurs. 2000 April; 7(1): 26-30 1322-8803
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Estriol in recurrent urinary tract infection in elderly women? Source: Bergstrom, H Acta-Obstet-Gynecol-Scand-Suppl. 1987; 14079-83 0300-8835
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First-time urinary tract infection and sexual behavior. Author(s): Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, USA. Source: Foxman, B Geiger, A M Palin, K Gillespie, B Koopman, J S Epidemiology. 1995 March; 6(2): 162-8 1044-3983
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Hypercalciuria and recurrent urinary tract infection in Venezuelan children. Author(s): Equipex SA, Miami FL 33102-0010, USA.
[email protected] Source: Lopez, M M Castillo, L A Chavez, J B Ramones, C Pediatr-Nephrol. 1999 June; 13(5): 433-7 0931-041X
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N-nitrosamine generation by urinary tract infections in spine injured patients. Author(s): School of Pure and Applied Biology, University of Wales, College of Cardiff, UK. Source: Stickler, D J Chawla, J C Tricker, A R Preussmann, R Paraplegia. 1992 December; 30(12): 855-63 0031-1758
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Observation on therapeutic effect of clearing heat and dredging stranguria in 103 cases of urinary tract infection. Source: Xu, J F Liu, B H Cui, X M Sun, S L Yu, P J Gao, R J Liu, X J-Tradit-Chin-Med. 1989 September; 9(3): 163-5 0254-6272
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Pathogenesis and management of recurrent urinary tract infection in women. Author(s): Department of Urology, University of Vienna, Austria.
[email protected] Source: Madersbacher, S Thalhammer, F Marberger, M Curr-Opin-Urol. 2000 January; 10(1): 29-33 0963-0643
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Piperacillin 2 g/tazobactam 0.5 g is as effective as imipenem 0.5 g/cilastatin 0.5 g for the treatment of acute uncomplicated pyelonephritis and complicated urinary tract infections. Author(s): Clinic of Urology, St. Elisabeth Hospital, St. Elisabeth Strasse 23, D-94315, Straubing, Germany.
[email protected] Source: Naber, Kurt G Savov, Orlin Salmen, Hans C Int-J-Antimicrob-Agents. 2002 February; 19(2): 95-103 0924-8579
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Potential preventive strategies and therapies in urinary tract infection. Author(s): Lawson Research Institute, London, Ontario, Canada.
[email protected] Source: Reid, G World-J-Urol. 1999 December; 17(6): 359-63 0724-4983
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Recurrent urinary tract infection in women. Author(s): University of Washington School of Medicine, Harborview Medical Center, Madison Clinic, 325 9th Avenue, Seattle, WA 98104-2499, USA.
[email protected] Source: Hooton, T M Int-J-Antimicrob-Agents. 2001 April; 17(4): 259-68 0924-8579
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Regular drinking of cranberry-lingonberry juice concentrate reduced recurrent urinary tract infections in women. Author(s): LAMP Community Health Centre, Toronto, Ontario, Canada. Source: Goodine, Wendy Evid-Based-Nurs. 2002 April; 5(2): 43 1367-6539
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The possible value of ascorbic acid as a prophylactic agent for urinary tract infection. Author(s): Pharmacy Department, Hospital de Traumatologia i Rehabilitacio Vall d'Hebron, Barcelona, Spain. Source: Castello, T Girona, L Gomez, M R Mena Mur, A Garcia, L Spinal-Cord. 1996 October; 34(10): 592-3 1362-4393
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Therapeutic effects of cefozopran against experimental mixed urinary tract infection with Enterococcus faecalis and Pseudomonas aeruginosa in mice. Author(s): Pharmaceutical Research Laboratories III, Takeda Chemical Industries, Ltd, Yodogawa-ku, Osaka, Japan.
[email protected] Source: Tsuchimori, N Yamazaki, T Okonogi, K J-Antimicrob-Chemother. 1997 March; 39(3): 423-5 0305-7453
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Therapy of uncomplicated urinary tract infections. Author(s): University of Sao Paulo, Rua Tabapua 649-81, CEP 04533-012, Sao Paulo, SP, Brazil. Source: Ribeiro, R M Rossi, P Pacetta, A M Haddad, J M Pinotti, J A Int-Urogynecol-JPelvic-Floor-Dysfunct. 2002; 13(3): 190-4 0937-3462
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Treatment of lower urinary tract infections in children: single dose fosfomycin trometamol versus pipemidic acid. Author(s): Pediatric Clinic I, University of Milan, Italy. Source: Careddu, P Borzani, M Scotti, L Varotto, F Garlaschi, L Fontana, P Chemioterapia. 1987 August; 6(4): 290-4 0392-906X
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Urinary tract infection in children associated with idiopathic hypercalciuria. Author(s): Department of Pediatrics, University of Tennessee Graduate School of Medicine, Knoxville, USA.
[email protected] Source: Vachvanichsanong, P Malagon, M Moore, E S Scand-J-Urol-Nephrol. 2001 April; 35(2): 112-6 0036-5599
Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •
healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0
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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov
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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov
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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/
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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/
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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/
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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/
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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/
Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
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Google: http://directory.google.com/Top/Health/Nutrition/
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Healthnotes: http://www.healthnotes.com/
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Open Directory Project: http://dmoz.org/Health/Nutrition/
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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
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WebMDHealth: http://my.webmd.com/nutrition
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html
The following is a specific Web list relating to urinary tract infections; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •
Vitamins Vitamin A Source: Healthnotes, Inc.; www.healthnotes.com Vitamin C Source: Healthnotes, Inc.; www.healthnotes.com Vitamin C Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,904,00.html
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•
Food and Diet Berries Source: Healthnotes, Inc.; www.healthnotes.com Cinnamon Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,271,00.html Cranberries Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,144,00.html Juices Source: Healthnotes, Inc.; www.healthnotes.com Natural Sweeteners Source: Healthnotes, Inc.; www.healthnotes.com Pumpkin Seeds Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,176,00.html Refined Sweeteners Source: Healthnotes, Inc.; www.healthnotes.com Sugar Alcohols Source: Healthnotes, Inc.; www.healthnotes.com
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CHAPTER 3. ALTERNATIVE MEDICINE AND URINARY TRACT INFECTIONS Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to urinary tract infections. At the conclusion of this chapter, we will provide additional sources.
National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to urinary tract infections and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “urinary tract infections” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to urinary tract infections: •
A randomized trial to evaluate effectiveness and cost effectiveness of naturopathic cranberry products as prophylaxis against urinary tract infection in women. Author(s): Stothers L. Source: Can J Urol. 2002 June; 9(3): 1558-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12121581&dopt=Abstract
•
Acupuncture in the prophylaxis of recurrent lower urinary tract infection in adult women. Author(s): Aune A, Alraek T, LiHua H, Baerheim A. Source: Scandinavian Journal of Primary Health Care. 1998 March; 16(1): 37-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9612877&dopt=Abstract
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Acupuncture treatment in the prevention of uncomplicated recurrent lower urinary tract infections in adult women. Author(s): Alraek T, Soedal LI, Fagerheim SU, Digranes A, Baerheim A. Source: American Journal of Public Health. 2002 October; 92(10): 1609-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12356607&dopt=Abstract
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Antimicrobial activity of intraurethrally administered probiotic Lactobacillus casei in a murine model of Escherichia coli urinary tract infection. Author(s): Asahara T, Nomoto K, Watanuki M, Yokokura T. Source: Antimicrobial Agents and Chemotherapy. 2001 June; 45(6): 1751-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11353622&dopt=Abstract
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Are cranberry juice or cranberry products effective in the prevention or management of urinary tract infection? Author(s): Gray M. Source: Journal of Wound, Ostomy, and Continence Nursing : Official Publication of the Wound, Ostomy and Continence Nurses Society / Wocn. 2002 May; 29(3): 122-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12011903&dopt=Abstract
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Autoantibodies to Tamm-Horsfall glycoprotein in children with renal damage associated with urinary tract infections. Author(s): Fasth A, Bjure J, Hellstrom M, Jacobsson B, Jodal U. Source: Acta Paediatr Scand. 1980 November; 69(6): 709-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7211355&dopt=Abstract
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Can regular intake of either cranberry juice or a drink containing Lactobacillus bacteria prevent urinary tract infection (UTI) recurrence in women after an initial episode? Author(s): Triezenberg DJ. Source: The Journal of Family Practice. 2001 October; 50(10): 841. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11674882&dopt=Abstract
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Cranberries for preventing urinary tract infections. Author(s): Jepson RG, Mihaljevic L, Craig J. Source: Cochrane Database Syst Rev. 2001; (3): Cd001321. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11686987&dopt=Abstract
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Cranberries for preventing urinary tract infections. Author(s): Jepson RG, Mihaljevic L, Craig J. Source: Cochrane Database Syst Rev. 2000; (2): Cd001321. Review. Update In: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10796774&dopt=Abstract
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Cranberries for treating urinary tract infections. Author(s): Jepson RG, Mihaljevic L, Craig J. Source: Cochrane Database Syst Rev. 2000; (2): Cd001322. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10796775&dopt=Abstract
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Cranberry juice and prevention of recurrent urinary tract infection. Author(s): Kerr KG. Source: Lancet. 1999 February 20; 353(9153): 673. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10030358&dopt=Abstract
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Cranberry juice and urinary tract infections: is there a beneficial relationship? Author(s): Kuzminski LN. Source: Nutrition Reviews. 1996 November; 54(11 Pt 2): S87-90. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9110581&dopt=Abstract
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Cranberry juice and urinary tract infections: what is the evidence? Author(s): Lowe FC, Fagelman E. Source: Urology. 2001 March; 57(3): 407-13. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11248607&dopt=Abstract
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Cranberry juice in the treatment of urinary tract infections. Author(s): Papas PN, Brusch CA, Ceresia GC. Source: Southwest Med. 1966 January; 47(1): 17-20. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5900988&dopt=Abstract
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Dietary factors protecting women from urinary tract infection. Author(s): Kontiokari T, Laitinen J, Jarvi L, Pokka T, Sundqvist K, Uhari M. Source: The American Journal of Clinical Nutrition. 2003 March; 77(3): 600-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12600849&dopt=Abstract
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Do cranberries aid in the treatment of urinary tract infections? Author(s): Cunningham E. Source: Journal of the American Dietetic Association. 2002 August; 102(8): 1118. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12171456&dopt=Abstract
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Does cranberry juice prevent or treat urinary tract infection? Author(s): Kiel RJ, Nashelsky J, Robbins B. Source: The Journal of Family Practice. 2003 February; 52(2): 154-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12585995&dopt=Abstract
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Empowering female residents: alternative approaches to urinary tract infections (UTIs) in nursing homes. Author(s): Ritchie BF. Source: Aust J Holist Nurs. 2000 April; 7(1): 26-30. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11898217&dopt=Abstract
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Evolution of single kidney glomerular filtration rate in urinary tract infection. Author(s): Arnello F, Ham HR, Tondeur M, Piepsz A. Source: Pediatric Nephrology (Berlin, Germany). 1999 February; 13(2): 121-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10228997&dopt=Abstract
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High-dosage co-amoxiclav in a single dose versus 7 days of co-trimoxazole as treatment of uncomplicated lower urinary tract infection in women. Author(s): Masterton RG, Bochsler JA. Source: The Journal of Antimicrobial Chemotherapy. 1995 January; 35(1): 129-37. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7768760&dopt=Abstract
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Incidence of diarrhea in the treatment of genitourinary tract infections with ampicillin. Author(s): Horrax TM. Source: Conn Med. 1971 May; 35(5): 301-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5089290&dopt=Abstract
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Incidence of urinary tract infections following endoscopic surgery in immunodepressed patients treated with thymostimulin. Author(s): Cocimano V, Casetta G, Piana P, Tizzani A. Source: J Exp Pathol. 1987 Summer; 3(4): 607-11. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3454808&dopt=Abstract
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Influence of circumcision technique on frequency of urinary tract infections in neonates. Author(s): Harel L, Straussbergr R, Jackson S, Amir J, Tiqwa P. Source: The Pediatric Infectious Disease Journal. 2002 September; 21(9): 879-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12380588&dopt=Abstract
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Inhibition of bacterial adherence by cranberry juice: potential use for the treatment of urinary tract infections. Author(s): Sobota AE. Source: The Journal of Urology. 1984 May; 131(5): 1013-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6368872&dopt=Abstract
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Managing lower urinary tract infections. What is the best approach? Author(s): Hickey J.
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Source: Can Fam Physician. 2000 August; 46: 1577-8. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10955175&dopt=Abstract •
Observation on therapeutic effect of clearing heat and dredging stranguria in 103 cases of urinary tract infection. Author(s): Xu JF, Liu BH, Cui XM, Sun SL, Yu PJ, Gao RJ, Liu X. Source: J Tradit Chin Med. 1989 September; 9(3): 163-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2615443&dopt=Abstract
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Overall and single-kidney clearance in children with urinary tract infection and damaged kidneys. Author(s): Arnello F, Ham HR, Tondeur M, Piepsz A. Source: Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine. 1999 January; 40(1): 52-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9935056&dopt=Abstract
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Pathogenesis and management of recurrent urinary tract infection in women. Author(s): Madersbacher S, Thalhammer F, Marberger M. Source: Current Opinion in Urology. 2000 January; 10(1): 29-33. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10650512&dopt=Abstract
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Pelvic-floor therapy in girls with recurrent urinary tract infections and dysfunctional voiding. Author(s): De Paepe H, Hoebeke P, Renson C, Van Laecke E, Raes A, Van Hoecke E, Van Daele J, Vande Walle J. Source: British Journal of Urology. 1998 May; 81 Suppl 3: 109-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9634033&dopt=Abstract
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Pharmacokinetics of [18F]fleroxacin in patients with acute exacerbations of chronic bronchitis and complicated urinary tract infection studied by positron emission tomography. Author(s): Fischman AJ, Livni E, Babich JW, Alpert NM, Bonab A, Chodosh S, McGovern F, Kamitsuka P, Liu YY, Cleeland R, Prosser BL, Correia JA, Rubin RH. Source: Antimicrobial Agents and Chemotherapy. 1996 March; 40(3): 659-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8851589&dopt=Abstract
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Potential preventive strategies and therapies in urinary tract infection. Author(s): Reid G. Source: World Journal of Urology. 1999 December; 17(6): 359-63. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10654366&dopt=Abstract
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Probiotics feeding in prevention of urinary tract infection, bacterial sepsis and necrotizing enterocolitis in preterm infants. A prospective double-blind study. Author(s): Dani C, Biadaioli R, Bertini G, Martelli E, Rubaltelli FF. Source: Biology of the Neonate. 2002 August; 82(2): 103-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12169832&dopt=Abstract
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Questions and answers. I am a 65-year-old woman who gets frequent urinary tract infections. What can I do to prevent recurrences? Author(s): Fihn SD. Source: Health News. 2003 September; 9(9): 12. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14584477&dopt=Abstract
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Randomised trial of cranberry-lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women. Author(s): Kontiokari T, Sundqvist K, Nuutinen M, Pokka T, Koskela M, Uhari M. Source: Bmj (Clinical Research Ed.). 2001 June 30; 322(7302): 1571. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11431298&dopt=Abstract
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Recurrent urinary tract infection in women. Author(s): Hooton TM. Source: International Journal of Antimicrobial Agents. 2001 April; 17(4): 259-68. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11295405&dopt=Abstract
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Renal function 16 to 26 years after the first urinary tract infection in childhood. Author(s): Wennerstrom M, Hansson S, Jodal U, Sixt R, Stokland E. Source: Archives of Pediatrics & Adolescent Medicine. 2000 April; 154(4): 339-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10768669&dopt=Abstract
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Salmonella urinary tract infections associated with exposure to pet iguanas. Author(s): Embil JM, Nicolle LE. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 1997 July; 25(1): 172. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9243066&dopt=Abstract
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Systematic review of nursing management of urinary tract infections in the cognitively impaired elderly client in residential care: is there a hole in holistic care? Author(s): Brown S. Source: International Journal of Nursing Practice. 2002 February; 8(1): 2-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11831423&dopt=Abstract
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The effect of repeated instillations of antiseptics on catheter-associated urinary tract infections: a study in a physical model of the catheterized bladder. Author(s): King JB, Stickler DJ.
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Source: Urological Research. 1992; 20(6): 403-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1462478&dopt=Abstract •
Urinary tract infection following ritual Jewish circumcision. Author(s): Goldman M, Barr J, Bistritzer T, Aladjem M. Source: Isr J Med Sci. 1996 November; 32(11): 1098-102. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8960080&dopt=Abstract
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Urinary tract infection in individuals with spinal cord lesion. Author(s): Biering-Sorensen F. Source: Current Opinion in Urology. 2002 January; 12(1): 45-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11753133&dopt=Abstract
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Urinary tract infections and acupuncture. Author(s): Katz AR. Source: American Journal of Public Health. 2003 May; 93(5): 702; Author Reply 702-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12721123&dopt=Abstract
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Urinary tract infections cranberry juice, underwear, and probiotics in the 21st century. Author(s): Miller JL, Krieger JN. Source: The Urologic Clinics of North America. 2002 August; 29(3): 695-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12476532&dopt=Abstract
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Urinary tract infections in the aged: improvement with thymostimulin. Author(s): Casale G, Zurita IE, Colombo M, de Nicola P. Source: Arzneimittel-Forschung. 1983; 33(6): 889-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6684446&dopt=Abstract
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Whirlpool-associated Pseudomonas aeruginosa urinary tract infections. Author(s): Salmen P, Dwyer DM, Vorse H, Kruse W. Source: Jama : the Journal of the American Medical Association. 1983 October 21; 250(15): 2025-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6413703&dopt=Abstract
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Why do cranberries reduce incidence of urinary tract infections? Author(s): Dearing MD, Appel HM, Schultz JC. Source: Journal of Ethnopharmacology. 2002 May; 80(2-3): 211. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12007714&dopt=Abstract
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Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
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Chinese Medicine: http://www.newcenturynutrition.com/
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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html
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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
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Google: http://directory.google.com/Top/Health/Alternative/
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Healthnotes: http://www.healthnotes.com/
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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine
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Open Directory Project: http://dmoz.org/Health/Alternative/
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HealthGate: http://www.tnp.com/
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WebMDHealth: http://my.webmd.com/drugs_and_herbs
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html
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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
The following is a specific Web list relating to urinary tract infections; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •
General Overview Alcoholism Source: Integrative Medicine Communications; www.drkoop.com Allergies and Sensitivities Source: Healthnotes, Inc.; www.healthnotes.com Alzheimer's Disease Source: Integrative Medicine Communications; www.drkoop.com Benign Prostatic Hyperplasia Source: Healthnotes, Inc.; www.healthnotes.com Bladder Infection Alternative names: Urinary Tract Infection [UTI] Source: Prima Communications, Inc.www.personalhealthzone.com Diverticular Disease Source: Integrative Medicine Communications; www.drkoop.com
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Hyperparathyroidism Source: Integrative Medicine Communications; www.drkoop.com Infection Source: Healthnotes, Inc.; www.healthnotes.com Kidney Stones Source: Integrative Medicine Communications; www.drkoop.com Pelvic Inflammatory Disease Source: Integrative Medicine Communications; www.drkoop.com Prostate Cancer Source: Integrative Medicine Communications; www.drkoop.com Prostate Infection Source: Integrative Medicine Communications; www.drkoop.com Prostatitis Source: Healthnotes, Inc.; www.healthnotes.com Prostatitis Source: Integrative Medicine Communications; www.drkoop.com Reiter's Syndrome Source: Integrative Medicine Communications; www.drkoop.com Urinary Incontinence Source: Integrative Medicine Communications; www.drkoop.com Urinary Tract Infection Source: Healthnotes, Inc.; www.healthnotes.com Urinary Tract Infection in Women Source: Integrative Medicine Communications; www.drkoop.com UTI Source: Integrative Medicine Communications; www.drkoop.com •
Alternative Therapy Acupuncture Source: Healthnotes, Inc.; www.healthnotes.com
•
Homeopathy Aconitum Napellus Source: Healthnotes, Inc.; www.healthnotes.com
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Apis Mellifica Source: Healthnotes, Inc.; www.healthnotes.com Belladonna Source: Healthnotes, Inc.; www.healthnotes.com Berberis Vulgaris Source: Healthnotes, Inc.; www.healthnotes.com Borax Source: Healthnotes, Inc.; www.healthnotes.com Cantharis Source: Healthnotes, Inc.; www.healthnotes.com Chimaphila Umbellata Source: Healthnotes, Inc.; www.healthnotes.com Clematis Source: Healthnotes, Inc.; www.healthnotes.com Lycopodium Source: Healthnotes, Inc.; www.healthnotes.com Nux Vomica Source: Healthnotes, Inc.; www.healthnotes.com Sarsaparilla Source: Healthnotes, Inc.; www.healthnotes.com Sepia Source: Healthnotes, Inc.; www.healthnotes.com Staphysagria Source: Healthnotes, Inc.; www.healthnotes.com •
Herbs and Supplements Achillea Alternative names: Yarrow; Achillea millefolium L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Acidophilus Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,748,00.html Arctostaphylos Uva Ursi Source: Integrative Medicine Communications; www.drkoop.com
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Bayberry Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Bearberry Source: Integrative Medicine Communications; www.drkoop.com Beargrape Source: Integrative Medicine Communications; www.drkoop.com Bilberry Alternative names: Vaccinium myrtillus Source: Healthnotes, Inc.; www.healthnotes.com Bilberry Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10007,00.html Blueberry Alternative names: Vaccinium spp. Source: Healthnotes, Inc.; www.healthnotes.com Bromelain Source: Healthnotes, Inc.; www.healthnotes.com Buchu Alternative names: Barosma betulina, Agathosma betulina, Agathosma crenultata Source: Healthnotes, Inc.; www.healthnotes.com Butcher's Broom Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10010,00.html Cranberry Alternative names: Vaccinium macrocarpon Source: Healthnotes, Inc.; www.healthnotes.com Cranberry Alternative names: Vaccinium macrocarpon Source: Integrative Medicine Communications; www.drkoop.com Cranberry Source: Prima Communications, Inc.www.personalhealthzone.com Cranberry Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10019,00.html
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Echinacea Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,775,00.html Goldenseal Alternative names: Hydrastis canadensis Source: Healthnotes, Inc.; www.healthnotes.com Goldenseal Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,791,00.html Horseradish Alternative names: Cochlearia armoracia Source: Healthnotes, Inc.; www.healthnotes.com Horsetail Alternative names: Equisetum arvense Source: Healthnotes, Inc.; www.healthnotes.com Hyoscyamine Source: Healthnotes, Inc.; www.healthnotes.com Juniper Alternative names: Juniperus communis Source: Healthnotes, Inc.; www.healthnotes.com Juniper Berry Source: Prima Communications, Inc.www.personalhealthzone.com L. Acidophilus Source: Integrative Medicine Communications; www.drkoop.com Lactobacillus Acidophilus Source: Integrative Medicine Communications; www.drkoop.com Methionine Source: Prima Communications, Inc.www.personalhealthzone.com Nettle Alternative names: Urtica dioica Source: Healthnotes, Inc.; www.healthnotes.com Nettle Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10048,00.html
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Oregon Grape Alternative names: Berberis aquifolium Source: Healthnotes, Inc.; www.healthnotes.com Parsley Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,869,00.html Phenazopyridine Source: Healthnotes, Inc.; www.healthnotes.com Plantain Alternative names: Plantago lanceolata, Plantago major Source: Healthnotes, Inc.; www.healthnotes.com Sandalwood Alternative names: Santalum album Source: Healthnotes, Inc.; www.healthnotes.com Saw Palmetto Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,819,00.html Trimethoprim Source: Healthnotes, Inc.; www.healthnotes.com Trimethoprim/sulfamethoxazole Alternative names: Bactrim, Cotrim, Septra, Sulfatrim Source: Prima Communications, Inc.www.personalhealthzone.com Uva Ursi Alternative names: Arctostaphylos uva-ursi Source: Healthnotes, Inc.; www.healthnotes.com Uva Ursi Alternative names: Arctostaphylos uva ursi, Bearberry, Beargrape Source: Integrative Medicine Communications; www.drkoop.com Uva Ursi Source: Prima Communications, Inc.www.personalhealthzone.com Uva Ursi Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10063,00.html Vaccinium Macrocarpon Source: Integrative Medicine Communications; www.drkoop.com
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General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.
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CHAPTER 4. INFECTIONS
DISSERTATIONS
ON
URINARY
TRACT
Overview In this chapter, we will give you a bibliography on recent dissertations relating to urinary tract infections. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “urinary tract infections” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on urinary tract infections, we have not necessarily excluded non-medical dissertations in this bibliography.
Dissertations on Urinary Tract Infections ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to urinary tract infections. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •
An Educational Approach to the Reduction of Catheter-associated Urinary Tract Infections in a Community Hospital by Jakubowitch, Roseann, PhD from Temple University, 1987, 90 pages http://wwwlib.umi.com/dissertations/fullcit/8803818
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Molecular Epidemiologic Analysis of Uropathogenic Escherichia Coli Causing Urinary Tract Infections in Young, Healthy Women by Manges, Amee Rosenblum; PhD from University of California, Berkeley, 2002, 150 pages http://wwwlib.umi.com/dissertations/fullcit/3082306
•
Motherhood: a Hazardous Endeavour. Maternal Deaths and Urinary Tract Infections in Pregnancy in Rural Northern Tanzania by Olsen, Bjorg Evjen; PhD from Universitetet I Bergen (Norway), 2002, 341 pages http://wwwlib.umi.com/dissertations/fullcit/f840689
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•
Studies of the Pathogenesis and Treatment of Urinary Tract Infections Using a Model of the Human Bladder by Eftekhar, Fereshteh; PhD from The University of British Columbia (Canada), 1982 http://wwwlib.umi.com/dissertations/fullcit/NK63105
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The Influence of Market Forces on How Doctors Treat Urinary Tract Infections by Flach, Stephen Dale; PhD from University of Pennsylvania, 2000, 235 pages http://wwwlib.umi.com/dissertations/fullcit/9989591
Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.
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CHAPTER 5. CLINICAL TRIALS AND URINARY TRACT INFECTIONS Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning urinary tract infections.
Recent Trials on Urinary Tract Infections The following is a list of recent trials dedicated to urinary tract infections.8 Further information on a trial is available at the Web site indicated. •
ORWH:SCOR - Sex/Gender Factors Affecting Women's Health Condition(s): Urinary Tract Infection Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Purpose - Excerpt: This project is the clinical project of a Specialized Center of Research (SCOR) proposal which is designed to further our understanding of urinary tract infection (UTI) in women. Acute uncomplicated urinary tract infections (UTIs) occur in an estimated 7-11 million women each year, and the annual costs of caring for these women are thought to approach $1.6 billion. Approximately 20-30% of women suffer from frequent recurrent infections. UTIs in young women result in substantial symptoms, time lost from work, and medical costs. An improved understanding of the mechanisms underlying UTIs could result in new approaches to their prevention and reduced numbers of women with infections and the amount of antibiotics use. In this project we seek a better understanding of the causes of UTI. Most experts believe that vaginal colonization with UTI-causing bacteria from the rectal flora precedes colonization of the urethra (the tube from the bladder for urination) and bladder and subsequent UTI, but the relationships between these events has not been established. Moreover, recent information from studies in mice strongly suggest that persistent bladder infection follows an initial bladder infection. In this project, we will prospectively follow a large group of women with recurrent UTI to determine: 1) the
8
These are listed at www.ClinicalTrials.gov.
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relationships in time between vaginal colonization with a UTI-causing bacteriuria, asymptomatic bacteriuria (bacteria in the bladder but without any UTI symptoms) and symptomatic UTI, and 2) the presence of persistent bacteria in the bladder following the symptomatic UTI at entry into the study and whether such bacteria are related to later UTIs that are caused by the same bacteria that caused the UTI at entry into the study. We will thus be able to determine the relative importance of vaginal colonization vs. persistent infection of the bladder as the origin of the bacteria causing recurrent UTI. UTI-causing bacteria cultured from women with symptomatic UTI and asymptomatic bacteriuria will undergo studies by Dr. Scott Hultgren's group at Washington University in Project 1 to identify unique genes that may help us understand why some bacteria cause symptoms and others do not. The effect of bacteria causing UTI in these women on host response will also be determined by studies by Dr. Jeff Gordon's laboratory at Washington University in Project 3. A better understanding of the molecular and epidemiologic basis of UTI is critical in developing the best possible prevention and management strategies. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00068120 •
UTI Prophylaxis Using Bacterial Interference Following SCI Condition(s): Urinary Tract Infections Study Status: This study is currently recruiting patients. Sponsor(s): Department of Veterans Affairs Rehabilitation Research and Development Service Purpose - Excerpt: Urinary tract infection (UTI) is the most common infection in patients with SCI and is a major cause of morbidity and mortality in this population. The bladder of patients with SCI, especially those who have indwelling catheters, is often colonized by bacteria that may or may not cause symptoms of UTI. Bacteria that do not cause symptoms are usually considered benign colonizers and are often left untreated because they may afford some protection against symptomatic infection with more harmful bacteria. We applied the concept of using benign bacteria to prevent symptomatic infection, so-called bacterial interference, by deliberately colonizing the bladder of patients with SCI with a non-pathogenic prototype of Escherichia coli (strain 83972). The preliminary results of our VA-funded study that compared the rates of symptomatic UTI in patients with SCI while colonized with E. coli 83972 vs. historical rates of symptomatic UTI prior to study enrollment indicated that deliberate colonization of the bladder of patients with SCI with E. coli 83972 is safe and very promising as to its ability to prevent symptomatic UTI. However, before this innovative approach of bacterial interference can be successfully applied in the population of patients with SCI, it is essential to: (A) confirm the ultimate efficacy of bacterial interference by conducting a prospective, randomized, placebo-controlled clinical trial (objective #1); and (B) enhance the practicality of applying this innovative approach in SCI patients by delineating the bacterial and host factors that can promote successful colonization with E. coli 83972 (objectives #2-3). Phase(s): Phase II Study Type: Interventional Contact(s): Rabih Darouiche, M.D. 713-794-7117
[email protected] Web Site: http://clinicaltrials.gov/ct/show/NCT00037921
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•
Women's Use of Alternative Medicine: A Multiethnic Study Condition(s): Uterine Fibroids; Osteoporosis; Urinary Tract Infection; High Blood Pressure; Heart Disease; Arthritis; Depression; Headaches Study Status: This study is completed. Sponsor(s): National Center for Complementary and Alternative Medicine (NCCAM) Purpose - Excerpt: The purpose of this study is to examine socio-cultural factors of women's use of complementary and alternative medicine (CAM). The effects of socioeconomic status, social networks and acculturation on CAM use will be assessed among white, African-, Mexican-, and Chinese-American women. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00067249
Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “urinary tract infections” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: •
For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/
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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html
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For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/
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For eye-related trials, visit and search the Web page of the National Eye Institute: http://www.nei.nih.gov/neitrials/index.htm
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For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm
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For trials on aging, visit and search the Web site of the National Institute on Aging: http://www.grc.nia.nih.gov/studies/index.htm
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For rare diseases, visit and search the Web site sponsored by the Office of Rare Diseases: http://ord.aspensys.com/asp/resources/rsch_trials.asp
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For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm
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•
For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/
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For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm
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For hearing-related trials, visit the National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/clinical/index.htm
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For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm
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For drug abuse trials, visit and search the Web site sponsored by the National Institute on Drug Abuse: http://www.nida.nih.gov/CTN/Index.htm
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For trials on mental disorders, visit and search the Web site of the National Institute of Mental Health: http://www.nimh.nih.gov/studies/index.cfm
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For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinical_Trials
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CHAPTER 6. PATENTS ON URINARY TRACT INFECTIONS Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.9 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “urinary tract infections” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on urinary tract infections, we have not necessarily excluded non-medical patents in this bibliography.
Patents on Urinary Tract Infections By performing a patent search focusing on urinary tract infections, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. 9Adapted from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
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The following is an example of the type of information that you can expect to obtain from a patent search on urinary tract infections: •
8-Alkyl-5-oxo-5,8-dihydro-pyrido(2,3-d)pyrimidine-6-carboxylic acids for treating urinary tract infections Inventor(s): Pesson; Marcel (Paris, FR) Assignee(s): Laboratoire Roger Bellow (Neuilly-sur-Seine, FR) Patent Number: 4,034,094 Date filed: October 24, 1975 Abstract: Valuable antibacterial 8-alkyl-5-oxo-5,8-dihydro-pyrido(2,3-d)pyrimidine-6carboxylic acids, some of which are new compounds, are made from corresponding pyrimidines by a process involving condensation with an amino-ester, cyclization, halogenation, dehydrohalogenation, and saponification. Excerpt(s): The compounds of formula I are valuable anti-bacterial agents, especially those in which R is 4-hydroxypiperidino, piperazino, or N-substituted piperazino, which are new compounds. (e) and saponifying the compound of formula VI to yield the desired acid of formula I. In a modification of this process useful for preparing compounds in which R is --NR.sub.1 R.sub.2, the starting material is 2,4-dichloro-5carbethoxy-pyrimidine (II, R= Cl), condensation of which with an N-substituted ethyl.beta.-aminopropionate gives 2-chloro-4-.beta.-carbethoxyethylamino-5carbethoxy-pyrimidine (VII), which can be used by one of two methods. Web site: http://www.delphion.com/details?pn=US04034094__
•
Apparatus and method for non-invasively detecting urinary tract infection using ultrasound Inventor(s): McMorrow; Gerald J. (Kirkland, WA) Assignee(s): Diagnostic Ultrasound Corporation (Redmond, WA) Patent Number: 5,592,941 Date filed: October 20, 1995 Abstract: An ultrasound signal is transmitted into the center of the bladder. The received backscatter information is gated so that the data which remains is from a sample volume within the bladder and does not include information from the front or back walls and surrounding tissues of the bladder. The backscatter information is then compared with a preestablished threshold value. If the received backscatter is above a threshold value, it is indicative of a possible urinary tract infection, and an alarm is transmitted to the user. Excerpt(s): This invention generally concerns body condition monitoring apparatus and more specifically concerns ultrasound monitoring of the condition of urine in the bladder as a way of detecting possible urinary tract infections. Bladder dysfunction is associated with frequent incidents of urinary tract infection. A person with bladder dysfunction, due to injury, disease, or other cause, is unable to readily detect a possible infection; accordingly, such persons are at high risk for urinary infections. Other persons also may have a high risk of urinary tract infection, due to other causes. There is now available non-invasive means for detecting the volume of urine in the bladder, which has been quite helpful for those persons with bladder dysfunction, due to which the
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fullness of the bladder cannot be physically detected by the person. Such non-invasive means are shown in U.S. Pat. No. 4,926,871 to Ganguly et al. and U.S. Pat. No. 5,235,985 to McMorrow et al. However, those devices are only capable of detecting urine volume in the bladder, and are not directed toward detection of possible infection. For those persons at high risk for urinary tract infection, especially those with significant bladder dysfunction, it would be desirable to have an early warning of impending urinary tract infection, i.e. an ability to detect infection at an early stage, at which point it can be more readily and inexpensively treated. Web site: http://www.delphion.com/details?pn=US05592941__ •
Compositions comprising nitrofurantoin and uva ursi Inventor(s): Charbonneau; Duane Larry (Lebanon, OH), Taylor; Kevin Douglas (Mason, OH) Assignee(s): The Procter & Gamble Company (Cincinnati, OH) Patent Number: 6,521,270 Date filed: May 7, 2002 Abstract: Compositions and kits comprising nitrofurantoin and uva ursi are effective for treating infectious disorders, particularly urinary tract infections, cystitis, and pyclonephritis. Excerpt(s): The present invention relates to compositions and kits useful in treating infectious disorders. Urinary tract infections (UTI) are a serious health problem affecting millions of people each year. UTI infections account for about 10 million doctor visits in the United States alone, with only respiratory infections occurring more often. Many remedies are taught for the treatment of UTI. In particular, nitrofurantoin is a wellknown antibacterial compound and has been used extensively as an active ingredient in antibacterial pharmaceutical compositions. Nitrofurantoin has been used successfully for many years for the treatment of UTI. Its presumed mode of action is based upon its interference with several bacterial enzyme systems. However, the development of antibiotic resistant strains of microbes continues to be problematic, thereby diminishing the effectiveness of many antibiotics. Web site: http://www.delphion.com/details?pn=US06521270__
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Compositions for treating Escherichia coli urinary tract infections Inventor(s): Hakomori; Sen-Itiroh (Mercer Island, WA), Nudelman; Edward (Seattle, WA), Stamm; Walter E. (Seattle, WA), Stapleton; Ann (Seattle, WA) Assignee(s): The Biomembrane Institute (Seattle, WA), The Regents of the University of Washington (Seattle, WA) Patent Number: 6,432,681 Date filed: July 9, 1999 Abstract: Compositions and methods for diagnosing, treating and preventing recurrent E. coli urinary tract infections relate to the detection and use of globosides, such as disialosyl galactosyl-globoside (DSGG) and sialosyl galactosyl-globoside (SGG), and stabilized forms thereof, such as those wherein sialic acid is replaced by KDN
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Excerpt(s): The instant invention relates to a method for determining susceptibility to Escherichia coli urinary tract infections (UTI) and corresponding methods for diagnosing secretors and nonsecretors of histo-blood group antigens based on assaying urogenital cells and secretions. The instant invention also relates to methods and compositions for preventing and treating E. coli urinary tract infections. For example, disialosyl galactosyl-globoside is useful for diagnostic purposes and sialosyl galactosylgloboside is useful for treatment and prevention of UTI. Among the most common bacterial infections encountered in clinical practice are urogenital mucosal infections caused by E. coli, Chiamydlia trachomatis and N. gonorrheae which are diagnosed and treated at a cost to society in the billions of dollars. These infections are frequently recurrent and efforts at prevention have been largely fruitless, in part because of the apparent ineffectiveness of the mucosal immune system. Mucosal immunity is shortlived and in the long term, not protective. Despite much effort, attempts to develop vaccines against these mucosal urogenital pathogens have not succeeded and even natural immunity does not protect against recurrent episodes of infection with these agents. In addition, antigenic variability of the organisms has complicated vaccine development. In particular, acute uncomplicated urinary tract infections occur in millions of young women each year. While most of these women experience only single or sporadic infections, approximately 20% suffer very frequent (.gtoreq.3/year) recurrences (Mabeck, C. E., Postgrad. Med J., 48:69-75, 1972). The apparent increased susceptibility to urinary tract infection in these patients cannot be explained by underlying functional or anatomic abnormalities of the urinary tract, but instead appears to arise from the interaction of infecting E. coli strains with these patients' epithelial cells. Web site: http://www.delphion.com/details?pn=US06432681__ •
Fem-Ease, a supplement for the symptoms of cystitis, urinary tract infections and premenstrual syndrome Inventor(s): Stevenot; Robin Ann (P.O. Box 578487, Modesto, CA 95357-8487) Assignee(s): Stevenot; Robin Ann (Northbend, OR) Patent Number: 6,143,300 Date filed: August 11, 1998 Abstract: Over 450,000 women in the united states suffer from the medical disorder cystitis and several hundred in addition to this number, from urinary tract infections and premenstrual syndrome. Hundreds of clinical studies have shown the benefits of Kava Kava, Dandelion and L Arginine, each individually, as the relief for the many unpleasant symptoms that accompany cystitis, urinary tract infection and premenstrual syndrome. These beneficial results have been published in several prominent medical journals. Fem-Ease is a unique combination of all three ingredients together in one caplet. A light brown, cylinder shaped caplet with rounded corners, provides ease for the symptoms of cystitis, urinary tract infection and premenstrual syndrome. Two caplets in the morning and two caplets in the evening, provides a daily dose of 3000 mg of L Arginine, 790 mg of Kava Kava and 475 mg of Dandelion recommended to take at the first onset of symptoms. Excerpt(s): This invention relates to an herbal and amino acid supplement designed to ease the discomfort of cystitis, urinary tract infection and premenstrual syndrome. Medical doctors currently advise two types of treatments for cystitis: synthetic medications and surgery. Cystitis is inflammation of the bladder, usually occurring
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secondary to infections that involve associated organs (kidney, prostate, urethra). Lesion or ulcerative areas form in the lining of the bladder causing painful-frequent urination, abdominal pain, stress and severe depression. Cystitis sufferers find themselves frequenting the bathroom up to 60 times a day. The state of California provides permanent disability to women with long term documented histories of cystitis. Sufferers find themselves relying upon pain medications and antidepressants to get through the day. Work, relationships and normal daily activities become things of the past. Etiology of cystitis is still unknown. The four medications being used at this time to treat the symptoms of cystitis are Elmiron, DMSO, Hydroxyzine and Cystistat. These medications offer temporary relief but are not without side effects. Both DMSO and Cystistat are medications that need to be instilled into the bladder through means of catheterization. The user inserts a small flexible tube into the urethra and instills the medication into the bladder then holds it in as long as possible. Both of these medications attack the bacteria and free radical cells in the lining of the bladder then remove them as urination occurs. The method has been proven safe but with side effects. Those are: exacerbation of urinary frequency and urgency, odor, bladder irritation, bleeding of the gums and potential for increased infection during insertion of the catheter. The length of time the user holds the medication in, improves the benefits but is not worth the pain and discomfort. Treatment is 1-3 times a week for 2-4 months before symptoms begin to subside. Both Cystistat and DMSO are still in experimental stages. Medication costs are up to $200.00 per 4 installations a month plus $20.00 for FDA clearance fees. Additional treatments will cost up to $150.00 each. Elmiron and Hydroxyzine are two medications to be taken by mouth 1-3 times a day. Its is necessary to increase doses until adequate levels are reached in the body. This is estimated at 6-8 weeks. Elmiron has been shown to decrease the inflammation in the bladder wall reducing the symptoms of urination frequency and painful urination. Side effects may include hair loss, rash, head ache, swelling of the extremities, stomach upset and diarrhea. Hydroxyzine has been shown to decrease the histamine release in the body. Its benefits are unknown, yet cystitis sufferers have noticed some relief while taking this medication. Side effects are dry mouth , sedation, increased depression in patients diagnosed with concurrent depression and fetal abnormalities have been seen in animal studies. Medication costs are up to $160.00 for a one month supply. Taking these two drugs for eight weeks to four months may be required before reaching the maximum effect. Urinary tract infections (UTI) have been treated for years with the antibiotics Bactrim, Macrodantin and a combination of Sulfa drugs that offer quick relief, but for those sufferers of chronic UTI's these same antibiotics after several prescriptions become useless as the body forms a resistance to them. Side effects of these antibiotics include, and are limited to, body rash, abdominal pain, nausea, headache, lupus, shock, kidney disease, liver disease, lung disease, insomnia, weakness and rare deaths. Urinary tract infections are caused by germs that invade the tract causing symptoms of frequenturgent need to urinate, severe burning sensation upon urination, bloating or water retention and stress. Dietary changes and hygiene changes along with encouragement to drink 2000-3000 cc of water per day, that is twelve 8 oz glasses, leaves the sufferer full and visiting the bathroom too often to enjoy normal daily routines. UTI sufferers become dependent on pain relievers to alleviate the pain. Premenstrual Syndrome (PMS) is a combination of symptoms that for years have gone untreated. Symptoms occur a few days prior to onset of the menstrual cycle. Emotional unpredictability, depression, weight gain from fluid retention, breast tenderness and bouts of crying, anger and migraines headaches can be seen during this period. Over this past two decades, more attention has been focused on this condition. Antidepressant and mood elevators such as Prozac, Valium, Xanax, Elival, Zoloft and Effexor have been prescribed, more than any other class of medications in the USA, for the relief of
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symptoms. Yet most doctors will tell you this is a band-aid treatment. The side effects of these medications then requires additional medication. Side effects include but are not limited to, general malaise, insomnia, nervousness, dry mouth, headache, nausea, hallucinations, blurred vision, fast heart rate, chest pain and sexual dysfunction. The sufferers finds themselves lifeless and absent of normal emotions. Web site: http://www.delphion.com/details?pn=US06143300__ •
Method and a removable device which can be used for the self-administered treatment of urinary tract infections or other disorders Inventor(s): Simon; John G. (Boston, MA) Assignee(s): UroMed Corporation (Watertown, MA) Patent Number: 5,479,945 Date filed: December 20, 1991 Abstract: The present invention is a removable drug delivery system used by patients suffering from lower urinary tract infections or urine disorders and disorders of the urethra and bladder. The present invention delivers antibiotics to the infected areas utilizing modified urethral plugs. It is particularly advantageous in that it maintains a therapeutic effect without risking contamination. The device includes of a balloon at the proximal end and a fluid receiving port at the distal end. The balloon is inflated by injecting fluid into the fluid receiving port and deflated by pulling on a deflation string. Excerpt(s): The present invention is a novel urethral plug which can be used as a medicine delivery system by patients suffering from lower urinary tract infections or other urine disorders and disorders of the urethra and bladder. The lower urinary tract is subject to a variety of bacterial illnesses and other disorders, which can be further characterized as renal, urethral, bladder, urethral and urinary. For example, bacteria infections of the lower urinary tract are very common, and after infancy occur about ten times more often in women than in men. The main route of infections in women ascends from the vagina through the urethra to the bladder. The majority of urinary tract infections (UTIs) are caused by gram negative bacteria such as Escherichia coli (up to 85% of UTIs), Klebsiella sp., Proteus sp., Enterobacter (Aerobacter) aerogenes, and Pseudomonas aeruginosa. Occasionally gram positive pathogens may be involved, including Staphylococcus epidermis (albus), and Staphylococcus aureus. The most common UTI is bacteriuria, or the proliferation of bacteria within the urine; as many as 10% of adolescent girls have this condition, often in asymptomatic form. The condition is considered deserving of treatment at bacterial counts above 100,000 per ml, and acute at counts above 500,000 per ml or more. Bacteriuria may lead to, or stem from, infections of the urethra and/or bladder. Most such conditions involve urea-splitting bacteria which render the urine alkaline and favor the formation of calcified deposits and urinary stones, which in turn harbor and protect the proliferating bacteria. Infections involving bacteria in the urine and/or in the superficial regions of the urethral and bladder tissues should be highly amenable to treatment by the release of antibiotics into the urine in the bladder, or onto the walls of the urethra. The present invention comprises the delivery of antibiotics to the infected areas utilizing modified urethral plugs. Web site: http://www.delphion.com/details?pn=US05479945__
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Method and composition for treating urinary tract infections Inventor(s): Griffith; Donald P. (4425 Hazelton, Houston, TX 77035), Musher; Daniel M. (4903 Heatherglen, Houston, TX 77035) Assignee(s): none reported Patent Number: 4,024,256 Date filed: September 18, 1975 Abstract: A method for the treatment of urinary tract infections and a composition for use in such method, such method comprising administering to a patient suffering from a urinary tract infection an effective anti-bacterial dosage of a composition comprising in combination:A. a source of methenamine, e.g. methenamine; andB. a source of hydroxamate groups, e.g., acetohydroxamic acid.The source of hydroxamate groups is administered in the amount effective to potentiate the anti-bacterial effect of the source of methenamine. The method is specifically applied to the treatment of urinary infections caused by urease producing bacteria, especially bacteria of the species proteus.In addition, where colonization of the bacteria can be tolerated and where it is only necessary to eliminate the pathogenicity of the urease producing bacteria induced infection, effective treatment can be achieved by administration of only the source of hydroxamate groups, preferably acetohydroxamic acid. Also, by maintaining the urine at an acid pH in the presence of urease producing bacteria by administering a source of hydroxamate groups, struvite and apatite urinary stones normally associated with urease producing bacteria can be dissolved. Excerpt(s): This invention relates to a method for treating urinary tract infections and a composition for use in such method; and more specifically the present invention relates to such method and composition for the treatment of urinary tract infections, specifically urinary tract infections caused by bacteria that produce urease, especially those of the species Proteus, wherein the anti-bacterial effect of methenamine is potentiated or synergized by administering a source of methenamine in combination with a source of hydroxamate groups. In addition, this invention relates to a method of eliminating the pathogenicity of urease producing bacteria by administering to a patient suffering from an infection caused by urease producing bacteria a source of hydroxamate groups. Furthermore, the present invention provides a method of dissolving struvite and apatite urinary stones generally associated with urease producing bacteria by administering a source of hydroxamate groups which provides urine of physiological pH, which due to under-saturation with respect to struvite and apatite crystals can effectively dissolve the associated stones. The increasing awareness of the importance of urinary tract infections has brought about the realization that adequate drug therapy is required for the treatment of the infection. With this awareness for the need for adequate drug therapy, a corresponding awareness has developed that such adequate drug therapy is difficult to provide. For example, patients with urinary tract infections often have an associated condition of stasis, stone or obstruction in the urinary tract and the chronicity or recurrence of the urinary tract infections renders unlikely successful treatment. Where such conditions exist and where the infection reoccurs, antibiotics often lose their effect due to the rapid development or acquisition of resistant mutant organisms. Still further, when a patient has a urinary stone, while the infection might be satisfactorily treated initially with a conventional antiobiotic, the stone contains viable bacteria which serve as a source for reinfection. Accordingly, while conventional antibiotics may provide short time relief from urinary tract infections complete cure freuently cannot be achieved through the
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administration of the conventional antibiotic agent. However, with synthetic antibacterial agents, the development of resistance is much less common. Web site: http://www.delphion.com/details?pn=US04024256__ •
Method for rapid diagnostic of urinary tract infections Inventor(s): Drocourt; Jean-Louis (Yerres, FR), Foissac; Louis (Neuilly Sur Seine, FR), Groner; Warren (Great Neck, NY) Assignee(s): Chemunex (Maisons-Alfort, FR) Patent Number: 5,858,697 Date filed: June 20, 1996 Abstract: Method for the rapid diagnostic of an infection of the urinary tract (UTI), by a specific examination of urine.The method of analyzing a urine specimen, for the rapid and simultaneous counting of both viable bacteria and leucocytes (white blood cells or WBC), consists of:(1) simultaneous labeling of said bacteria and said white blood cells (WBC) present in said urine specimen, with a fluorescent viability marker of bacteria, said marker tagging and accumulating in both bacteria and white blood cells, under the same conditions and leading to different fluorescent elements;(2) automatically counting all the fluorescent elements by photoelectric detection of the fluorescent marker; and(3) simultaneously classifying said fluorescent elements in fluorescent viable bacteria and in fluorescent white blood cells, in view to obtain in one part the total number of bacteria and on the other part, the total number of white blood cells, on the basis of their size. Excerpt(s): The instant invention relates to a method for the rapid diagnostic of an infection of the urinary tract (UTI), by a specific examination of urine. Two laboratory findings are more particularly carried out in case of an infection of the urinary tract, i.e. count of white blood cells (pyuria) and culture of microorganisms (bacteriuria). bacteriuria without pyuria indicates contamination of the specimen or colonization of the bacteria in the urine without tissue invasion. Web site: http://www.delphion.com/details?pn=US05858697__
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Method for screening compounds for inhibiting bacterial attachment to host cell receptors Inventor(s): Sun; Tung-Tien (Scarsdale, NY), Wu; Xue-Ru (Woodside, NY) Assignee(s): New York University (New York, NY) Patent Number: 6,290,959 Date filed: October 24, 1997 Abstract: Uroplakins Ia and Ib are the major urothelial receptors of type 1 fimbriated microorganisms. These uroplakins are used to screen compounds for treating urinary tract infections by testing if the compounds inhibit bacterial adhesion to the uroplakins. Additionally, compounds which inhibit adhesion of microorganisms expressing type 1 fimbriae, such as Tamm-Horsfall protein, are used to treat or inhibit infection by these microorganisms. Excerpt(s): The present invention is directed to a method for identifying compounds for their efficacy in inhibiting bacterial infections of the urinary tract. This application is
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based upon provisional application Ser. No. 60/029,762, the entire contents of which are hereby incorporated. Type 1 fimbriae promote microbial adherence to a variety of mammalian cells and are thought to play an important role in the establishment of various infections. These type 1 fimbriae have mannose-specific adhesins, which enable these microorganisms to infect an organism. To facilitate the attachment to eukaryotic receptors, microorganisms bearing type 1 fimbriae assemble these fimbriae to present at their tips adhesin molecules (Hanson et al., 1998; Jones et al., 1995; Kuehn et al., 1992). Two major classes of fimbriae have been functionally defined in uropathogenic E. coli that can account for over 90% of the urinary tract infections. P fimbriae are expressed in about 70% of urinary tract isolates, particularly those from pyelonephritis patients, and they bind to the galactose-alpha(1,4)-galactose portion of the glycolipid receptors of the kidney (Johnson et al., 1992; O'Hanley et al., 1985; Stromberg et al., 1990; Stromberg et al., 1991). The type 1 fimbriae are expressed by over 90% of the uropathogenic E. coli, and they can bind, via mannose moieties, to the urothelial surface (Lin et al., 1995; Hutgren et al., 1985; O'Hanley et al., 1985; Sater et al., 1993; Schaeffer, 1991; Venegas et al., 1995). Immunohistochemical staining of voided urothelial cells of urinary tract infection patients showed adhering E. coli with type 1 fimbriae (Fujita et al., 1989; Kisielius et al., 1989). Animal studies showed that E. coli expressing type 1 fimbriae, but not those harboring mutated ones, can cause urinary tract infection. These results clearly establish the functional importance of the mannose-sensitive, type 1 fimbriae in urinary tract infections (Iwahi et al., 1983; Keith et al., 1986; Schaeffer et al., 1987; Johanson et al., 1992). Virtually nothing is known, however, about the receptors that presumably bear the mannoses that are recognized by type 1 fimbriae. Consequently, the precise role of this kind of fimbriae and their functional relationship with the P fimbriae in various types of infections heretofore have not been well understood (Eisenstein, 1989; Falkow et al., 1992; Hopelmann and Tuamanen, 1992; Hultgren et al., 1993; Schoolnik et al., 1987; Stamm et al., 1989). Web site: http://www.delphion.com/details?pn=US06290959__ •
Method of predicting threatened premature delivery in a pregnant woman Inventor(s): Awaya; Juichi (Nagoya, JP), Kamiya; Masami (Nagoya, JP), Kanayama; Naohiro (Hamamatsu, JP), Kurono; Masayasu (Nagoya, JP), Morioka; Akihiro (Nagoya, JP), Sawai; Kiichi (Nagoya, JP), Terao; Toshihiko (Nagoya, JP), Yasuda; Yoshika (Nagoya, JP) Assignee(s): Sanwa Kagaku Kenkyusho Co., Ltd. (Nagoya, JP) Patent Number: 5,290,679 Date filed: June 15, 1992 Abstract: Even when the specimen contains human granulocyte elastase in the form of a mixture of free elastase with an elastase-inhibitor complex or complexes, the present invention enables the total quantity of elastase in that specimen to be precisely detected. The inhibitor is added to free elastase to convert it into an elastase-inhibitor complex, whereby the quantity of elastase can be measured by immunoassay as the total amount including the previously existing elastase-inhibitor complex. It is possible to precisely measure the total amount of elastase in mucus collected from the cervical canal of a pregnant woman, sputum or a rinsed solution of bronchovesicular lavage in which free elastase is mixed with an elastase-inhibitor complex. It is thus possible to predict and prevent threatened premature delivery, premature delivery or premature rupture of membranes by immunoassay of mucus collected from the cervical canal of a pregnant
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woman, to make a diagnosis of chronic or repetitive airway infections and pulmonary emphysema based on chronic respiratory diseases by immunoassay of sputum and a rinsed solution of bronchovesicular lavage and to make a diagnosis of urinary tract infections by immunoassay of urine. Excerpt(s): The present invention relates generally to making immunoassay of human granulocyte elastase and, more particularly, to a method for precisely assaying the amount of human granulocyte elastase in the specimen to be assayed as the total amount of human granulocyte elastase, when that specimen contains a mixture of free elastase with an elastase-inhibitor complex as well as how to use it clinically. Human granulocytes are located in the forefront of the biophylaxis mechanism, gathering on the site of infection at the very initial stage of invasion and releasing proteases and active enzymes for decomposition, degradation and sterilization of foreign matters and bacteria. Of the released proteases, elastase has the strongest action and so holds a central position of the biophylaxis mechanism. However, on the other hand, this enzyme is too low in substrate specificity to decompose various connective tissue components (elastin, collagen, proteoglycan, etc.), inducing destruction of the living body's tissue due to digestion and degradation of constructive proteins. Usually, a living body has in its blood a large amount of inhibitors, like.alpha.sub.1 -antitrypsin, so as to protect the tissue not subject to invasion against the strong digestive actions of enzymes; that is, even when elastase released from granulocytes gathering on the site of invasion is diffused throughout the living body by blood circulation, elastase-inhibitor complexes are immediately formed, whereby the activity of elastase is deactivated to prevent the tissue from being destructed more than required. Web site: http://www.delphion.com/details?pn=US05290679__ •
Microbiological medium and method of assay Inventor(s): Bochner; Barry (Alameda, CA) Assignee(s): Biolog, Inc. (Hayward, CA) Patent Number: 5,464,755 Date filed: April 29, 1994 Abstract: The present invention is directed to methods and media for the isolation and presumptive identification of various bacteria. In particular, the organisms commonly associated with urinary tract infections are distinguished based on their colonial morphology and color. Excerpt(s): The present invention relates to culture media useful for rapid screening of clinical cultures to detect some of the most common bacterial pathogens. The reactions observed on these media are useful for rapid and cost-effective presumptive diagnosis of infection due to various bacteria. Although many additional applications are contemplated, these media are particularly useful for testing urine samples. The diagnosis of infectious disease has traditionally relied upon microbiological culture methods to identify the causative organism and determine the appropriate antimicrobial treatment. This has remained so despite recent advances in molecular and immunological diagnostics. While the development of rapid and automated methods has served to increase the efficiency of microbiological analysis, traditional quantitative culture methods remain critical for definitive diagnosis of urinary tract and other infections (Baron & Finegold, Diagnostic Microbiology, 8th ed., C. V. Mosby, [1990], p. 253). After proper specimen collection and transport, the laboratory professional must
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determine which of a multitude of culture media are most appropriate to use with the culture at hand. It is important to consider the type of specimen (e.g., urine, blood, sputum, etc.), and the most commonly isolated organisms associated with disease or infection at the site of specimen collection. The time and cost necessary to achieve a final diagnosis also must be borne in mind. Web site: http://www.delphion.com/details?pn=US05464755__ •
Process for making a methenamine salt of an optically active acid Inventor(s): Diamond; Julius (Morris Plains, NJ) Assignee(s): William H. Rorer, Inc. (Fort Washington, PA) Patent Number: 4,001,231 Date filed: March 29, 1973 Abstract: Novel salts of hexamethylenetetramine formed from d- or l- enantiamorph of a selected acid are disclosed, and a process for the preparation is described. A new method for the treatment of urinary tract infections is also described. Excerpt(s): This invention describes new salts of hexamethylenetetramine and particularly to salts formed with either the d- or the l- enantiamorph of a selected acid. Hexamethylenetetramine is commonly known as methenamine. This invention also described a new method for the treatment of urinary tract infections by the administration of novel methenamine compounds. Methenamine has been used for about seventy-five years as a urinary antiseptic and it has received this universal, longterm acceptance because it is effective while being relatively nontoxic. Methenamine per se is not active as a drug, but in the presence of an acid urine, it hydrolyzes and liberates formaldehyde. This formaldehyde is effective against bacteria, fungi, and virus and the exceptional utility of methenamine lies in the fact that it produces formaldehyde at the site of infection. Another feature of methenamine is that it possesses the convenience of being taken orally. It is absorbed as methenamine from the intestinal tract into the blood stream, it circulates unchanged in all body fluids, and is rapidly excreted in the urine. Because, as mentioned above, methenamine is attacked by an acid environment, it has been deduced that from 10 to 30% of it is destroyed by gastric juice, but this can be compensated for by the administration of a compensating dose. Of, the methenamine can be enteric coated so that it passes unchanged into the intestine without being attacked by stomach acids. Web site: http://www.delphion.com/details?pn=US04001231__
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Synthetic vaccine against urinary infections Inventor(s): O'Hanley; Peter (Palo Alto, CA), Schmidt; M. Alexander (Palo Alto, CA), Schoolnik; Gary K. (Palo Alto, CA) Assignee(s): The Board of Trustees of the Leland Stanford Junior University (Stanford, CA) Patent Number: 4,740,585 Date filed: July 30, 1984 Abstract: A vaccine effective in protecting mammals against urinary tract infections is prepared from synthetic peptides substantially equivalent to short sequences contained
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in HU849 pilin conjugated to substantially antigenically neutral carriers or from a CNBrII fragment of HU849 pilin. Excerpt(s): The present invention relates to the field of immunizing humans or animals against urinary tract infection. More specifically, it relates to vaccination of such subjects with short amino acid sequences linked to carriers. These sequences correspond to portions of a protein associated with the pili structures of pathogenic organisms. Urinary infections constitute a fairly serious medical problem in the United States and the developed world. Approximately 1-5% of the population of the United States is documented to suffer from recurrent urinary tract infection. Approximately 0.1% of these cases encounter the complication of pyelonephritis. Substantially larger numbers of the population, while not afflicted with recurrent infection, are at potential risk to serious complications, even with one episode of pyelonephritis because of an underlying medical condition. Persons at risk include those who have diabetes mellitus (approximately 10 million in the United States), the elderly, persons with renal insufficiency, users of excessive quantities of analgesics, and persons whose immune systems are suppressed e.g., patients being treated with chemotherapy for neoplasms. All of these individuals are at risk for serious complications, permanent disability, and even death from urinary tract infections. It would be helpful to provide an effective vaccine which would protect the relevant members of the population from urinary tract infection. Not only would this prevent the suffering and debilitation now occasioned by the onset of actual infection, it also obviates the need for administration of antibiotics which would be required to treat it. Such avoidance lessens the selective pressure on the infectious biomass caused by excessive use of antibiotics, and delays the appearance of resistant strains. Web site: http://www.delphion.com/details?pn=US04740585__ •
Telemetric in vivo bladder urine monitor system Inventor(s): Abita; Joseph L. (Boyds, MD), Carkhuff; Bliss G. (Laurel, MD), Mostwin; Jacek L. (Baltimore, MD) Assignee(s): The Johns Hopkins University (Baltimore, MD) Patent Number: 6,319,208 Date filed: December 3, 1999 Abstract: A telemetric in vivo bladder urine monitor system is disclosed. The invention includes a small, buoyant recorder that floats in the bladder of an animal and telemetrically relays data to an external receiver. The invention may be used in measuring urinary tract pressure in diagnosing and treating urinary tract infections, anomalous bladder contraction, etc. The invention may also be used as a monitoring system for bed wetting syndrome, artificial bladders and sphincters. Excerpt(s): The invention relates generally to sensor devices and sensing systems and, more specifically, to a system capable of in vivo telemonitoring of various properties of urine in the bladder. This monitoring system may be used, for example, in studies relating bladder pressure to urinary tract infections and anomalous bladder muscular behavior. This monitoring system applies to diagnostic and therapy measures for bed wetting syndrome, artificial bladders and sphincters. Catheters and cables are currently utilized in taking urinary tract pressure measurements. For example, U.S. Pat. No. 5,807,278 involves inserting such catheters and cables into such areas as the urethra, rectum and abdomen of the human body, which frequently causes physical discomfort
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to the patient, as well as restricting the patient's mobility. Accordingly, there exists a need for eliminating such catheters and cables, while simultaneously improving the means for continuously measuring urinary tract pressure, especially for ambulatory subjects in natural environments. The invention fulfills the above-described needs and provides for an improved system for measuring urinary tract pressure. In vivo telemetric monitoring of bladder pressure aids in determining bladder events during normal activities, as well as serving as a means for notification of voiding. Further, in vivo telemetric monitoring provides new and improved data for diagnosis and modeling of conditions involving bladder pressure. The invention affords new diagnostic capabilities, such as for the homebound and institutionalized elderly, for children in their natural surroundings, and for animals in a research environment. Web site: http://www.delphion.com/details?pn=US06319208__ •
Therapeutic derivatives of diphosphonates Inventor(s): Farcasiu; Dan (4729 Bayard St., Pittsburgh, PA 15213), Hartmann; John F. (1 Woodmeadow La., Princeton Junction, NJ 08550) Assignee(s): none reported Patent Number: 5,854,227 Date filed: June 7, 1995 Abstract: Novel chemotherapeutic agents having utility in treating infectious diseases such as periodontal disease, certain urinary tract infections, infectious urinary tract stones, and bone cancer, are obtained by combining chemically a diphosphonate compound with a therapeutic agent effective against the foregoing diseases. Excerpt(s): Urinary calculi can develop anywhere in the urinary tract. They are hard, mineralized substances producing pain, obstructions and secondary infections. Basically there are two types of urinary stones: metabolic, originating through metabolic dysfunctions, and infectious, associated with bacterial infections. Infection persists in 40% of patients treated with antibiotics, and a full 60% of those develop recurring stones. Left untreated, infected calculi can result in kidney loss and even death in 25% of such cases. Some metabolic stones become contaminated and bacteria are entrapped within the interstices during its crystallization. Such infected stones are notoriously resistant to eradication. Current treatment of infectious urinary calculi involves surgical removal with concomitant administration of antimicrobial agents. Broadly speaking, there are two categories of periodontal disease: gingivitis and periodontitis, both generated by micro-organisms in dental plaque on the tooth surface. Both conditions are characterized by an inflammation of the gingiva, the gum tissue at the base of the teeth. Periodontitis also involves bone erosion and loss of dentition over a long period of time. Burt (1992) Clin. Geriat. Med. 3:447. Osteosarcoma is an exceedingly malignant tumor that usually occurs in children and young adults. The type and extent of the tumor determines the type of treatment which ranges from variously-administered chemotherapeutic agents to limb amputation in conjunction with chemotherapy. Web site: http://www.delphion.com/details?pn=US05854227__
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Urethral catheter capable of preventing urinary tract infection and process for producing the same Inventor(s): Sakamoto; Izumi (Kyoto, JP), Takagi; Kunihiko (Kyoto, JP) Assignee(s): Unitika Ltd. (Amagasaki, JP) Patent Number: 4,539,234 Date filed: May 27, 1982 Abstract: A urethral catheter composed of olefin polymer, diene polymer or silicone polymer as a base material wherein an antimicrobial substance being chemically bonded with the inside wall and/or the outside wall thereof, and a process for producing the same. This urethral catheter effectively prevents urinary tract infection for a long period of time. Excerpt(s): The present invention relates to a urethral catheter capable of preventing urinary tract infection and a process for producing the same. In many cases of spinal injury, cerebral hemorrhage and softening of the brain, after an operation the patient develops symptoms such as dysuria or urinary incontinence. In such cases, urethral catheterization using a catheter is adopted in order to secure a smooth urinary passage. This is done in order to maintain kidney functions or prevent or promote the leakage of urine. The catheters used in such cases are called urethral catheters. Such catheters must have sufficient flexibility, elasticity and innoxious property because of their use. Almost all of them are composed of a material such as an olefin polymer, diene polymer or silicone polymer as the base material. Since catheterization is a remarkably useful curative means for carrying out rapid urination, it is frequently used in fields other than urology such as surgery, internal medicine and obstetrics and gynecology. However, the procedure is defective in that the occurrence of infection is nearly unavoidable if the urethral catheter is inserted into the urinary tract. Since the urethral catheter is left in the urinary tract for a long time, microbes intrude into the urinary tract through the catheter frequently causing symptoms such as urethritis, cystitis or pyelitis. It has been reported that performing an opening continuation catheterization which is frequently used hitherto (a method of collecting urine in a container such as a glass bottle which is not sterilized), infection occurs within 3 days in 42 to 80% of the clinical test and the infection is observed in all cases after the 7th day. Web site: http://www.delphion.com/details?pn=US04539234__
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Urinary catheter, hygiene system and process therefor Inventor(s): Kay; Dennis M. (1188 Omaha Cir., Palm Harbor, FL 33563) Assignee(s): none reported Patent Number: 4,723,946 Date filed: February 12, 1986 Abstract: A novel urinary catheter, hygiene unit and daily process for cleansing this catheter while in place within the user's bladder. This equipment and process are intended to reduce the occurrence of urinary tract infections and associated sepsis in individuals with chronic, long-term indwelling urinary catheters. Pressurized fluids delivered through a specially configured catheter dislodge, rinse and remove bacteria and bacterial growth medium formed by mucus, crystalline urinary deposits and urinary debris from the inner aspect or urinary lumen of the catheter. Special safety
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features of the catheter provide for a separation of the inner aspects of the catheter from the bladder lumen while the cleansing process is occuring and prevent attachment of the hygiene unit to the catheter unless this separation is accomplished. These safety features prevent the introduction of cleansing fluids into the user's body. The hygiene unit accomplishes this cleansing process by pumping sterile water and cleansing fluids in an orderly predetermined sequence at the required flow rates, volumes and composition. The hygiene unit is equipped with a "Unit" function so that it can clean itself and also a safety function, so that it shuts itself off when its fluid reservoirs are empty. Excerpt(s): A urinary catheter is a tube passed through the urethra or abdominal wall (suprapubic catheter) and into the bladder. Urinary catheters have been in use for the drainage of the bladder for many years. Over 40 years ago the last major development in urinary catheters was introduced, the Foley Catheter. The Foley Catheter has an inflatable balloon at its distal end which allows the catheter to be held within the bladder. There is a significant major drawback associated with the use of current urinary catheters. Urinary catheters, especially when used on a chronic basis, are associated with a markedly increased incidence of urinary tract infection. Urinary tract infection can take the form of cystitis, pyelonephritis and in the immunocompromised patient, older or particularly debilitated individuals these urinary tract infections can result in the development of systemic sepsis and even death. Identification of the cause or factors associating urinary catheterization and increased rates of urinary tract infections has been illusive. To date, the actual factors causing increased rates of urinary tract infections in patients with urinary catheters has not been identified. Probably as a consequence, the medical products industry has been unable to provide a urinary catheter that is associated with a lower incidence of urinary tract infections. Length of time of catheterization has been associated with an increasing frequency and severity of urinary tract infections. Therefore, although widely used on a chronic basis, urinary catheters are currently not recommended for chronic use. As yet, no clear evidence has been established to identify the cause or factors relating chronic urinary catheterization to the associated increased rates of urinary tract infection. Web site: http://www.delphion.com/details?pn=US04723946__ •
Vaccine composition for immunization against urinary tract infection caused by E. coli Inventor(s): Brinton, Jr.; Charles C. (Pittsburgh, PA), Fusco; Peter C. (Pittsburgh, PA) Assignee(s): Bactex, Inc. (Pittsburgh) Patent Number: 4,725,435 Date filed: June 18, 1986 Abstract: There is provided a vaccine material capable of providing substantial levels of protection against urinary tract infection caused by Escherichia coli. The protecting means comprises pili of organisms having pili of the same pilic family as those on the infecting organism. Protection is given by administering the pili to the subject to be protected. Excerpt(s): Escherichia coil is a ubiquitous pathogen of man and animals causing a wide variety of diseases of clinical and economic importance. E. coli is the most frequent cause of urinary tract infections (UTI) causing the symptoms of acute and chronic cystitis, pyelonephritis, and asymptomatic bacteriuria (ABU). A general approach to this problem is disclosed in U.S. Pat. Nos. 4,454,116 and 4,454,117 to Brinton. It has been
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found that UTI infections are caused by E. coli organisms carrying pili belonging to three pilic families, namely, Type 1, P and p (See Race & Sanger, Blood Groups in Man, 6th. Ed., 1975, Blackwell, Oxford; Naiki & Kato, Vox Sanguinis, 37, 30, 1979). In particular, it has been found that the majority of infections are caused by organisms having one or more pili belonging to at least one of seven pilic groups within the Type 1 family, four pilic groups within the P family and two pilic groups within the p family. The important designating factor in the design of the vaccines of the present invention is not the identity of the organism giving rise to the particular protecting pili. Thus, the designation of the strains giving rise to these pili is merely a matter of identifying convenience and should in no way be considered as limiting the invention to pili specifically derived from the named strains. It is considered that the present invention extends to pili derived from any strains which generate pili which fall within the above named Type 1, P and p families and furthermore, will generate antibodies which would cross react with or agglutinate the pili derived from the above named strains. Web site: http://www.delphion.com/details?pn=US04725435__ •
Vaccine for the treatment of urinary tract infections containing aluminum phosphate Inventor(s): Pavic; Rodmila (Basel, CH), Spasojevic; Vera (Augst, CH), Stojkovic; Llubinko (Basel, CH) Assignee(s): Solco Basel AG (Basel, CH) Patent Number: 4,606,919 Date filed: August 30, 1985 Abstract: A vaccine for curative and prophylactic treatment of urinary tract infections in humans. The vaccine contains inactivated bacteria which originate from the cultures of 8 to 14 uropathogenic bacteria strains isolated from the urine of a person suffering from a urinary tract infection and aluminum phosphate in an amount of 1.5-10 mg of AlPO.sub.4 per ml of solution. Such bacteria are of the species E. coli, Klebsiella pneumoniae, Proteus mirabilis, Proteus morganii and Streptococcus faecolis. Excerpt(s): Vaccines against various diseases in humans or animals have already been proposed, and these have also been used for a long time. For example, according to Swiss Pat. No. 158,980, an individual mixed vaccine can be prepared for a sick person by removing the germs present on the particular disease focus, for example the tonsils, the vagina, the sputum or the feces, culturing them indiscriminately and inactivating them. According to French Pat. No. 2,034,743, an antigen of the most diverse origins can be rendered water-insoluble by adding aluminium tannate to an appropriate liquid extract; the product has a delayed absorption and hence an extended action. According to European Pat. No. 28,172, U.S. Pat. No. 4,338,298 or Unlisted Drugs 30 (1978), 123-Gletvax K88, a vaccine based on enteropathogenic strains of the species Escherichia coli is said to be used for passive immunization of new-born animals for slaughter. The vaccine is administered intramuscularly or subcutaneously to the dam some time before delivery and protects the calves, piglets and the like, after birth, from diarrhea caused by coli bacteria. Vaccines based on coli bacteria have also already been proposed for humans. According to German Offenlegungsschrift No. 1,931,195, microorganisms are taken from the sputum of persons suffering from infections of the respiratory tract and are killed and worked up to a vaccine in the form of an aerosol; they are administered by inhalation and are intended for immunotherapy of the respiratory tract. Besides many other species and strains of bacteria, the vaccine contains those of Escherichia coli.
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Web site: http://www.delphion.com/details?pn=US04606919__ •
Vaginal suppository vaccine for urogenital infections Inventor(s): Hertelendy; Zsolt Istvan (Cincinnati, OH), Weiner; Murray (Cincinnati, OH) Assignee(s): Protein Express (Cincinnati, OH) Patent Number: 6,099,853 Date filed: September 4, 1997 Abstract: This invention is directed to a suppository-based vaccine delivery system for immunizing against urogenital infectious disease in humans and a method for treating same. More particularly, this invention is directed to a suppository-based vaccine delivery system for the prophylaxis against urogenital infectious diseases, such as urinary tract infections. The suppository-based vaccine delivery system is comprised of a vaccine comprised of inactivated bacteria which originate from cultures of 8 to 14 uropathogenic bacteria strains of the species: Escherichia coli, Klebsiella pnieumoniae, Proteus mirabilis, Proteus morganii, and Streptococcus faecalis; and polyethylene glycol suppository base; wherein the suppository is adapted to be inserted into a bodily orifice of a human so as to allow the suppository to be in contact with tissue of the bodily orifice to facilitate transfer of suppository material therethrough. Excerpt(s): The present invention relates generally to a system and method for treating disease in humans, specifically a prophylactic treatment of urogenital infections in humans. More particularly, the invention relates to a suppository-based, intravaginal vaccine delivery system for prophylaxis against urinary tract infections in humans, wherein the suppository is comprised of a vaccine derived from whole or fractionated pathogenic microorganisms. Still more particularly, the present invention relates to a suppository based delivery system for prophylaxis against recurrent urinary tract infections in humans, wherein the suppository is comprised of a vaccine of whole, inactivated bacteria which originate from cultures of 4 to 20 uropathogenic bacterial strains isolated from the urine of persons suffering urinary tract infections, and which include a polyethylene glycol suppository base. Urinary tract infections are a major problem in medicine. Every part of the urinary tract may be affected. The most common forms of the illness are: cystitis, the urethral syndrome, pyelitis, and pyelonephritis. A tendency for recurrence and chronic progression is characteristic of urinary tract infections. The disease is ten times more common in women than men. This difference is due mainly to the fact that the particular anatomy of the female urethra favors infection by the body's own bacterial intestinal flora. The main diagnostic criterion of urinary tract infections is bacteriuria, the presence of bacteria in the properly collected urine sample (midstream urine). For bacteriuria to be considered diagnostically significant, it has to exceed a concentration of 10.sup.5 bacteria per milliliter of urine. bacteriuria to be considered diagnostically significant, it has to exceed a concentration of 10.sup.5 bacteria per milliliter of urine. Bacteria that reach the urinary tract establish infection either through the bloodstream or by ascending from the urethra to the bladder and then up the ureter to the kidneys. Ascending infection is the most common mode and explains the more frequent occurrence in women. The position of the urethral ostium and the short urethra in women favor infection. Various bacteria originating from the fecal flora are always resident in the urethral ostium and in the distal part of the female urethra. Urinary tract infections in women is initiated when one of the Enterobacteriaceae derived from the fecal flora colonizes in the vaginal vestibule. Web site: http://www.delphion.com/details?pn=US06099853__
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Patent Applications on Urinary Tract Infections As of December 2000, U.S. patent applications are open to public viewing.10 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to urinary tract infections: •
Closed system irrigation connector for urinary catheters Inventor(s): Russo, Ronald D.; (Barrington, RI) Correspondence: Robert J Doherty ESQ.; 10-11 George ST.; Barrington; RI; 02806; US Patent Application Number: 20030195478 Date filed: March 29, 2003 Abstract: A closed system irrigation connector for use with both 3-way and 2-way urinary catheters is disclosed. The connector fits all urinary catheters and accepts continuous irrigation sets as well as all bulb, piston, and Toomey catheter tip irrigation syringes. The connector eliminates the use of catheter plugs and reduces the mess and leakage often associated with present urinary catheter irrigation procedures. The connector converts an open procedure to a closed system procedure protecting the patient from outside contamination to reduce urinary tract infections as well as the clinician from potentially infectious body fluids. It comprises an assembly of a plastic housing with an internal silicone diaphragm slit valve and a plastic entrance port that are unitized in assembly by sonic welding. The entrance port forms a tapered wedge lock engagement with irrigation sets as well as catheter tip irrigation syringes. Excerpt(s): The inventor claims the full benefit of the following U.S. Provisional Patent Applications: "Closed System Urinary Catheter Adapter", filed Apr. 16, 2002, application No. 60/372,728, and "Side-Port Closed Urinary Catheter Adapter", filed Jun. 27, 2002 application No. 60/391,906. Interventional surgical procedures in the urinary tract system such as prostate surgery or trans-urethral resection typically require the insertion of an indwelling urological catheter for bladder drainage and to permit irrigation of the bladder. Urological catheters can be either 3-way and 2-way foley catheters or suprapubic catheters that are inserted through the abdomen into the bladder. Foley catheters used in these surgical procedures are called 3-way catheters in that they have three ports having a center port for drainage, a first side port for inflating the internal retention balloon, and a second side port for infusion of irrigation fluid and for aspiration of blood clots. The center port is usually attached to a drainage bag for collection of drainage. The second side port is called the irrigation access port, which is sealed closed with the insertion of a simple plastic catheter plug. Blood clots and accumulated body tissue within the bladder need to be flushed out through the irrigation port using continuous irrigation or catheter tip irrigation syringe of 60 cc capacity. Irrigation syringes are either the squeeze bulb type or the piston type, but all irrigation syringes have a large bore tapered catheter tip. These irrigation syringes with catheter tips have no standard dimensions and vary as to length and degree of taper. Post-operative recovery of the urological surgical patient can take up to several weeks and requires repeated catheter irrigations as often as once every hour. This means that the catheter plug must be removed to insert the irrigation syringe that causes the clinician to come in contact with potentially infectious urinary drainage fluid opening the urinary drainage system is often the cause of introducing outside contamination in
10
This has been a common practice outside the United States prior to December 2000.
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the body that can cause urinary tract infections. As such, the current catheter plug device is messy and presents difficulties for both the patient and clinician. The usual practice is to use a continuous irrigation set attached directly into the side irrigation port of a 3-way foley catheter to deliver a continuous stream of irrigation fluid through the catheter into the bladder. After about 24-48 hours continuous irrigation is discontinued and catheter tip intermittent irrigation is substituted. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Dissociated pili, their production and use Inventor(s): Denich, Kenneth; (Edmonton, CA), O'Hanley, Peter; (Washington, DC) Correspondence: Stephen B. Maebius; Foley & Lardner; Suite 500; 3000 K Street, N.W.; Washington; DC; 20007-5109; US Patent Application Number: 20020054888 Date filed: April 12, 2001 Abstract: A method of producing pili and vaccines containing pili is described using bacteria harboring mutations that facilitate detachment of pili from the bacteria. Wild type pili have known immunoprotective effects in treating urinary tract infections. The mutant pili produced by this method are also shown to have such immunoprotective effects. Therefore, the pili may be used to make vaccines for treating urinary tract infections. Excerpt(s): The present invention relates to pili-based vaccines, their production, and use, and more particularly, to the production of pili through the use of pilus-producing strains having at least one mutation that leads to a greater number of pili dissociated from the cell surface compared to a wild type. U.S. Pat. No. 4,740,585 discloses peptide vaccines for urinary tract infections prepared from synthetic peptides based on short sequences contained in HUR849 pilin A. U.S. Pat. No. 4,736,017 discloses peptide vaccines for urinary tract infections prepared from purified whole Gal-Gal pilus proteins or fragments thereof. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Magnetic valve bladder cycler drainage system and use method with urinary catheters Inventor(s): Flinchbaugh, David E.; (Orlando, FL) Correspondence: Law Offices OF Brian S Steinberger; 101 Brevard Avenue; Cocoa; FL; 32922; US Patent Application Number: 20020143318 Date filed: December 7, 2001 Abstract: A low-pressure fluid flow control magnetic valve (cycler) device, system and method for use emptying the contents of bladder by a catheter. The device can be connected with a specified drainage tubing to function as a hydrodynamically balanced system (to empty into a typical two-liter collection bag). The cycler can be connected externally to a urinary catheter for hospital, clinical and home-care use for the emptying of the bladder of a patient through a catheter in a biologically more natural, filling and draining, cyclic manner. Fully automatic, modes of operation are provided for opening and closing this valve to empty the bladder of urine when appropriate or necessary. The
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modes of operation respond to normal human (or animal) body pressures, or are automatic with a manual override. This device is U.S.F.D.A. approved for human use and responds to normal human (or animal) body pressures to assist the detrusor muscle to function normally in spite of an indwelling catheter challenge. The cycler device avoids problems with bladder atone, bladder spasms, harmful struvite crystal formation, bladder retraining after surgery, and allowing urine tract washout to occur as the body's primary defense mechanism against urinary tract infections. Excerpt(s): This invention relates to urinary catheters, and in particular to a method and apparatus for a pressure-activated, magnetic-force-controlled human (or animal) bladder drainage cycling valve system(Uro Cycler), for restoring normal body functions of bladder filling and emptying in cyclic manners of catheterized patients, and this invention claims the benefit of priority to U.S. Provisional Application 60/280,767, filed Apr. 12, 2001, U.S. Provisional Application 60/280,768 filed Apr. 2, 2001, and U.S. Provisional Application 60/324,601 filed Sep. 25, 2001. Urinary catheters bypass the normal bladder process of storing urine, and only releasing the urine by using the bladder detrusor muscle. Catheters can be a necessary tool to open the bladder to allow urination when patients have trouble urinating. A catheter can be a lifesaving tool since an uncontrolled buildup of urine can cause serious medical problems including death. However, there are known problems with catheters. Struvite crystal encrustation is the effect of stagnated urine in the neck of the bladder when using a catheter. In the face of an indwelling catheter, urine can pool at the neck of the bladder, and the pooled urine can shift from a normal pH factor to an abnormal pH level of 10 or more while it stagnates. Urine shifts to an ammonia state where struvite crystals can precipitate and enlarge on the indwelling catheter. This situation can occur as the bladder loses its natural ability to cyclically flush itself in the face of an indwelling catheter. Bladder wall thickening has also be observed in long-term catheterizations and may be a result of the increasing pH levels. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Method of administering FimH protein as a vaccine for urinary tract infections Inventor(s): Ballou, W. Ripley JR.; (Silver Springs, MD), Langermann, Solomon; (Baltimore, MD) Correspondence: Pennie And Edmonds; 1155 Avenue OF The Americas; New York; NY; 100362711 Patent Application Number: 20030138449 Date filed: November 27, 2002 Abstract: The present invention relates to methods of stimulating an immune response in a primate utilizing compositions comprising bacterial adhesin proteins and/or immunogenic fragments thereof. The compositions are useful for the prevention and treatment of bacterial induced diseases involving bacterial adherence to a target cell, such as diseases of the urinary tract. More specifically, the invention relates to the vaccination of primates, preferably humans, with protein complexes, such as a purified FimH polypeptides, a purified FimC-FimH (FimCH) polypeptide complex, or immunogenic fragments thereof, to stimulate protective immunity in the recipient against infection by pathogenic bacteria, including all types of Enterobacteriaceae, preferably E. coli to produce specific immunoglobin molecules in the serum and urine or mucosal secretions of the subject.
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Excerpt(s): This application claims the benefit of priority to U.S. Patent Application Serial No. 60/226,146, filed Aug. 18, 2000, which is incorporated herein in its entirety. Urinary tract infections (herein, "UTI") present a disease process that is mediated (or assisted or otherwise induced) by the attachment of bacteria to cells. Escherichia coli (E. coli) is the most common pathogen of the urinary tract, accounting for more than 85% of cases of asymptomatic bacteriuria, acute cystitis and acute pyelonephritis, as well as greater than 60% of recurrent cystitis, and at least 35% of recurrent pyelonephritis infections. Furthermore, approximately 25%-30% of women experience a recurrent E. coli urinary tract infection within the first 12 months following an initial infection but after a second or third infection the rate of recurrence increases to 60%-75%. Given the high incidence, continued persistence, and significant expense associated with E. coli urinary tract infections, there is a need for a prophylactic vaccine to reduce susceptibility to this disease. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
OSTOMY BAG UNDERGARMENT Inventor(s): GUPTON, KENNETH; (CHARLOTTE, NC) Correspondence: Kenneth Gupton; 9535 Fairmead DR; Charlotte; NC; 28269 Patent Application Number: 20020016578 Date filed: June 2, 1999 Abstract: A shorts-type undergarment with an inner pocket (1) secured to the waistband (6) having a U-shaped cutout (2) where the flange (8a) of an ostomy bag (8c) is situated. Said inner pocket (1) is attached to the waistband (6) and holds and ostomy bag (8c). At the bottom of the inner pocket (1) is a horizontal strip of oppositely mated Velcro strips (9) which can be detached to allow the exit of the bag's tube to dispose of the accumulated bodily fluids. It has two vertical openings on the front of the shorts. The first opening, 4, is located at the bottom of the crotch and extends upward. This opening, 4, allows for the insertion of a catheter. The second opening, is an access panel, 1, which is opened by pulling back a long vertical strip of Velcro.RTM., 3, attached to a corresponding strip of oppositely mated Velcro.RTM., 2, which horizontally extends partially across one front side. The patient is able to retain a high degree of modesty and dignity, when the catheter is attended to by medical personnel. Since the catheter is secured, in a straight pathway, there is a decreased likelihood the patient will develop secondary medical complications like urinary tract infections, discomfort and irritation associated with a catheter which is not properly secured. Excerpt(s): This invention relates to an undergarment which provides an inner compartment to hold an ostomy bag. Additionally, it provides easy access to the crotch area for examination, or treatment, by medical personnel when the patient is catheterized. It affords the patient a sense of dignity and modesty by allowing them to wear an undergarment while fitted with an ostomy bag. The inner compartment has an opening at the bottom which detaches to allow the user to empty the ostomy bag without taking off the undergarment. The design has the additional effect of keeping the catheter securely aligned, in a straight path, to avoid harmful sideways movement. This movement creates irritation and increased risk of urinary tract infections. One arrangement involved simply having an open crotch portion with no covering. Shaull U.S. Pat. No. 4,300,241 (1981) is specifically designed for use by female patients undergoing gynecological examinations. Although suitable for this limited purpose, the opening is much too small to allow medical personnel sufficient access to the crotch area
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to safely insert a catheter and sanitize the area during routine hygiene maintainence. Additionally, the open design does not afford the patient any degree of privacy because the opening can not be closed. Shaull does not have any compartment for an ostomy bag. Another arrangement, shown in Smith U.S. Pat. No. 4,597,110 (1986) demonstrates a panty-type undergarment with a horizontal opening at the bottom of the crotch. This invention is not intended to be accessed by medical personnel and does not have a opening for the insertion of a catheter. Smith does not have any compartment for an ostomy bag. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Synthetic peptide composition as immunogens for prevention of urinary tract infection Inventor(s): Wang, Chang Yi; (Cold Spring Harbor, NY) Correspondence: Morgan & Finnegan L.L.P; Maria C.H. Lin; 345 Park Avenue; New York; NY; 10154-0053; US Patent Application Number: 20030027979 Date filed: December 22, 2000 Abstract: The invention provides a peptide immunogen comprising a FAFSD target peptide or an anlogue thereof, covalently linked to a helper T cell epitope and optionally to an invasin immunostimulatory domain. The present invention also provides for the use of such peptide immunogens to elicit the production in mammals of high titer polyclonal antibodies, which are specific to the FAFSD target peptide. The peptide immunogens are expected to be useful in evoking antibodies that prevent the adherence of E. coli and other enterobacteria to the bladder mucosa for protection against urinary tract infection. Excerpt(s): This invention relates to peptide compositions that are useful as immunogens for the prevention of urinary tract infection. The peptide immunogen of the present invention comprises a FimH Adhesin Functional Site-Derived (FAFSD) target peptide and a helper T cell epitope (Th) having multiple class II MHC binding motifs. Optionally, the immunogenic peptide further comprises an invasin domain, which acts as a general immune stimulator. The helper T cell epitope and the invasin domain enable the host to generate an immune response specific against the FAFSD target peptide to prevent the adherence of Escherichia coli and other enterobacteria to the bladder mucosa and confer protection against urinary tract infection. Urinary tract infection (UTI) is one of the most common disorders in women and children, resulting in 7-8 million physician and hospital visits per year at a cost of over $1 billion. It is estimated that by age 30, roughly 50 percent of women have had at least one incidence of UTI with 2-10 percent having recurrent UTI. Females are generally more prone to UTI because of their anatomy. Recent studies have shown that, on average, women who are 18-40 years old suffer 1-2 infections over a two year period. Older women are at risk with the incidence being as high as 30%. In most cases, UTI is not life threatening. Standard antibiotics usually offer quick relief, but when left untreated, the chronic recurrence of urinary tract infection can cause kidney damage and even death. A vaccine would reduce this toll but there has been little success in the development of a practicable vaccine for UTI (Service, Science 1997, 276:533). Earlier attempts to produce a UTI vaccine using whole fimbriae were not successful in protecting against a broad range of disease-causing bacteria. Intact whole fimbriae do not elicit a strong antibody response to FimH adhesin. (Hanson and Brinton, Nature 1988, 332:265; Johnson, 1991;
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U.S. Pat. No. 4,454,117, Langermann et al, 1997). Vaccines comprising peptides of the major fimbrial protein FimA have been reported (Schmidt et al, J Exp Med, 1985; 161:705; U.S. Pat. No. 4,740,585). However, antibodies raised against FimA are not antiadhesive and do not block attachment. Furthermore, vaccines based on the major components of the fimbriae contain variable sites and are expected to provide a narrow typespecific protection (Abraham et al, 1988). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Treatment of urinary tract infections with antibacterial oxazolidinones Inventor(s): Batts, Donald Herman; (Kalamazoo, MI) Correspondence: Bruce Stein; Pharmacia & Upjohn Company; Global Intellectual Property; 301 Henrietta Street; Kalamazoo; MI; 49001; US Patent Application Number: 20010046992 Date filed: March 15, 2001 Abstract: The present invention is a method of treating a warm blooded mammal who has a urinary tract infection caused by a Gram-positive organism who is in need of such treatment, which comprises administering to the mammal in need of such treatment a urinary therapeutically effective amount of an antibacterial oxazolidinone. Excerpt(s): This application claims the benefit of the following provisional application: U.S. Ser. No. 60/190,961, filed Mar. 22, 2000, under 35 USC 119(e)(i). The present invention is the treatment of urinary tract infections (UTIs) with antibacterial oxazolidinones. Oxazolidinones are well known to those skilled in the art as gram positive anti-bacterial agents, see, for example, U.S. Pat. Nos. 5,688,792, 5,529,998, 5,547,950, 5,627,181, 5,700,799, 5,843,967, 5,792,765, 5,684,023, 5,861,413, 5,827,857, 5,869,659, 5,698,574, 5,968,962 and 5,981,528. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Use of COX-2 inhibitors to treat sepsis, complications thereof, and EP receptor modulation Inventor(s): Daly, John M.; (Pelham Manor, NY), Mack Strong, Vivian E.; (New York, NY), Stapleton, Philip P.; (New York, NY) Correspondence: Michael L. Goldman, ESQ.; Nixon Peabody Llp; Clinton Square; P.O. Box 31051; Rochester; NY; 14603; US Patent Application Number: 20020006915 Date filed: February 14, 2001 Abstract: The present invention is directed to methods of preventing, inhibiting, reversing and/or ameliorating complications in those having or at risk for systemic inflammatory response syndrome, e.g., sepsis, including multiple organ dysfunction syndrome, pancreatitis, burns, trauma, and complications of sepsis such as bacteremia, pneumonia, urinary tract infections, wound infections, and drug reactions. The methods comprise administration of an effective amount of at least one of a selective inhibitor of cyclooxygenase-2, a drug which stimulates one or more PGE.sub.2 receptors or a drug which interferes with binding of PGE.sub.2 to one of more PGE.sub.2 receptors.
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Excerpt(s): This application was originally filed as provisional application Ser. No. 60/182,524 on Feb. 15, 2000. The present invention is directed to the prevention and treatment of patients at risk for, or having, systemic inflammatory response syndrome and septic complications. The present invention therefore pertains to treatment of patients in the clinical settings of shock, sepsis, trauma, major elective surgery and critical care. Although numerous studies have demonstrated that injury induces a state of immunosuppression, the precise mechanisms are still under investigation prostaglandin receptors EP2 and EP4 are down regulated and that reversing this down regulation of receptor subtypes markedly improves survival. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Keeping Current In order to stay informed about patents and patent applications dealing with urinary tract infections, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “urinary tract infections” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on urinary tract infections. You can also use this procedure to view pending patent applications concerning urinary tract infections. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.
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CHAPTER 7. BOOKS ON URINARY TRACT INFECTIONS Overview This chapter provides bibliographic book references relating to urinary tract infections. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on urinary tract infections include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.
Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “urinary tract infections” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on urinary tract infections: •
Urinary Tract Infections: Detection, Prevention and Management. 5th ed Source: Baltimore, MD: Williams and Wilkins. 1997. 419 p. Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201. (800) 638-0672. Fax (800) 447-8438. E-mail:
[email protected]. PRICE: $30.00 (paperback). ISBN: 0683181025. Summary: The fifth edition of this book provides health care professionals with a comprehensive reference guide to the prevention, diagnosis, and treatment of urinary tract infections (UTI). The current edition has been entirely rewritten and includes summary tables of important concepts. Each chapter is designed to stand alone if desired, and includes its own set of references. Topics include an overview of UTIs; bacteriuria, pyuria, proteinuria, hematuria, and pneumaturia; diagnostic methods; UTIs in children and adults; vesicoureteral reflux and reflux nephropathy; dysuria syndromes
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(infections of the urethra, vagina, bladder, and prostate); pyelonephritis and other kidney infections; caring for urinary catheters; pathogenesis of infection; and UTI management. The section on UTIs in adults discusses pregnancy, diabetes, the elderly, renal transplantation, hypertension, and other risk factors. Tables, guidelines, and illustrations are presented throughout the text. A subject index concludes the book. •
What I Need to Know About Urinary Tract Infections Source: Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). 2002. 15 p. Contact: Available from National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). 3 Information Way, Bethesda, MD 20892-3580. (800) 891-5390 or (301) 654-4415. Fax (301) 634-0716. E-mail:
[email protected]. Website: http://www.niddk.nih.gov/health/kidney/nkudic.htm. PRICE: Full-text available online at no charge; single copy free; bulk orders available. NIH Publication number: 024807. Summary: This booklet describes urinary tract infections (UTIs), how they are treated, and how to prevent them. Written in non-technical language, the booklet answers common questions about UTIs, covering topics including the causes of UTIs, typical symptoms, when to consult a health care provider about a UTI, how UTIs are diagnosed, recurrent UTIs, how to prevent getting more UTIs, and current research in this area. The booklet concludes with a glossary of terms, a list of resources for readers wishing to obtain more information, and a list of acknowledgments. The booklet is illustrated with black-and-white line drawings. At the end of the booklet is a brief description of the activities of the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), a services of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 5 figures.
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Management of Urinary Tract Infections Source: London: Royal Society of Medicine. 1990. 120 p. Contact: Available from Royal Society of Medicine. Barbara Selves, Publications Department, 1 Wimpole Street, London. W1M 8AE. PRICE: $20 US plus shipping and handling. ISBN: 1853151114. Summary: This publication reprints the proceedings of an International Consensus Conference held in Montreal, Canada in November 1988 on the management of urinary tract infections (UTIs). Thirteen papers are presented, on topics including differential diagnosis of UTIs; United States' and international perspectives on treatment; pharmaceutical research, notably the use of nitrofurantoin; preventive therapy in UTIs; management considerations for acute, recurrent, and/or complicated UTIs; women's attitudes and the treatment of UTIs; and a roundtable discussion of worldwide consensus in the treatment of uncomplicated UTIs. Each chapter includes numerous tables, figures, and references. A test to receive continuing medical education credits for the material covered in the document is included.
Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also
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include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “urinary tract infections” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “urinary tract infections” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “urinary tract infections” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •
2A Laboratory Diagnosis of Urinary Tract Infections/No 090-C02A (1990); ISBN: 9992767138; http://www.amazon.com/exec/obidos/ASIN/9992767138/icongroupinterna
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Atlas of Infectious Diseases: Urinary Tract Infections and Infections of the Female Pelvis (Atlas of Infectious Diseases) by J. Sobel (Editor); ISBN: 1878132482; http://www.amazon.com/exec/obidos/ASIN/1878132482/icongroupinterna
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Clinician's Manual of Urinary Tract Infections by R.N. Grueneberg, A.P.R. Wilson; ISBN: 1858730090; http://www.amazon.com/exec/obidos/ASIN/1858730090/icongroupinterna
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Conceptualization and Measurement of Physiologic Health for Adults: Urinary Tract Infection by J.V. Zielske (Editor) (1981); ISBN: 0833002759; http://www.amazon.com/exec/obidos/ASIN/0833002759/icongroupinterna
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Contemporary Diagnosis and Management of Urinary Tract Infections by Paul B. Iannini; ISBN: 1884065988; http://www.amazon.com/exec/obidos/ASIN/1884065988/icongroupinterna
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Cumitech 2B: Laboratory Diagnosis of Urinary Tract Infections (1998); ISBN: 9990910804; http://www.amazon.com/exec/obidos/ASIN/9990910804/icongroupinterna
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Detection, Prevention, and Management of Urinary Tract Infections by Calvin M. Kunin; ISBN: 0812110463; http://www.amazon.com/exec/obidos/ASIN/0812110463/icongroupinterna
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Detection, Prevention, and Management of Urinary Tract Infections; ISBN: 0812106806; http://www.amazon.com/exec/obidos/ASIN/0812106806/icongroupinterna
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Diagnosis and management of uncomplicated urinary tract infections : a guide for physicians; ISBN: 0444014233; http://www.amazon.com/exec/obidos/ASIN/0444014233/icongroupinterna
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Handbook of Infectious Diseases: Urinary Tract Infections by William Brumfitt; ISBN: 1556640595; http://www.amazon.com/exec/obidos/ASIN/1556640595/icongroupinterna
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Host-Parasite Interactions in Urinary Tract Infections: Proceedings of the Fourth International Symposium on Pyelonephritis Held in Goteborg Sweden, (Studies in Infectious Disease Research) by Sweden)/ Eden, Catharina Svanborg International Symposium on Pyelonephritis 1986 Goteborg (Editor), et al (1989); ISBN: 0226184439; http://www.amazon.com/exec/obidos/ASIN/0226184439/icongroupinterna
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Laboratory Diagnosis of Urinary Tract Infections (Cumitech Ser.) by Jill E. Clarridge (1987); ISBN: 9990058172; http://www.amazon.com/exec/obidos/ASIN/9990058172/icongroupinterna
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Modern Trend in the Treatment of Lower Urinary Tract Infections by A. Jardin (Editor), J.D. Williams (Editor) (1987); ISBN: 3805545592; http://www.amazon.com/exec/obidos/ASIN/3805545592/icongroupinterna
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New Trends in Urinary Tract Infections: The Single-Dose Therapy by Harold C. Neu, John D. Williams (Editor) (1988); ISBN: 3805546378; http://www.amazon.com/exec/obidos/ASIN/3805546378/icongroupinterna
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Path Genesis and Treatment of Urinary Tract Infections by Stamey; ISBN: 0683079093; http://www.amazon.com/exec/obidos/ASIN/0683079093/icongroupinterna
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Single Dose Therapy of Urinary Tract Infection by Xxx Bailey; ISBN: 0867920076; http://www.amazon.com/exec/obidos/ASIN/0867920076/icongroupinterna
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The challenge of urinary tract infections by A. W. Asscher; ISBN: 0808912682; http://www.amazon.com/exec/obidos/ASIN/0808912682/icongroupinterna
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The Official Patient's Sourcebook on Urinary Tract Infection: A Revised and Updated Directory for the Internet Age by Icon Health Publications (2002); ISBN: 0597832838; http://www.amazon.com/exec/obidos/ASIN/0597832838/icongroupinterna
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The prevention and management of urinary tract infection among people with spinal cord injuries (SuDoc ED 1.310/2:414662) by U.S. Dept of Education; ISBN: B00010YFZ0; http://www.amazon.com/exec/obidos/ASIN/B00010YFZ0/icongroupinterna
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Urinary Tract Infection (New Clinical Applications. Nephrology) by G.R.D. Catto (Editor) (1989); ISBN: 074620115X; http://www.amazon.com/exec/obidos/ASIN/074620115X/icongroupinterna
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Urinary Tract Infection and Inflammation by Jackson E. Fowler (Editor); ISBN: 0815132654; http://www.amazon.com/exec/obidos/ASIN/0815132654/icongroupinterna
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Urinary tract infection and its management by Donald Kaye; ISBN: 0801626234; http://www.amazon.com/exec/obidos/ASIN/0801626234/icongroupinterna
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Urinary tract infection in childhood and its relevance to disease in adult life by Victoria Smallpeice; ISBN: 043330460X; http://www.amazon.com/exec/obidos/ASIN/043330460X/icongroupinterna
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Urinary Tract Infection in Clinical and Laboratory Practice by Rosalind Maskell (1988); ISBN: 0713145358; http://www.amazon.com/exec/obidos/ASIN/0713145358/icongroupinterna
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Urinary Tract Infection in the Female by Stuart L. Stanton (Editor), Peter L. Dwyer (Editor); ISBN: 1853176893; http://www.amazon.com/exec/obidos/ASIN/1853176893/icongroupinterna
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Urinary Tract Infection, Calculi and Tubular Disorders by J. Walls; ISBN: 0852004249; http://www.amazon.com/exec/obidos/ASIN/0852004249/icongroupinterna
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Urinary Tract Infection: Proceedings of the Second Nationa Symposium Held in London, March 1972 (Oxford Medical Publications) by William Brumfitt (Editor), A. W. Asscher (Editor); ISBN: 0192612107; http://www.amazon.com/exec/obidos/ASIN/0192612107/icongroupinterna
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Urinary tract infection; proceedings of the first national symposium held in London, April, 1968; ISBN: 0192612069; http://www.amazon.com/exec/obidos/ASIN/0192612069/icongroupinterna
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Urinary Tract Infections by Brumfit, et al (1999); ISBN: 0412630508; http://www.amazon.com/exec/obidos/ASIN/0412630508/icongroupinterna
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Urinary Tract Infections by Tom Bergan (Editor) (1997); ISBN: 3805564406; http://www.amazon.com/exec/obidos/ASIN/3805564406/icongroupinterna
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Urinary Tract Infections by A. Rane; ISBN: 1873413432; http://www.amazon.com/exec/obidos/ASIN/1873413432/icongroupinterna
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Urinary Tract Infections by David Gerrick; ISBN: 091675071X; http://www.amazon.com/exec/obidos/ASIN/091675071X/icongroupinterna
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Urinary Tract Infections (Practical Clinical Medicine) by D. Brooks (Editor) (1987); ISBN: 0852006950; http://www.amazon.com/exec/obidos/ASIN/0852006950/icongroupinterna
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Urinary Tract Infections (Pyelonephritis, Vol 5) by H. Losse, et al; ISBN: 0865771456; http://www.amazon.com/exec/obidos/ASIN/0865771456/icongroupinterna
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Urinary Tract Infections (Series in Clinical Epidemiology) by John R. Dalton, et al; ISBN: 0709945108; http://www.amazon.com/exec/obidos/ASIN/0709945108/icongroupinterna
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Urinary Tract Infections and Infections of the Female Pelvis (Atlas of Infectious Diseases, V. 9) by Gerald L. Mandell (Editor), et al; ISBN: 0443077703; http://www.amazon.com/exec/obidos/ASIN/0443077703/icongroupinterna
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Urinary Tract Infections Fast Facts Series by Hannan, et al; ISBN: 1899541268; http://www.amazon.com/exec/obidos/ASIN/1899541268/icongroupinterna
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Urinary Tract Infections in Children by Stanley. Hellerstein; ISBN: 0815142277; http://www.amazon.com/exec/obidos/ASIN/0815142277/icongroupinterna
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Urinary Tract Infections: Detection, Prevention, and Management by Calvin M. Kunin; ISBN: 0683181025; http://www.amazon.com/exec/obidos/ASIN/0683181025/icongroupinterna
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Urinary Tract Infections: Molecular Pathogenesis and Clinical Management by Harry L. T., PhD Mobley (Editor), John W., MD Warren (Editor); ISBN: 1555810934; http://www.amazon.com/exec/obidos/ASIN/1555810934/icongroupinterna
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What I need to know about urinary tract infections (SuDoc HE 20.3302:2002019843) by U.S. Dept of Health and Human Services; ISBN: B000116JUI; http://www.amazon.com/exec/obidos/ASIN/B000116JUI/icongroupinterna
The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “urinary tract infections” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:11 11 In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button
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Detection, prevention and management of urinary tract infections; a manual for the physician, nurse and allied health worker. Author: Kunin, Calvin M.,; Year: 1965; Philadelphia, Lea; Febiger, 1972; ISBN: 0812103955 http://www.amazon.com/exec/obidos/ASIN/0812103955/icongroupinterna
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Kidney and urinary tract infections. [Contributors: E. Lovell Becker et al.]. Author: Becker, E. Lovell (Ernest Lovell),; Year: 1962; Indianapolis, Lilly Research Laboratories [c1971]
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Prevent urinary tract infections in your hospital. Author: Kidney Disease Control Program (National Center for Chronic Disease Control); Year: 1967; [Arlington, Va., 1969]
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The treatment of urinary tract infections. Author: Petersdorf, Robert G.,; Year: 1969; [New York] National Kidney Foundation, 1970
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Urinary tract infection in childhood and its relevance to disease in adult life. Author: Smallpeice, Victoria.; Year: 1967; London, Heinemann [1968]; ISBN: 43330460X
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Urinary tract infection in the aged: an epidemiological study. Author: Sourander, Leif B.; Year: 1963; Turku, 1966
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Urinary tract infection. Proceedings of the first national symposium held in London, April, 1968; edited by Francis O'Grady and William Brumfitt. Author: Brumfitt, William.; Year: 1968; London, New York, Oxford Univ. Press, 1968
Chapters on Urinary Tract Infections In order to find chapters that specifically relate to urinary tract infections, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and urinary tract infections using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “urinary tract infections” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on urinary tract infections: •
Pediatric Urinary Tract Infection Source: in Gearhart, J.P.; Rink, R.C.; Mouriquand, P.D. Pediatric Urology. Philadelphia, PA: W.B. Saunders Company. 2001. p. 237-258. Contact: Available from Elsevier, Health Sciences Division. The Curtis Center, 625 Walnut Street, Philadelphia, PA 19106. (800) 523-1649. E-mail:
[email protected]. Website: www.us.elsevierhealth.com. PRICE: $239.00 plus shipping and handling. ISBN: 072168680X. Summary: In infants and children, the urinary tract is a relatively common site of infection. This chapter on pediatric urinary tract infections (UTIs) is from a comprehensive textbook on pediatric urology that emphasizes the pathophysiology of various disorders. UTIs result in significant acute morbidity as well as long term
that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
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medical problems including delayed hypertension (high blood pressure) and progressive renal (kidney) dysfunction. Accurate diagnosis and timely treatment are vital in limiting these long term problems because the pediatric kidney is particularly susceptible to permanent renal damage. The authors focus on the pathogenesis and natural history of pediatric UTIs and discusses means of preventing renal damage. 3 figures. 6 tables. 296 references. •
Urinary Tract Infection and Diabetes: Diagnosis and Treatment Source: in Mogensen, C.E. Kidney and Hypertension in Diabetes Mellitus, 3rd ed. Norwell, MA: Kluwer Academic Publishers. 1997. p. 433-437. Contact: Available from Kluwer Academic Publishers. 101 Philip Drive, Assinippi Park, Norwell, MA 02061. (617) 871-6600. Fax (617) 871-6528. PRICE: $130.00. ISBN: 0792343530. Summary: In this chapter, from a text on the kidney and hypertension in diabetes mellitus, the author reviews recent work on the diagnosis and treatment of urinary tract infection (UTI) in patients with diabetes. The author encourages the use of urine cultures for diagnosis, in order to isolate the infecting pathogen and provide more specific, more effective antibacterial therapy. Pregnant women with diabetes, in particular, should be screened for bacteriuria because failure to identify and treat an infected pregnant woman places her at increased risk of acute pyelonephritis and enhances the likelihood of premature birth. The author briefly discusses antimicrobial treatment, stressing that UTI is not a homogeneous disease. The response to antimicrobial treatment may be particularly bad in patients confined to the bed with diabetes, infected with resistant organisms, and having indwelling catheters. Lower UTIs are usually easily eradicated unless there is some local defect. Chronic UTIs are common in people with diabetes and are often due to abnormalities such as bladder emptying problems. Long term, low dosage antibiotic prophylaxis prevents symptomatic recurrences. Low dosage prophylactic treatment has also been shown to prevent clinical episodes of infection in children with recurrent, symptomatic infections, and it may prevent kidney damage in children in whom infections are associated with vesicoureteral reflux. 7 references. (AAM).
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Managing Recurrent Urinary Tract Infections Source: in Harrison, L.H. Management of Urinary Tract Infections. London: Royal Society of Medicine. 1990. p. 79-84. Contact: Available from Royal Society of Medicine. Barbara Selves, Publications Department, 1 Wimpole Street, London. W1M 8AE. PRICE: $20 US plus shipping and handling. ISBN: 1853151114. Summary: This article, from the proceedings of an international conference, discusses the management of recurrent urinary tract infections. (UTIs). To manage recurrent UTIs appropriately, they must be evaluated in context. In infants and male patients, a recurrent UTI suggests an underlying anatomic anomaly. In contrast, recurrences in adult women are usually uncomplicated, acute infections. Microscopic analysis and dipstick testing suffice to diagnose the infection with most patients, but further evaluation may be necessary in specific instances. Self-medication with an appropriate antimicrobial may be a useful approach for patients who have multiple recurrences of uncomplicated UTI. 23 references. (AA-M).
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Lower Urinary Tract Infections in Women Source: in Hanno, P.M.; Malkowicz, S.B.; Wein, A.J. Clinical Manual of Urology. New York, NY: McGraw-Hill, Inc. 2001. p.173-183. Contact: Available from McGraw-Hill, Inc. 1221 Avenue of the Americas, New York, NY 10020. (612) 832-7869. Website: www.bookstore.mcgraw-hill.com. PRICE: $54.95;plus shipping and handling. ISBN: 0071362010. Summary: This chapter is from a handbook that serves as a basic, portable reference tool for the busy medical student and house officer rotating on the urology service and that enables program directors to use the information presented as a framework on which to present their particular management styles and strategies. In addition, the handbook can serve as a ready reference for the primary care physician, who is often the first person to see the patient with what ultimately proves to be a urologic problem. This chapter considers lower urinary tract infections (UTIs) in women. Topics include the incidence of UTIs; definition and classification; pathogenesis; patient care management, including for uncomplicated isolated (one time) cystitis (bladder infection), for unresolved bacteriuria (bacteria in the urine), and for recurrent bacterial cystitis; the choice of appropriate antibiotic for treatment; and managing asymptomatic bacteriuria in pregnant women and in elderly patients. A patient care algorithm is provided. The information in the chapter is presented in outline format, for ease of reference, and line drawings and radiographs illustrate the chapter. The chapter concludes with a list of five self-assessment questions and their answers. 1 figure. 1 table. 7 references.
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Acute Dysuria and Urinary Tract Infections Source: in Carlson, K.J. et al. Primary Care of Women. St. Louis, MO: Mosby-Year Book, Inc. 1995. p. 126-132. Contact: Available from Mosby-Year Book, Inc. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 325-4177 or (314) 872-8370. Fax (314) 432-1380. PRICE: $69.95 (as of 1995). ISBN: 0801676770. Summary: This chapter, from a medical reference for clinicians engaged in the primary care of women, discusses acute dysuria and urinary tract infections (UTI's). Topics include epidemiology; the causes of acute cystitis; the evaluation of acute dysuria, including history and physical examination, and diagnostic tests; management, including choice of therapy; and recurrent UTI's, including diagnostic tests and management options. The author dispels many myths traditionally taught about women with dysuria and proposes a scheme for categorizing the condition of women with acute dysuria. The author also presents dosage information for treating specific types of UTI's. 5 tables. 20 references.
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Urinary Tract Infections and Infection Stones Source: in Kursh, E.D., and McGuire, E.J., eds. Female Urology. Philadelphia, PA: Lippincott-Raven Publishers. 1994. p. 495-516. Contact: Available from Lippincott-Raven Publishers. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030 or (301) 714-2300. Fax (301) 824-7390. PRICE: $108.00 plus shipping. ISBN: 039751154X. Summary: This chapter, from a textbook on female urology, reviews urinary tract infections (UTIs) and infection stones. The first section discusses UTIs, including definitions; pathogenesis; host susceptibility; epidemiology; clinical manifestations, such
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as acute or chronic pyelonephritis, focal bacterial nephritis, renal abscess, pyonephrosis, xanthogranulomatous pyelonephritis, renal tuberculosis, and acute cystitis; diagnostic considerations; and treatment options for acute cystitis, recurrent cystitis, acute pyelonephritis, asymptomatic bacteriuria, and renal abscess. The latter section describes infection stones, discussing their pathogenesis, evaluation, treatment, and follow-up. 13 figures. 1 table. 79 references. •
Practice Parameter: The Diagnosis, Treatment, and Evaluation of the Initial Urinary Tract Infection in Febrile Infants and Young Children Source: in American Academy of Pediatrics. Clinical Practice Guidelines of the American Academy of Pediatrics: A Compendium [Compilation] of Evidence-Based Research for Pediatric Practice. Elk Grove Village, IL: American Academy of Pediatrics. 1999. p. 435-460. Contact: Available from American Academy of Pediatrics. P.O. Box 747, Elk Grove Village, IL 60009-0747. (800) 433-9016 or (947) 228-5005. Fax (847) 228-1281. PRICE: $39.95 for members; $44.95 for nonmembers. ISBN: 1581100264. Summary: This Clinical Practice Guideline from the American Academy of Pediatrics offers recommendations for the diagnosis, treatment, and evaluation of the initial urinary tract infection (UTI) in febrile infants (those who have a fever) and young children. The overall problem of managing UTI in children between 2 months and 2 years of age was conceptualized as an evidence model. The model depicts the relationship between the steps in diagnosis and management of UTI. The steps are divided into four phases: recognizing the child with UTI, making the diagnosis of UTI, short term treatment of UTI, and evaluation of the child with UTI for possible urinary tract abnormality. Phase 1 represents the recognition of the child at risk for UTI. Age and other clinical features define a prevalence or a prior probability of UTI, determining whether the diagnosis should be pursued. In Phase 2, alternative diagnostic strategies may be characterized by their cost, sensitivity, and specificity. In Phase 3, alternatives for treatment of UTI may be compared, based on their likelihood of clearing the initial UTI. Phase 4 depicts the imaging evaluation of infants with the diagnosis of UTI to identify those with urinary tract abnormalities such as vesicoureteral reflux (VUR). Children with VUR are believed to be at risk for ongoing renal damage with subsequent infections, resulting in hypertension and renal failure. The parameter includes eleven recommendations for the diagnosis, management and followup evaluation of infants and young children with unexplained fever who are later found to have a diagnosed UTI. The chapter includes an algorithm summarizing diagnostic strategies. 3 figures. 4 tables. 53 references.
•
Technical Report: Urinary Tract Infections in Febrile Infants and Young Children Source: in American Academy of Pediatrics. Clinical Practice Guidelines of the American Academy of Pediatrics: A Compendium [Compilation] of Evidence-Based Research for Pediatric Practice. Elk Grove Village, IL: American Academy of Pediatrics. 1999. p. 461-554. Contact: Available from American Academy of Pediatrics. P.O. Box 747, Elk Grove Village, IL 60009-0747. (800) 433-9016 or (947) 228-5005. Fax (847) 228-1281. PRICE: $39.95 for members; $44.95 for nonmembers. ISBN: 1581100264. Summary: This Technical Report was created as part of the process establishing a Clinical Practice Guideline from the American Academy of Pediatrics that offers recommendations for the diagnosis, treatment, and evaluation of the initial urinary tract
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infection (UTI) in febrile infants (those who have a fever) and young children. The overall problem of managing UTI in children between 2 months and 2 years of age was conceptualized as an evidence model. The Technical Report describes how a conceptual model of the steps in diagnosis and management of UTI was developed to examine alternative management strategies for UTI in infants. The model depicts the relationship between the steps in diagnosis and management of UTI. The model was expanded into a decision tree. Probabilities for branch points in the decision tree were obtained by review of the literature on childhood UTI. Cost data were obtained by literature review and from hospital billing data. The data were collated into evidence tables and are presented in this Technical Report. Analysis of the decision tree was used to produce risk tables and incremental cost effectiveness ratios for alternative strategies. The objective of the practice parameter and this Technical Report that supports it is to minimize the risk of chronic renal damage within reasonable economic constraints. Steps involved in achieving these objectives are identification of UTI, short term treatment of UTI, and evaluation for urinary tract abnormalities. 3 appendices. 15 figures. 12 tables. 190 references. •
Urinary Tract Infections in Adults Source: in Landau, L.; Kogan, B.A. 20 Common Problems in Urology. New York, NY: McGraw-Hill, Inc. 2001. p. 63-76. Contact: Available from McGraw-Hill, Inc. 1221 Avenue of the Americas, New York, NY 10020. (612) 832-7869. Website: www.bookstore.mcgraw-hill.com. PRICE: $45.00;plus shipping and handling. ISBN: 0070634130. Summary: Urinary tract infections (UTIs) continue to occupy a large proportion of the primary care clinician's practice. Primary care clinicians must maintain an interest in UTI, must understand the mechanisms that result in such infection, and need to develop a rational, therapeutic strategy that incorporates the most up to date evidence-based information available to them. This chapter on UTIs in adults is from a text on common problems in urology (written for the primary care provider). The author first offers a practical classification system for UTIs to use in general practice; this system simply divides UTIs into two categories: simple and complicated. This categorization of UTIs into uncomplicated and complicated allows the physician to develop a rational diagnostic treatment algorithm that is useful in clinical practice. The author then discusses uncomplicated UTI (simple cystitis or bladder infection, recurrent simple cystitis, and acute nonobstructive pyelonephritis, kidney infection), and complicated UTI, including acute infections, catheter-associated UTI, urinary stones (urolithiasis), pregnancy, UTI in the elderly, and prostatitis. The author covers three types of prostatitis: acute bacterial prostatitis, chronic prostatitis, and prostatodynia. A patient evaluation algorithm is also provided. The presentation, diagnosis, and treatment of simple cystitis are relatively simple and consistent. The patient is started on a short course of a first line antibiotic. It appears from the literature that 3 days of treatment is superior to single dose therapy, and in the particular case of simple cystitis, longer therapy may offer no further advantages. The antibiotics of choice for simple cystitis include the fluoroquinolones, trimethroprimsulfmathoxazole (or trimethroprim alone), or nitrofurantoin. The dose, adverse effects, and potential drug interactions should be familiar to all clinicians; regimes for uncomplicated UTIs are summarized in a table. 3 figures. 6 tables. 15 references.
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CHAPTER 8. INFECTIONS
MULTIMEDIA
ON
URINARY
TRACT
Overview In this chapter, we show you how to keep current on multimedia sources of information on urinary tract infections. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.
Video Recordings An excellent source of multimedia information on urinary tract infections is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “urinary tract infections” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “urinary tract infections” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on urinary tract infections: •
Breaking the Chain of Urinary Tract Infections Source: Chapel Hill, NC: Health Sciences Consortium. 1993. Contact: Available from Health Sciences Consortium. 201 Silver Cedar Court, Chapel Hill, NC 27514. (919) 942-8731. PRICE: $395; plus $5 shipping and handling. Order Number: 930-VI-005. Summary: This videotape program, designed for nurses and other nursing home staff members, focuses on catheter-associated urinary tract infections (UTIs). Topics include: infection rates, risk factors, symptoms, diagnosis, complications, treatment, and prevention (including infection control guidelines). Other topics discussed include the most-likely pathogens responsible for UTIs; drug therapy, including choice of antimicrobials; equipment and supplies, including in-dwelling catheters, closed-catheter systems, and condom catheters; and alternatives to catheterization. The videotape shows
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catheterization of both males and females. Viewers can qualify for continuing education credit for this program.
Bibliography: Multimedia on Urinary Tract Infections The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in urinary tract infections (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on urinary tract infections: •
Assessment of urinary tract infection in adults [slide] Source: Radiological Society of North America; Year: 1975; Format: Slide; [Chicago]: The Society: [for loan or sale by its Educational Materials Division], c1975
•
Assessment of urinary tract infection in children [slide] Source: Radiological Society of North America; Year: 1975; Format: Slide; [Chicago]: The Society: [for loan or sale by its Educational Materials Division], c1975
•
Diagnosis & management of urinary tract infections in females [motion picture] Source: Eli Lilly and Company; Year: 1976; Format: Motion picture; Indianapolis: Lilly, [1976]
•
Diseases of the kidney [slide]: infections of the kidney and the urinary tract: urinary tract infection Source: Ramzi S. Cotran and Michael Kashgarian; under the auspices of Association of Pathology Chairmen; Year: 1974; Format: Slide; [Cambridge, Mass.]: R. S. Cotran, 1974
•
Management of urinary tract infections in children [slide] Source: John W. Duckett and the A. U. A., inc; Year: 1980; Format: Slide; [Baltimore]: A. U. A.; Norwich, N. Y.: for loan or sale by Norwich-Eaton Pharmaceuticals, Film Library, 1980]
•
The Child with urinary tract infection [slide] Source: Ambulatory Pediatric Association and the Audiovisual Committee of the Association of Medical School Pediatric Department Chairmen; Year: 1974; Format: Slide; Atlanta: U. S. Dept. of Health, Education, and Welfare, Public Health Service, National Institutes of Health, National Library of Medicine, National Medical Audiovisual Center, 1974
•
Urinary tract infection [slide] Source: University of Michigan Medical Center; Year: 1974; Format: Slide; [Ann Arbor]: The University: [for sale by its Media Library], c1974
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Urinary tract infection following transplantation [videorecording] Source: Academy of Health Sciences; Year: 1975; Format: Videorecording; Fort Sam Houston, Tex.: The Academy, [1975]
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Urinary tract infections [slide] Source: Biomed limited Partnership; Year: 1977; Format: Slide; [Washington]: S.M.I. Learning Systems, c1977
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Urinary tract infections [slide] Source: Biomed limited Partnership; Year: 1977; Format: Slide; [Washington]: S.M.I. Learning Systems, c1977
•
Urinary tract infections in children [videorecording] Source: Faculty of Health Sciences, McMaster University. [et al.]; Year: 1974; Format: Videorecording; Hamilton, Ont.: The University: [for sale by its Faculty of Health Sciences], 1974
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CHAPTER 9. PERIODICALS AND NEWS ON URINARY TRACT INFECTIONS Overview In this chapter, we suggest a number of news sources and present various periodicals that cover urinary tract infections.
News Services and Press Releases One of the simplest ways of tracking press releases on urinary tract infections is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “urinary tract infections” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to urinary tract infections. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “urinary tract infections” (or synonyms). The following was recently listed in this archive for urinary tract infections: •
Vaginal vaccine curbs urinary tract infections Source: Reuters Industry Breifing Date: August 18, 2003
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•
Experimental vaccine curbs urinary tract infection Source: Reuters Health eLine Date: August 18, 2003
•
Maternal urinary tract infections may protect against unexplained fetal death Source: Reuters Medical News Date: November 01, 2002
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Nitrofurantoin effective for uncomplicated urinary tract infections Source: Reuters Industry Breifing Date: October 16, 2002
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Short-course antibiotics effective for lower urinary tract infection in children Source: Reuters Industry Breifing Date: August 08, 2002
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Vaginal vaccine may prevent recurrent urinary tract infections Source: Reuters Industry Breifing Date: December 18, 2001
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Some women can self-treat urinary tract infection Source: Reuters Health eLine Date: July 03, 2001
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Cranberry juice keeps urinary tract infection away Source: Reuters Health eLine Date: June 29, 2001
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Mom's urinary tract infections tied to retardation Source: Reuters Health eLine Date: June 12, 2001
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Levofloxacin as safe and effective as ofloxacin for urinary tract infections Source: Reuters Industry Breifing Date: December 11, 2000
•
Homeopathic treatment of urinary tract infection promising in animal model Source: Reuters Medical News Date: September 28, 2000
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Urinary tract infection during pregnancy linked to retardation Source: Reuters Health eLine Date: July 11, 2000
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Maternal urinary tract infections linked to mental retardation in infants Source: Reuters Medical News Date: July 10, 2000
•
Condom use may reduce risk of second urinary tract infection in women Source: Reuters Medical News Date: June 20, 2000 The NIH
Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date
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at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “urinary tract infections” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “urinary tract infections” (or synonyms). If you know the name of a company that is relevant to urinary tract infections, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “urinary tract infections” (or synonyms).
Newsletters on Urinary Tract Infections Find newsletters on urinary tract infections using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Limit your search to “Newsletter” and “urinary tract infections.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” Type “urinary tract infections” (or synonyms) into the “For these words:” box. The following list was generated using the options described above:
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•
Overused Antibiotics Lead to Resistant UTIs: Assessing Resistance Risk, Testing Fluoroquinolone Alternatives Key Source: Urology Times. 22(3): 2. March 1994. Contact: Available from Advanstar Communications, Inc. Corporate and Editorial Offices, 7500 Old Oak Boulevard, Cleveland, OH 44130. (216) 243-8100. Summary: This brief news article, from a professional newsletter, warns that physicians' overuse of fluoroquinolones to treat urinary tract infections (UTIs) has led to a significant increase in ciprofloxacin-resistant Escherichia coli. Topics include problems with recurrence of urinary tract infections; recent increases in the use of fluoroquinolones; risk factors for ciprofloxacin-resistant E coli UTIs; experience with 54 patients with resistant UTIs; and the course of ciprofloxacin-resistant E coli-induced UTIs. The article concludes with a brief discussion of alternative treatments, including the combination of amoxicillin and potassium clavulanate.
•
Understanding Enuresis Source: Informer. p. 1-2. Winter-Spring 1994. Contact: Available from Simon Foundation. P.O. Box 815, Wilmette, IL 60091. (800) 2374666. Summary: This brief newsletter article provides a general overview of enuresis, the involuntary discharge of urine by day or night or both, in a child aged 5 years or older, in the absense of congenital or acquired problems. Topics include primary and secondary enuresis; the prevalence and incidence of enuresis in different age groups; the psychosocial impact of enuresis, particularly in older children; contributing factors that may cause enuresis; the role of urinary tract infections; and treatment programs available. The author concludes with the hope that, as the issue of incontinence receives more enlightened attention by our society, the stigma and negative attitudes surrounding nocturnal enuresis will change, alleviating the anxiety and guilt often felt by the parents, and the withdrawal from social activities experienced by the child.
Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “urinary tract infections” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on urinary tract infections: •
What Causes a Urinary Tract Infection? Source: Columbia-Presbyterian Urology. p. 1-2. Spring 1997. Contact: Available from Columbia-Presbyterian Urology. Dana W. Atchley Pavilion, 11 Floor, 161 Fort Washington Avenue, New York, NY 10032-3784. (212) 305-0111. Summary: This newsletter article describes the causes of urinary tract infections (UTIs), the most common infections in women. The author first lists the symptoms that a person
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with a UTI may have: burning and pain on urination, urinating frequently, urge to urinate, blood in the urine, fever and chills, cloudy urine, and foul smelling urine. The author then discusses the causes of a UTI, including escherichia coli (bacteria) colonization, lack of vaginal estrogen, urinary blockages, and other bacterial infections. The article concludes with a list of strategies for treatment and prevention, including antibiotics for 3 to 7 days, increased fluid intake, aspirin or acetominophen for pain and discomfort, drinking acid-containing juice, refraining from sex during treatment for the infection, appropriate wiping after bowel movements (for women), drinking 4 to 6 glasses of fluid each day, urinating 3 to 5 times each day, and having a urine culture test several days after the antibiotic is finished.
Academic Periodicals covering Urinary Tract Infections Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to urinary tract infections. In addition to these sources, you can search for articles covering urinary tract infections that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”
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CHAPTER 10. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.
U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for urinary tract infections. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with urinary tract infections. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.).
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The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to urinary tract infections: Atropine, Hyoscyamine, Methenamine, Methylene Blue, Phenyl Salicylate, and Benzoic Acid •
Systemic - U.S. Brands: Atrosept; Dolsed; Hexalol; Prosed/DS; UAA; Urimed; Urised; Uriseptic; Uritab; Uritin; Uro-Ves http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202075.html
Cinoxacin •
Systemic - U.S. Brands: Cinobac http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202141.html
Fosfomycin •
Systemic - U.S. Brands: Monurol http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203522.html
Loracarbef •
Systemic - U.S. Brands: Lorabid http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202680.html
Methenamine •
Systemic - U.S. Brands: Hiprex; Mandelamine; Urex http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202354.html
Nitrofurantoin •
Systemic - U.S. Brands: Furadantin; Macrobid; Macrodantin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202414.html
Phosphates •
Systemic - U.S. Brands: K-Phos M. F.; K-Phos Neutral; K-Phos No. 2; K-Phos Original; Neutra-Phos; Neutra-Phos-K; Uro-KP-Neutral http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202463.html
Sulfonamides and Trimethoprim •
Systemic - U.S. Brands: Bactrim; Bactrim DS; Bactrim I.V.; Bactrim Pediatric; Cofatrim Forte; Cotrim; Cotrim DS; Cotrim Pediatric; Septra; Septra DS; Septra Grape Suspension; Septra I.V.; Septra Suspension; Sulfatrim; Sulfatrim Pediatric; Sulfatrim S/S; Sulfatrim Suspension; S http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202781.html
Trimethoprim •
Systemic - U.S. Brands: Proloprim; Trimpex http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202579.html
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Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.
Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/.
PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.
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APPENDICES
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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.
NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute12: •
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
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National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25
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National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm
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National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm
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National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375
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National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/
12
These publications are typically written by one or more of the various NIH Institutes.
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•
National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm
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National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/
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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm
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National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm
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National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/
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National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/
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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html
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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm
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National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm
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National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm
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National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html
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National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm
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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp
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National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/
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National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp
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Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html
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Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm
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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.13 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:14 •
Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
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Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
13 Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 14 See http://www.nlm.nih.gov/databases/databases.html.
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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html The Combined Health Information Database
A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to one of the following: Brochure/Pamphlet, Fact Sheet, or Information Package, and “urinary tract infections” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years.” Select your preferred language and the format option “Fact Sheet.” Type “urinary tract infections” (or synonyms) into the “For these words:” box. The following is a sample result: •
Prevention and Management of Urinary Tract Infections in Paralyzed Persons: Summary, Evidence Report/Technology Assessment No. 6 Source: Silver Spring, MD: Agency for Health Care Policy and Research, U.S. Department of Health and Human Services. 1999. 3 p. Contact: Available from AHCPR Publications Clearinghouse. P.O. Box 8547, Silver Spring, MD 20907-8547. (800) 358-9295. TDD (888) 586-6340. Website: www.ahcpr.gov. AHCPR Publication Number 99-E007. PRICE: Single copy free; also available at website. Summary: This document summarizes the results found by a 13 member panel of experts, consumers, and a managed care organization representative, convened to analyze the evidence on selected aspects of the prevention and management of urinary tract infections (UTIs) in paralyzed persons. The two populations most commonly affected are persons having spinal cord injury (SCI) and people with multiple sclerosis (MS). Eighty percent of persons with SCI experience a UTI by their 16th year post injury, and diseases of the urinary system are overall the fifth most common primary or secondary cause of death in this population. Between 70 to 90 percent of persons with MS develop bladder dysfunction over the course of their disease, placing them at increased risk for UTIs. The panel utilized a literature review to address three areas: the signs, symptoms, and laboratory findings that are associated with risks to persons with paralysis due to neurogenic bladder; the risk factors for recurrent UTIs; and the risks and benefits of long term use of antibiotic prophylaxis. Risk factors can include febrile (fever) episodes in earlier years (before the UTIs), the presence of certain bacteria or of multiple organisms early after SCI, and indwelling catheterization (which is associated with more frequent infections than intermittent catheterization). Antibiotic prophylaxis significantly reduces bacteriuria among acute spinal cord injury patients; however, antibiotic prophylaxis results in a twofold increase in the occurrence of antibiotic resistant bacteria. The report concludes by calling for additional research and by providing the availability information for the full evidence report from which this summary was taken.
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The NLM Gateway15 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.16 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “urinary tract infections” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total
Items Found 32078 371 944 132 10 33535
HSTAT17 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.18 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.19 Simply search by “urinary tract infections” (or synonyms) at the following Web site: http://text.nlm.nih.gov.
Coffee Break: Tutorials for Biologists20 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are 15
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.
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The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 17 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 18 19
The HSTAT URL is http://hstat.nlm.nih.gov/.
Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 20 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.
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used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.21 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.22 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
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Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
The Genome Project and Urinary Tract Infections In the following section, we will discuss databases and references which relate to the Genome Project and urinary tract infections. Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for Biotechnology Information (NCBI).23 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI’s Entrez database of MEDLINE articles and sequence information. To search the database, go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html. Type “urinary tract infections” (or synonyms) into the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related research and databases. In particular, the option “Database Links” will search across technical databases that offer an abundance of
21 The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 22 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process. 23 Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.
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information. The following is an example of the results you can obtain from the OMIM for urinary tract infections: •
Urinary Tract Infections, Recurrent, Susceptibility to Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?603806 Genes and Disease (NCBI - Map)
The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. This Web site categorizes each disorder by system of the body. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to revisit it from time to time. The following systems and associated disorders are addressed: •
Cancer: Uncontrolled cell division. Examples: Breast and ovarian cancer, Burkitt lymphoma, chronic myeloid leukemia, colon cancer, lung cancer, malignant melanoma, multiple endocrine neoplasia, neurofibromatosis, p53 tumor suppressor, pancreatic cancer, prostate cancer, Ras oncogene, RB: retinoblastoma, von Hippel-Lindau syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Cancer.html
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Immune System: Fights invaders. Examples: Asthma, autoimmune polyglandular syndrome, Crohn’s disease, DiGeorge syndrome, familial Mediterranean fever, immunodeficiency with Hyper-IgM, severe combined immunodeficiency. Web site: http://www.ncbi.nlm.nih.gov/disease/Immune.html
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Metabolism: Food and energy. Examples: Adreno-leukodystrophy, atherosclerosis, Best disease, Gaucher disease, glucose galactose malabsorption, gyrate atrophy, juvenile-onset diabetes, obesity, paroxysmal nocturnal hemoglobinuria, phenylketonuria, Refsum disease, Tangier disease, Tay-Sachs disease. Web site: http://www.ncbi.nlm.nih.gov/disease/Metabolism.html
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Muscle and Bone: Movement and growth. Examples: Duchenne muscular dystrophy, Ellis-van Creveld syndrome, Marfan syndrome, myotonic dystrophy, spinal muscular atrophy. Web site: http://www.ncbi.nlm.nih.gov/disease/Muscle.html
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Nervous System: Mind and body. Examples: Alzheimer disease, amyotrophic lateral sclerosis, Angelman syndrome, Charcot-Marie-Tooth disease, epilepsy, essential tremor, fragile X syndrome, Friedreich’s ataxia, Huntington disease, Niemann-Pick disease, Parkinson disease, Prader-Willi syndrome, Rett syndrome, spinocerebellar atrophy, Williams syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Brain.html
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Signals: Cellular messages. Examples: Ataxia telangiectasia, Cockayne syndrome, glaucoma, male-patterned baldness, SRY: sex determination, tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html
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Transporters: Pumps and channels. Examples: Cystic fibrosis, deafness, diastrophic dysplasia, Hemophilia A, long-QT syndrome, Menkes syndrome, Pendred syndrome, polycystic kidney disease, sickle cell anemia, Wilson’s disease, Zellweger syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Transporters.html Entrez
Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI). These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: •
3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
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Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books
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Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome
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NCBI’s Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/
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Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide
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OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM
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PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset
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ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
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Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein
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PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
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Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure
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Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy
To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=genome, and then select the database that you would like to search. The databases available are listed in the drop box next to “Search.” Enter “urinary tract infections” (or synonyms) into the search box and click “Go.”
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Jablonski’s Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database24 This online resource has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html, you can search across syndromes using an alphabetical index. Search by keywords at http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html. The Genome Database25 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB’s mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “urinary tract infections” (or synonyms) into the search box, and review the results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms).
24 Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html. 25 Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html - mission.
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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on urinary tract infections can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to urinary tract infections. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to urinary tract infections. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “urinary tract infections”:
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Guides on urinary tract infections Urinary Tract Infections http://www.nlm.nih.gov/medlineplus/urinarytractinfections.html
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Other guides Bladder Diseases http://www.nlm.nih.gov/medlineplus/bladderdiseases.html Infections and Pregnancy http://www.nlm.nih.gov/medlineplus/infectionsandpregnancy.html Kidney Diseases http://www.nlm.nih.gov/medlineplus/kidneydiseases.html
Within the health topic page dedicated to urinary tract infections, the following was listed: •
General/Overviews JAMA Patient Page: Urinary Tract Infections Source: American Medical Association http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZMNZZTJAC &sub_cat=324 Urinary Tract Infection Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=DS00286
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Diagnosis/Symptoms Cystoscopy http://www.nlm.nih.gov/medlineplus/tutorials/cystoscopyloader.html Cystoscopy and Ureteroscopy Source: National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov/kudiseases/pubs/cystoscopy/index.htm Hematuria (Blood in the Urine) Source: National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov/kudiseases/pubs/hematuria/index.htm Painful Urination Source: American Academy of Family Physicians http://familydoctor.org/284.xml Urinalysis Source: American Association for Clinical Chemistry http://www.labtestsonline.org/understanding/analytes/urinalysis/test.html Urination Problems: Self-Care Flowcharts Source: American Academy of Family Physicians http://familydoctor.org/535.xml Urine Culture Source: American Association for Clinical Chemistry http://www.labtestsonline.org/understanding/analytes/urine_culture/test.html
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Specific Conditions/Aspects Cystitis Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=DS00285
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Children Recurrent Urinary Tract Infections and Related Conditions Source: Nemours Foundation http://kidshealth.org/parent/medical/kidney/recurrent_uti_infections.html Treating Urinary Tract Infections Source: American Academy of Pediatrics http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZWW6H1R7C &sub_cat=107 Urinary Tract Infections (UTIs) Source: Nemours Foundation http://kidshealth.org/kid/ill_injure/sick/uti.html Urine Tests Source: Nemours Foundation http://kidshealth.org/parent/general/sick/labtest7.html Vesicoureteral Reflux Source: National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov/kudiseases/pubs/vesicoureteralreflux/index.htm
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From the National Institutes of Health What I Need to Know about Urinary Tract Infections http://kidney.niddk.nih.gov/kudiseases/pubs/uti_ez/index.htm
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Men Bladder Infections in Men Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HO00022
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Organizations American Foundation for Urologic Disease http://www.afud.org/ National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov/ National Kidney and Urologic Diseases Information Clearinghouse Source: National Institute of Diabetes and Digestive and Kidney Diseases http://kidney.niddk.nih.gov/ UrologyHealth.org Source: American Urological Association http://urologyhealth.org/
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Research UTI Vaccine on the Horizon Source: National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov/about/Research_Updates/sum99/1.htm
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Statistics Kidney and Urologic Disease Statistics for the United States Source: National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov/kudiseases/pubs/kustats/index.htm
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Teenagers Kidneys and Urinary Tract Source: Nemours Foundation http://kidshealth.org/teen/your_body/body_basics/kidneys.html
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Women Keeping the Urinary System Healthy Source: American Medical Women's Association http://www.amwa-doc.org/publications/WCHealthbook/urinaryamwa-ch32.html Urinary Tract Infections Source: American College of Obstetricians and Gynecologists http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZ1LJ5770D&s ub_cat=2008 Urinary Tract Infections During Pregnancy Source: American Academy of Family Physicians http://familydoctor.org/497.xml
You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on urinary tract infections. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive:
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Urinary Tract Infections Source: New York, NY: National Kidney Foundation. 2000. 9 p. Contact: National Kidney Foundation. 30 East 33rd Street, New York, NY 10016. (800) 622-9010. Website: www.kidney.org. PRICE: Single copy free. Summary: Infection of the urinary tract is one of the most common problems treated by physicians. Written in a question and answer format, this brochure provides basic information about urinary tract infections (UTIs). Topics include the symptoms and causes of UTIs, risk factors for UTIs, diagnostic tests used, UTIs in children, and suggestions for preventing UTIs.
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Urinary Tract Infections in Children: Why They Occur and How to Prevent Them Source: American Family Physician. 57(10): 2448-2750. May 15, 1998. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. Summary: This article offers a general overview of urinary tract infections (UTIs) in children and how to prevent them. The author first lists the anatomical parts of the urinary tract and then addresses basic questions about how UTIs occur and how to prevent them. The urinary tract normally does not have bacteria in it, except at the very end of the urethra and on the skin around the opening of the urethra. When harmful bacteria get into the urinary tract, though, they can cause an infection. Urinary tract infections include bladder infections (cystitis), and kidney infections (pyelonephritis). UTIs are sometimes hard to diagnose in babies and young children, as they cannot explain where it hurts. Older children may say that it hurts to urinate, may have a sudden need to urinate, or may hold themselves or squat to keep from urinating. UTIs are diagnosed with a urine culture. Children who have had numerous UTIs, particularly kidney infections, will be tested with an x-ray or sonogram for problems that could be contributing to the infections. The article concludes with a list of good bathroom habits for parents to teach children to follow. These include teaching girls to wipe from front to back, teaching boys to completely open their pants and underpants so the penis is not pressed by clothing when urinating, teaching all children to urinate regularly, treating constipation, and giving children antibiotics only when indicated. 1 figure.
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Urinary Tract Infection in Women Source: New York, NY: Partnership for Women's Health at Columbia. 1998. 12 p. Contact: Available from Partnership for Women's Health at Columbia. 14 East 60th Street, Penthouse, New York, NY 10022. (212) 326-8860. Fax: (212) 326-8866. Website: cpmcnet.columbia.edu/dept/partnership/index.html. PRICE: Single copy free. Summary: This booklet helps readers understand urinary tract infections (UTIs), which manifest with symptoms including a sudden need to urinate, the need to urinate more often than usual, and an uncomfortable burning sensation, cramps, or pain when urinating or immediately afterward. In most cases, doctors can treat and cure UTIs quickly and easily. An untreated lower UTI (one that affects the lower part of the urinary tract, i.e., urethra and bladder) can become a serious condition involving the kidneys. These infections are more common in women who are sexually active, in women aged 20 to 50, and in those who have diabetes and other conditions that weaken the immune system. The anatomy of the external genitalia in women contributes to more UTIs in women than in men. The physician will usually prescribe oral antibiotics
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to treat a UTI; older women may need to take antibiotics for a longer time or may need to be given antibiotics by injection. The decision to prescribe one medication over another is usually made after considering antibiotic effectiveness, side effects, cost, and the possibility that the bacteria will resist the medicine. Most side effects are minor and do not last long. Complications of antibiotic therapy can include nausea, headaches, dizziness, or sensitivity to light; antibiotics sometimes affect the levels of bacteria normally found in the body, which may result in diarrhea or yeast infections. The booklet concludes with a list of suggestions to help prevent a recurrence of the UTI; these tips include drink at least 8 glasses of water a day, urinate frequently, avoid wearing tight clothing, practice good daily hygiene, and urinate after sexual intercourse. The booklet includes a brief glossary of terms, and a list summarizes the symptoms of a UTI. 3 figures. 1 table. •
Answers to Your Questions About Urinary Tract Infections Source: Baltimore, MD: American Foundation for Urologic Disease. July 1992. 8 p. Contact: Available from American Foundation for Urologic Disease. 1126 North Charles Street, Baltimore, MD 21201. (800) 242-2383 or (410) 468-1800. Fax (410) 468-1808. Website: www.afud.org. PRICE: Single copy free. Summary: This booklet is designed to answer questions about urinary tract infections: what they are, what causes them, how they are treated, how to get the most benefit from the treatment recommended by a health care provider, and how to help prevent future infections. Specific topics covered include the physiology of the bladder and kidneys, signs and symptoms of a urinary tract infection (UTI), the role of urine culture in diagnosing a UTI, the use of antibiotics in treating UTIs, risk factors for UTIs, the longterm effects of UTIs, and other conditions that may be confused with UTIs. The contact information for six support organizations is included. A quiz to test the reader's knowledge is included on the inside front cover; a glossary is provided on the inside back cover.
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Questions and Answers on Urinary Tract Infections Source: Alexandria, VA: American Medical Women's Association. 1997. 4 p. Contact: Available from American Medical Women's Association. 801 North Fairfax Street, Alexandria, VA 22314. (781) 585-8220. PRICE: Single copy free. Summary: This brochure outlines symptoms, diagnosis, and treatment of urinary tract infections (UTIs). An infection of the urinary tract commonly has the following symptoms: frequent and urgent need to urinate, painful urination, cloudy urine, lower back or abdominal pain, blood in the urine. About 80 to 90 percent of UTIs are caused by Escherichia coli bacteria, which are normally present in the rectum. Factors that may contribute to UTIs are sexual intercourse, some birth control methods, low water intake, and anatomic problems. The first step a health care provider will take to confirm a bacterial UTI is to review the symptoms and test the patient's urine. The infection should be diagnosed by a urine culture, since several other conditions, including vaginal infections, gonorrhea, chlamydia, irritable bladder, and bladder cancer, can have similar symptoms. When pain is the predominant symptom, the diagnosis may be interstitial cystitis. If the urine culture shows bacteria, the health care provider will prescribe a course of antibiotics. The brochure outlines other steps to take to treat a UTI, including drinking large amounts of water; avoiding caffeine, acid foods, spices, citrus fruits, tomatoes, alcohol, and chocolate; drinking cranberry juice cocktail; and trying hot water bottles or heating pads to ease cramps and soothe the pain. The brochure concludes with
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a section of suggestions for preventing UTIs, including drinking plenty of fluids, wiping from 'front to back' (vagina to anus) after urinating to avoid spreading bacteria, scheduling frequent bathroom breaks, drinking water before and after sex in order to ensure a good volume of urination afterward, checking the fit of a diaphragm or using another method of birth control, avoiding tight clothing and pantyhose, and wearing cotton underwear. •
Taking Care of Urinary Tract Infections Source: Santa Cruz, CA: ETR Associates. 1998. 6 p. Contact: Available from ETR Associates. 4 Carbonero Way, Scotts Valley, CA 950664200. (800) 321-4407. Fax (800) 435-8433. Website: www.etr.org. PRICE: Single copy free; $16.00 for 50 copies, discounts for larger orders. Order number: R024. Summary: This brochure provides basic information about urinary tract infections (UTIs) in men and women. A UTI is caused when bacteria enter the urinary tract and can be called urethritis (in the urethra), cystitis (in the bladder), or pyelonephritis (in the kidney). Any UTI symptoms should be checked by a health care provider, since untreated UTIs can result in more serious problems. The brochure describes the differences between UTIs in men and in women. The brochure also lists common symptoms of the different types of UTIs. These symptoms include pain or burning when urinating, feeling a sudden urgent need to urinate, urinating more often then usual, urinating only small amounts even though the bladder feels full, blood in the urine, cloudy or foul smelling urine, and pain. Sidebars consider the role of sexually transmitted diseases (STDs) in urinary tract infections. The brochure briefly reviews the treatment protocol for UTI, which includes a genital or pelvic exam, a urinalysis, and possible prescription for antibiotics. The brochure also outlines home care strategies for resolving a UTI more quickly, including drinking plenty of water, refraining from sexual activities, getting plenty of rest, limiting foods that may cause urinary burning (such as coffee, tea, alcohol, spicy foods), and using over the counter medications that can help with bladder pain. The brochure concludes with a list of strategies to help avoid UTIs, as well as a summary of the symptoms that indicate the need to contact a health care provider. 2 figures.
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Urinary Tract Infections: Guide for Women Source: Washington DC: National Kidney Foundation of the National Capital Area. 199x. 2 p. Contact: Available from National Kidney Foundation of the National Capital Area. 5335 Wisconsin Avenue, Suite 830, Washington DC 20015-2030. PRICE: Single copy free. Summary: This brochure provides readers with a basic overview of urinary tract infections (UTIs). Topics include the two kinds of UTIs (acute cystitis and pyelonephritis); UTI symptoms; how to know when to consult a health care provider; situations where UTI symptoms can mask a more serious condition; considerations during pregnancy; how UTIs are treated; and what patients can do to prevent recurrence of UTIs. The brochure concludes with the contact information for both national and local National Kidney Foundation offices. The brochure is also available in a version designed for people with low literacy skills (see KU BR 05337).
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Urinary Tract Infections in Women Source: Minneapolis, MN: Park Nicollet Health Source. 1995. 2 p.
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Contact: Available from Park Nicollet Health Source. 3800 Park Nicollet Boulevard, Minneapolis, MN 55416. (800) 372-7776 or (612) 993-3534. Fax (612) 993-1840. PRICE: $0.40 each for 25-99 copies; $0.36 each for 100-499 copies. Summary: This brochure reviews urinary tract infections (UTIs) in women. A UTI is an infection, usually located in the urethra, bladder, or kidneys, which often has the following symptoms: lower abdominal pressure, frequency and urgency of urination, burning during urination, back pain and fever, blood in the urine, and dark or foul smelling urine. Women who suspect they have a UTI are encouraged to call their health care provider; treatment can sometimes be prescribed over the telephone. Women between 18 and 65 years of age with symptoms of a urinary tract infection and no other complicating factors have an excellent chance of curing the infection with a 3-day course of antibiotics. Advantages of using this shorter course of antibiotics include fewer side effects, fewer yeast infections, and lower costs for medication. The brochure outlines the indications for a longer course of antibiotics (pregnancy, complicating medical factors, or a history of UTIs). The brochure also provides recommendations to follow while taking the antibiotics. The brochure concludes with a list of suggestions for preventing UTIs, such as emptying the bladder every 3 hours while awake, drinking at least 6 to 8 glasses of water daily, taking showers instead of baths, avoiding the use of feminine hygiene products and vaginal diaphragm, emptying the bladder after sexual intercourse, and wiping from front to back after urination or bowel movement. 1 figure. •
Urinary Tract Infection in Adults Source: Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH). 1999. 8 p. Contact: Available from National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). 3 Information Way, Bethesda, MD 20892-3580. (800) 891-5390 or (301) 654-4415. Fax (301)634-0716. E-mail:
[email protected]. Website: www.niddk.nih.gov/health/kidney/nkudic.htm. PRICE: Full-text available online at no charge; single copy free; bulk orders available. Order number: KU-03. Summary: This fact sheet reviews urinary tract infection (UTI) in adults, a serious health problem that affects millions of people each year. The fact sheet first briefly reviews the anatomy of the urinary tract and the incidence of UTIs, particularly in women. The fact sheet then explains that a urinary tract infection occurs when microorganisms, usually bacteria from the digestive tract, cling to the opening of the urethra and begin to multiply. Most infections arise from one type of bacteria, Escherichia coli, which normally live in the colon. Some people are more prone to getting a UTI than others. Any abnormality of the urinary tract that obstructs the flow of urine sets the stage for an infection; other risk factors include catheters placed in the bladder, the presence of diabetes, undetected abnormalities in the urinary tract of infants, female gender, sexual intercourse, and certain kinds of birth control methods. Recurrent infections may be due in part to the ability of bacteria to attach to cells lining the urinary tract in certain people. Symptoms of UTI can include a frequent urge to urinate and a painful, burning feeling in the area of the bladder or urethra during urination; fatigue; pain even while not urinating; milky or cloudy urine, or bloody urine; and fever (particularly associated with a kidney infection). UTIs are diagnosed primarily by urinalysis; recurrent infections may require an intravenous pyelogram, ultrasound, or cystoscopy. UTIs are treated with antibacterial drugs. The choice of drug and length of treatment depend on the patient's history and the urine tests that identify the offending bacteria. Often, a UTI can be cured with 1 or 2 days of treatment, if the infection is not complicated by an
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obstruction or nervous system disorder. The fact sheet describes strategies to use for women who have frequent recurrent infections; these strategies can include prophylactic antibiotics (including single dosing of antibiotics after sexual intercourse) or short course of antibiotics when symptoms appear. Preventive strategies can include drinking plenty of water every day, urinating as often as necessary (not resisting or postponing the urge to urinate), wiping from front to back to prevent bacteria around the anus from entering the vagina or urethra, taking showers instead of tub baths, cleaning the genital area before sexual intercourse, and avoiding the use of feminine hygiene sprays. The fact sheet concludes with a section discussing research work on the development of a vaccine that can prevent UTIs from coming back. Early tests indicate that a vaccine helps patients build up their own natural infection fighting powers. Appended to the text are a reading list and a brief description of the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). 1 figure. 7 references. •
Female Urinary Tract Infections and Your Health Source: Norwich, NY: Procter and Gamble Pharmaceuticals. 1992. 4 p. Contact: Available from Procter and Gamble Pharmaceuticals. Norwich, NY 13815-0231. (607) 335-2111. PRICE: Single copy free. Summary: This patient education brochure describes female urinary tract infections and why they can be a health threat. Topics include female urinary tract anatomy; bacteria and the lower urinary tract; the signs and symptoms of urinary tract infections, including bladder infections; the medical evaluation of urinary tract infections; and drug therapy for urinary tract infections. The brochure concludes with a brief list of helpful hints to avoid urinary infections. 2 figures.
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Preventing Urinary Tract Infections in Women Source: Pitman, NJ: Society of Urologic Nurses and Associates (SUNA). 1995. 2 p. Contact: Available from Society of Urologic Nurses and Associates (SUNA). East Holly Avenue, Box 56, Pitman, NJ 08071-0056. (609) 256-2335. Fax (609) 589-7463. PRICE: Single copy free. Summary: This patient education brochure, written in a question and answer format, provides guidelines for preventing urinary tract infections (UTIs) in women. Topics include the causes of UTIs, the signs and symptoms of a UTI, diagnostic tests used to confirm a UTI, treatment options, and prevention recommendations. One illustration diagrams the urinary tract system and notes where most UTIs occur.
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Urinary Tract Infections: News Briefings for Science Writers on Transplantation, Dialysis and Kidney Research (memorandum) Source: New York, NY: National Kidney Foundation, Inc. March 26-27, 1990. 9 p. Contact: Available from National Kidney Foundation, Inc. 30 East 33rd Street, New York, NY 10016. (800) 622-9010 or (212) 889-2210. Summary: This technical paper prepared for the National Kidney Foundation's 1990 science writers news briefing on transplantation, dialysis, and kidney/urology research discusses urinary tract infections (UTI's) and the role of bacterial adherence in the pathogenesis of UTI's. Research suggests that there is a widespread, genetically determined alteration in the cell-surface composition of mucosal epithelial cells in women with recurrent UTI's. This difference results in enhanced bacterial attachment
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and explains, in part, enhanced vaginal colonization and subsequent infection of the urothelium (mucosa lining the bladder and ureters) in women with recurrent infections. Research continues to delve into the problem of identifying which people are at increased risk for UTI, with particular success in correlating blood group phenotypes and recurrent UTI's. •
Understanding Urinary Tract Infections: Treatment and Prevention for Women and Men Source: San Bruno, CA: StayWell Company. 1999. 7 p. Contact: Available from StayWell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 244-4512. E-mail:
[email protected]. Website: www.staywell.com. PRICE: $1.10 per copy; plus shipping and handling. Summary: Urinary tract infections (UTIs) are common in both women and men. This brochure helps patients diagnosed with UTIs to understand their infection and how to treat it. The booklet stresses that an early diagnosis offers the best chance for successful treatment and helps prevent the infection from turning into a more serious problem (such as kidney infection). Diagnosis can include medical history, physical exam, and laboratory tests, including urinalysis, urine culture, blood tests, kidney ultrasound, intravenous pyelogram (IVP, an x ray of the kidney), cystoscopy, and cystogram (a x ray of the bladder, ureter, or urethra). The brochure briefly reviews the anatomy of the urinary tract and how UTIs occur, including sexual behavior, poor hygiene, urine that remains in the bladder after urination, a blockage in the kidneys, and a blockage caused by an enlarged prostate (in men). There are different kinds of UTIs, including cystitis (bladder infection) in women, urethral syndrome in women, pyelonephritis in men and women, prostatitis in men, urethritis in men, and cystitis in men. Treatment and prevention strategies include taking medications as directed, drinking enough fluids, practicing good personal hygiene, emptying bladder whenever the urge to urinate is present, avoiding foods that may irritate the urinary tract, and keeping followup medical appointments. Occasionally, surgery may be necessary to relieve blockages, such as an enlarged prostate or kidney stone. The brochure is illustrated with full color line drawings. 25 figures.
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Urinary Tract Infections in Young Children Source: Elk Grove Village, IL: American Academy of Pediatrics. 1999. [4 p.]. Contact: Available from American Academy of Pediatrics. Division of Publications, 141 Northwest Point Blvd., P.O. Box 747, Elk Grove Village, IL 60009-0747. (800) 433-9016. Fax (847) 228-1281. E-mail:
[email protected]. Website: www.aap.org. PRICE: $34.95 per pack of 100 brochures (nonmembers); $29.95 per pack of 100 brochures (members). Summary: Urinary tract infections are common in infants and young children: about 3 percent of girls and 1 percent of boys will have a UTI by 11 years of age. This brochure provides information about urinary tract infections (UTIs) in young children. Written for parents, the brochure notes that UTIs in this population may go untreated because the symptoms may not be obvious to the child or to parents. The brochure first briefly describes the anatomy of the urinary tract and the different infections caused by bacteria, including urethritis (urethral infection), cystitis (bladder infection), and pyelonephritis (kidney infection). Symptoms of UTIs may include the following: fever, pain or burning during urination, the need to urinate more often, difficulty getting urine out, bedwetting, vomiting (or refusal to eat), abdominal pain, side or back pain, foulsmelling urine, cloudy or bloody urine, unexplained and persistent irritability in an
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infant, or poor growth in an infant. The diagnostic workup includes a history of the child's symptoms, a review of the food and fluid intake, a physical examination, and a urinalysis (test of a urine sample from the child). The brochure describes the ways that a urine sample is obtained from a young child. UTIs are treated with antibiotics; infants and young children with UTIs usually need to take antibiotics for 7 to 14 days, sometimes longer. The brochure describes followup care, including the use of diagnostic tests to make sure the urinary tract is normal and that the infection did not cause any damage. These tests include kidney and bladder ultrasound, voiding cystourethrogram (VCUG), intravenous pyelogram, and nuclear scans. The brochure also briefly describes some of the other publications that are available from the American Academy of Pediatrics. 2 figures. •
Urinary Tract Infections in Children Source: American Family Physician. 59(6): 1485-1486. March 15, 1999. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. Summary: Urinary tract infections in children are sometimes associated with vesicoureteral reflux, which can lead to renal scarring if it remains unrecognized. This parent education handout accompanies an article that reviews pediatric urinary tract infection (UTI) and reflux. Since the risk of renal scarring is greatest in infants, any child who presents with a urinary tract infection prior to toilet training should be evaluated for the presence of reflux. The handout first reviews the two most common types of UTIs (bladder and kidney infections) and describes the symptoms that may be encountered. The handout defines reflux, describes the diagnostic tests that may be used to confirm a UTI, and discusses treatment (usually with antibiotics). The handout also discusses the diagnosis of other urinary tract problems, including urinary tract anomalies, focusing on testing methods including ultrasound, bladder x ray (voiding cystourethrogram), kidney scan, and intravenous pyelogram. It concludes by reviewing self care strategies that can help prevent UTIs in children.
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Urinary Tract Infection Source: New York, NY: National Kidney Foundation, Inc. 1990. 4p. Contact: National Kidney Foundation, Inc. 30 East 33rd Street, New York, NY 10016. (800) 622-9010. PRICE: Single copy free. Order No. 08-53. Summary: Written in a question and answer format, and using an anatomical diagram, this brochure defines and discusses the symptoms, causes, diagnosis, treatment and prevention of urinary tract infection. Special attention is given to the occurrence of urinary infection in children and women. Urine tests are used to detect the bacteria that has invaded the kidneys, bladder or urinary pathways.
The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “urinary tract infections” (or synonyms). The following was recently posted:
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Evidence based clinical practice guideline for patients 6 years of age or less with a first time acute urinary tract infection (UTI) Source: Cincinnati Children's Hospital Medical Center - Hospital/Medical Center; 1999 March 28 http://www.guideline.gov/summary/summary.aspx?doc_id=1970&nbr=1196&a mp;string=urinary+AND+tract+AND+infections
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The diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children Source: American Academy of Pediatrics - Medical Specialty Society; 1999 April 5; 19 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1838&nbr=1064&a mp;string=urinary+AND+tract+AND+infections
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Urinary tract infection Source: University of Michigan Health System - Academic Institution; 1999 June; 7 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2284&nbr=1510&a mp;string=urinary+AND+tract+AND+infections Healthfinder™
Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •
All About Urinary Tract Infections Summary: Urinary tract infections are explained to teens in this article. Information is presented on symptoms, diagnosis, treatment, and prevention. Source: Nemours Foundation http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4392
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Urinary Tract Infections in Adults Summary: Each year, urinary tract infections (UTI's) account for about 8 million doctor visits. Women are especially prone to UTI's for reasons that are poorly understood. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=833
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Urinary Tract Infections in Children Summary: Describes the function of the urinary tract and the signs, tests, and treatment of urinary tract infections. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6545 The NIH Search Utility
The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to urinary tract infections. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. PEDBASE Similar to NORD, PEDBASE covers relatively rare disorders, limited mainly to pediatric conditions. PEDBASE was designed by Dr. Alan Gandy. To access the database, which is more oriented to researchers than patients, you can view the current list of health topics covered at the following Web site: http://www.icondata.com/health/pedbase/pedlynx.htm. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/specific.htm
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Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
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Med Help International: http://www.medhelp.org/HealthTopics/A.html
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Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
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WebMDHealth: http://my.webmd.com/health_topics
Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to urinary tract infections. By consulting all of
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associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with urinary tract infections. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about urinary tract infections. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “urinary tract infections” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “urinary tract infections”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “urinary tract infections” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “urinary tract infections” (or a synonym) into the search box, and click “Submit Query.”
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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.26
Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of
26
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)27: •
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
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Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)
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Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
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California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html
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California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html
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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
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California: Gateway Health Library (Sutter Gould Medical Foundation)
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California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/
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California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
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California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/
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California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/
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California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/
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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html
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California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/
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Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/
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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
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Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
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Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
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Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml
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Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm
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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html
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Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
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Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp
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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/
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Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm
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Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html
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Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/
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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm
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Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/
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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/
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Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/
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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm
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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html
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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm
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Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/
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Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/
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Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10
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Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/
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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp
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Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html
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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp
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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/
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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
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Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/
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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm
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Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330
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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)
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National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
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National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
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National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
Finding Medical Libraries
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Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm
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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
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New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm
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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm
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New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/
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New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
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New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/
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New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html
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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
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Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp
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Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/
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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/
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Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml
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Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html
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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html
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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp
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Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm
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Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/
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South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp
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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72
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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
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MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
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Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
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Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
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On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/
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Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp
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Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
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MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
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Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
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Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
227
URINARY TRACT INFECTIONS DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. 5-alpha: Enzyme converting testosterone to dihydrotestosterone. [NIH] Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Ablate: In surgery, is to remove. [NIH] Abscess: A localized, circumscribed collection of pus. [NIH] Acculturation: Process of cultural change in which one group or members of a group assimilates various cultural patterns from another. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acetylgalactosamine: The N-acetyl derivative of galactosamine. [NIH] Acetylglucosamine: The N-acetyl derivative of glucosamine. [NIH] Acidosis: A pathologic condition resulting from accumulation of acid or depletion of the alkaline reserve (bicarbonate content) in the blood and body tissues, and characterized by an increase in hydrogen ion concentration. [EU] Acremonium: A mitosporic fungal genus with many reported ascomycetous teleomorphs. Cephalosporin antibiotics are derived from this genus. [NIH] Actin: Essential component of the cell skeleton. [NIH] Acyl: Chemical signal used by bacteria to communicate. [NIH] Adaptability: Ability to develop some form of tolerance to conditions extremely different from those under which a living organism evolved. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adenine: A purine base and a fundamental unit of adenine nucleotides. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the
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environment. [NIH] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Aeroembolism: Joint pains, respiratory distress, and central nervous system symptoms which may follow decompression after exposure to air or other gas mixture at a pressure greater than the normal atmospheric pressure. [NIH] Aerosol: A solution of a drug which can be atomized into a fine mist for inhalation therapy. [EU]
Afferent: Concerned with the transmission of neural impulse toward the central part of the nervous system. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Agar: A complex sulfated polymer of galactose units, extracted from Gelidium cartilagineum, Gracilaria confervoides, and related red algae. It is used as a gel in the preparation of solid culture media for microorganisms, as a bulk laxative, in making emulsions, and as a supporting medium for immunodiffusion and immunoelectrophoresis. [NIH]
Age Groups: Persons classified by age from birth (infant, newborn) to octogenarians and older (aged, 80 and over). [NIH] Age of Onset: The age or period of life at which a disease or the initial symptoms or manifestations of a disease appear in an individual. [NIH] Age-Adjusted: Summary measures of rates of morbidity or mortality in a population using statistical procedures to remove the effect of age differences in populations that are being compared. Age is probably the most important and the most common variable in determining the risk of morbidity and mortality. [NIH] Aged, 80 and Over: A person 80 years of age and older. [NIH] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Albumin: 1. Any protein that is soluble in water and moderately concentrated salt solutions
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and is coagulable by heat. 2. Serum albumin; the major plasma protein (approximately 60 per cent of the total), which is responsible for much of the plasma colloidal osmotic pressure and serves as a transport protein carrying large organic anions, such as fatty acids, bilirubin, and many drugs, and also carrying certain hormones, such as cortisol and thyroxine, when their specific binding globulins are saturated. Albumin is synthesized in the liver. Low serum levels occur in protein malnutrition, active inflammation and serious hepatic and renal disease. [EU] Alertness: A state of readiness to detect and respond to certain specified small changes occurring at random intervals in the environment. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Alleles: Mutually exclusive forms of the same gene, occupying the same locus on homologous chromosomes, and governing the same biochemical and developmental process. [NIH] Allograft: An organ or tissue transplant between two humans. [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alpha-1: A protein with the property of inactivating proteolytic enzymes such as leucocyte collagenase and elastase. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Aluminum: A metallic element that has the atomic number 13, atomic symbol Al, and atomic weight 26.98. [NIH] Alveoli: Tiny air sacs at the end of the bronchioles in the lungs. [NIH] Amebiasis: Infection with any of various amebae. It is an asymptomatic carrier state in most individuals, but diseases ranging from chronic, mild diarrhea to fulminant dysentery may occur. [NIH] Ameliorating: A changeable condition which prevents the consequence of a failure or accident from becoming as bad as it otherwise would. [NIH] Amine: An organic compound containing nitrogen; any member of a group of chemical compounds formed from ammonia by replacement of one or more of the hydrogen atoms by organic (hydrocarbon) radicals. The amines are distinguished as primary, secondary, and tertiary, according to whether one, two, or three hydrogen atoms are replaced. The amines include allylamine, amylamine, ethylamine, methylamine, phenylamine, propylamine, and many other compounds. [EU] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form
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proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Amoxicillin: A broad-spectrum semisynthetic antibiotic similar to ampicillin except that its resistance to gastric acid permits higher serum levels with oral administration. [NIH] Ampicillin: Semi-synthetic derivative of penicillin that functions as an orally active broadspectrum antibiotic. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH] Amputation: Surgery to remove part or all of a limb or appendage. [NIH] Amyloid: A general term for a variety of different proteins that accumulate as extracellular fibrils of 7-10 nm and have common structural features, including a beta-pleated sheet conformation and the ability to bind such dyes as Congo red and thioflavine (Kandel, Schwartz, and Jessel, Principles of Neural Science, 3rd ed). [NIH] Anaerobic: 1. Lacking molecular oxygen. 2. Growing, living, or occurring in the absence of molecular oxygen; pertaining to an anaerobe. [EU] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesics: Compounds capable of relieving pain without the loss of consciousness or without producing anesthesia. [NIH] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Analytes: A component of a test sample the presence of which has to be demonstrated. The term "analyte" includes where appropriate formed from the analyte during the analyses. [NIH]
Anaphylatoxins: The family of peptides C3a, C4a, C5a, and C5a des-arginine produced in the serum during complement activation. They produce smooth muscle contraction, mast cell histamine release, affect platelet aggregation, and act as mediators of the local inflammatory process. The order of anaphylatoxin activity from strongest to weakest is C5a, C3a, C4a, and C5a des-arginine. The latter is the so-called "classical" anaphylatoxin but shows no spasmogenic activity though it contains some chemotactic ability. [NIH] Anaplasia: Loss of structural differentiation and useful function of neoplastic cells. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Angiopathy: Disease of the blood vessels (arteries, veins, and capillaries) that occurs when someone has diabetes for a long time. There are two types of angiopathy: macroangiopathy and microangiopathy. In macroangiopathy, fat and blood clots build up in the large blood vessels, stick to the vessel walls, and block the flow of blood. In microangiopathy, the walls of the smaller blood vessels become so thick and weak that they bleed, leak protein, and
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slow the flow of blood through the body. Then the cells, for example, the ones in the center of the eye, do not get enough blood and may be damaged. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Anionic: Pertaining to or containing an anion. [EU] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Annealing: The spontaneous alignment of two single DNA strands to form a double helix. [NIH]
Anode: Electrode held at a positive potential with respect to a cathode. [NIH] Anomalies: Birth defects; abnormalities. [NIH] Antagonism: Interference with, or inhibition of, the growth of a living organism by another living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]
Antibiotic Prophylaxis: Use of antibiotics before, during, or after a diagnostic, therapeutic, or surgical procedure to prevent infectious complications. [NIH] Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticholinergics: Medicines that calm muscle spasms in the intestine. Examples are dicyclomine (dy-SY-kloh-meen) (Bentyl) and hyoscyamine (HY-oh-SY-uh-meen) (Levsin). [NIH]
Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Antifungal: Destructive to fungi, or suppressing their reproduction or growth; effective against fungal infections. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antigen-Antibody Complex: The complex formed by the binding of antigen and antibody molecules. The deposition of large antigen-antibody complexes leading to tissue damage causes immune complex diseases. [NIH]
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Antigen-presenting cell: APC. A cell that shows antigen on its surface to other cells of the immune system. This is an important part of an immune response. [NIH] Anti-infective: An agent that so acts. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Antiseptic: A substance that inhibits the growth and development of microorganisms without necessarily killing them. [EU] Antiviral: Destroying viruses or suppressing their replication. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Apolipoproteins: The protein components of lipoproteins which remain after the lipids to which the proteins are bound have been removed. They play an important role in lipid transport and metabolism. [NIH] Apoptosis: One of the two mechanisms by which cell death occurs (the other being the pathological process of necrosis). Apoptosis is the mechanism responsible for the physiological deletion of cells and appears to be intrinsically programmed. It is characterized by distinctive morphologic changes in the nucleus and cytoplasm, chromatin cleavage at regularly spaced sites, and the endonucleolytic cleavage of genomic DNA (DNA fragmentation) at internucleosomal sites. This mode of cell death serves as a balance to mitosis in regulating the size of animal tissues and in mediating pathologic processes associated with tumor growth. [NIH] Approximate: Approximal [EU] Aqueous: Having to do with water. [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Aromatic: Having a spicy odour. [EU] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arteriovenous: Both arterial and venous; pertaining to or affecting an artery and a vein. [EU] Ascorbic Acid: A six carbon compound related to glucose. It is found naturally in citrus fruits and many vegetables. Ascorbic acid is an essential nutrient in human diets, and necessary to maintain connective tissue and bone. Its biologically active form, vitamin C, functions as a reducing agent and coenzyme in several metabolic pathways. Vitamin C is considered an antioxidant. [NIH] Aseptic: Free from infection or septic material; sterile. [EU] Aspiration: The act of inhaling. [NIH] Aspirin: A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs
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to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: Having no signs or symptoms of disease. [NIH] Ataxia: Impairment of the ability to perform smoothly coordinated voluntary movements. This condition may affect the limbs, trunk, eyes, pharnyx, larnyx, and other structures. Ataxia may result from impaired sensory or motor function. Sensory ataxia may result from posterior column injury or peripheral nerve diseases. Motor ataxia may be associated with cerebellar diseases; cerebral cortex diseases; thalamic diseases; basal ganglia diseases; injury to the red nucleus; and other conditions. [NIH] Atrophy: Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. [NIH] Attenuated: Strain with weakened or reduced virulence. [NIH] Autodigestion: Autolysis; a condition found in disease of the stomach: the stomach wall is digested by the gastric juice. [NIH] Autoimmune disease: A condition in which the body recognizes its own tissues as foreign and directs an immune response against them. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Autonomic Dysreflexia: That part of the nervous system concerned with the unconscious regulation of the living processes of the body. [NIH] Axons: Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. [NIH] Back Pain: Acute or chronic pain located in the posterior regions of the trunk, including the thoracic, lumbar, sacral, or adjacent regions. [NIH] Bacteraemia: The presence of bacteria in the blood. [EU] Bacteremia: The presence of viable bacteria circulating in the blood. Fever, chills, tachycardia, and tachypnea are common acute manifestations of bacteremia. The majority of cases are seen in already hospitalized patients, most of whom have underlying diseases or procedures which render their bloodstreams susceptible to invasion. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Adhesion: Physicochemical property of fimbriated and non-fimbriated bacteria of attaching to cells, tissue, and nonbiological surfaces. It is a factor in bacterial colonization and pathogenicity. [NIH] Bacterial Infections: Infections by bacteria, general or unspecified. [NIH] Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Bacterial toxin: A toxic substance, made by bacteria, that can be modified to kill specific tumor cells without harming normal cells. [NIH] Bactericidal: Substance lethal to bacteria; substance capable of killing bacteria. [NIH] Bacteriophage: A virus whose host is a bacterial cell; A virus that exclusively infects bacteria. It generally has a protein coat surrounding the genome (DNA or RNA). One of the coliphages most extensively studied is the lambda phage, which is also one of the most
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important. [NIH] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH] Bacteriuria: The presence of bacteria in the urine with or without consequent urinary tract infection. Since bacteriuria is a clinical entity, the term does not preclude the use of urine/microbiology for technical discussions on the isolation and segregation of bacteria in the urine. [NIH] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Basal Ganglia Diseases: Diseases of the basal ganglia including the putamen; globus pallidus; claustrum; amygdala; and caudate nucleus. Dyskinesias (most notably involuntary movements and alterations of the rate of movement) represent the primary clinical manifestations of these disorders. Common etiologies include cerebrovascular disease; neurodegenerative diseases; and craniocerebral trauma. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basophil: A type of white blood cell. Basophils are granulocytes. [NIH] Baths: The immersion or washing of the body or any of its parts in water or other medium for cleansing or medical treatment. It includes bathing for personal hygiene as well as for medical purposes with the addition of therapeutic agents, such as alkalines, antiseptics, oil, etc. [NIH] Bends: The form of aeroembolism that is marked by intense pain in muscles and joints due to formation of gas bubbles in the tissues. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]
Benign prostatic hyperplasia: A benign (noncancerous) condition in which an overgrowth of prostate tissue pushes against the urethra and the bladder, blocking the flow of urine. Also called benign prostatic hypertrophy or BPH. [NIH] Beta-Lactamases: Enzymes found in many bacteria which catalyze the hydrolysis of the amide bond in the beta-lactam ring. Well known antibiotics destroyed by these enzymes are penicillins and cephalosporins. EC 3.5.2.6. [NIH] Bifida: A defect in development of the vertebral column in which there is a central deficiency of the vertebral lamina. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile Pigments: Pigments that give a characteristic color to bile including: bilirubin, biliverdine, and bilicyanin. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Biliary Tract: The gallbladder and its ducts. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Binding Sites: The reactive parts of a macromolecule that directly participate in its specific combination with another molecule. [NIH] Bioassay: Determination of the relative effective strength of a substance (as a vitamin,
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hormone, or drug) by comparing its effect on a test organism with that of a standard preparation. [NIH] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biofilms: Films of bacteria or other microbial organisms, usually embedded in extracellular polymers such as implanted medical devices, which adhere to surfaces submerged in, or subjected to, aquatic environments (From Singleton & Sainsbury, Dictionary of Microbiology and Molecular Biology, 2d ed). Biofilms consist of multilayers of microbial cells glued together to form microbial communities which are highly resistant to both phagocytes and antibiotics. [NIH] Biogenesis: The origin of life. It includes studies of the potential basis for life in organic compounds but excludes studies of the development of altered forms of life through mutation and natural selection, which is evolution. [NIH] Biological Factors: Compounds made by living organisms that contribute to or influence a phenomenon or process. They have biological or physiological activities. [NIH] Biological response modifier: BRM. A substance that stimulates the body's response to infection and disease. [NIH] Biological Transport: The movement of materials (including biochemical substances and drugs) across cell membranes and epithelial layers, usually by passive diffusion. [NIH] Biomarkers: Substances sometimes found in an increased amount in the blood, other body fluids, or tissues and that may suggest the presence of some types of cancer. Biomarkers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and GI tract cancers), and PSA (prostate cancer). Also called tumor markers. [NIH] Biomass: Total mass of all the organisms of a given type and/or in a given area. (From Concise Dictionary of Biology, 1990) It includes the yield of vegetative mass produced from any given crop. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Biotic: Pertaining to living organisms in their ecological rather than their physiological relations. [NIH] Bladder: The organ that stores urine. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber.
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Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bone Resorption: Bone loss due to osteoclastic activity. [NIH] Bone scan: A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]
Breakdown: A physical, metal, or nervous collapse. [NIH] Breeding: The science or art of changing the constitution of a population of plants or animals through sexual reproduction. [NIH] Broad-spectrum: Effective against a wide range of microorganisms; said of an antibiotic. [EU] Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bronchial: Pertaining to one or more bronchi. [EU] Bronchioles: The tiny branches of air tubes in the lungs. [NIH] Bronchiolitis: Inflammation of the bronchioles. [NIH] Bronchitis: Inflammation (swelling and reddening) of the bronchi. [NIH] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Burns: Injuries to tissues caused by contact with heat, steam, chemicals (burns, chemical), electricity (burns, electric), or the like. [NIH] Burns, Electric: Burns produced by contact with electric current or from a sudden discharge of electricity. [NIH] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH] Caffeine: A methylxanthine naturally occurring in some beverages and also used as a
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pharmacological agent. Caffeine's most notable pharmacological effect is as a central nervous system stimulant, increasing alertness and producing agitation. It also relaxes smooth muscle, stimulates cardiac muscle, stimulates diuresis, and appears to be useful in the treatment of some types of headache. Several cellular actions of caffeine have been observed, but it is not entirely clear how each contributes to its pharmacological profile. Among the most important are inhibition of cyclic nucleotide phosphodiesterases, antagonism of adenosine receptors, and modulation of intracellular calcium handling. [NIH] Calcification: Deposits of calcium in the tissues of the breast. Calcification in the breast can be seen on a mammogram, but cannot be detected by touch. There are two types of breast calcification, macrocalcification and microcalcification. Macrocalcifications are large deposits and are usually not related to cancer. Microcalcifications are specks of calcium that may be found in an area of rapidly dividing cells. Many microcalcifications clustered together may be a sign of cancer. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calculi: An abnormal concretion occurring mostly in the urinary and biliary tracts, usually composed of mineral salts. Also called stones. [NIH] Candidiasis: Infection with a fungus of the genus Candida. It is usually a superficial infection of the moist cutaneous areas of the body, and is generally caused by C. albicans; it most commonly involves the skin (dermatocandidiasis), oral mucous membranes (thrush, def. 1), respiratory tract (bronchocandidiasis), and vagina (vaginitis). Rarely there is a systemic infection or endocarditis. Called also moniliasis, candidosis, oidiomycosis, and formerly blastodendriosis. [EU] Candidosis: An infection caused by an opportunistic yeasts that tends to proliferate and become pathologic when the environment is favorable and the host resistance is weakened. [NIH]
Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Capsular: Cataract which is initiated by an opacification at the surface of the lens. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbapenems: A group of beta-lactam antibiotics in which the sulfur atom in the thiazolidine ring of the penicillin molecule is replaced by a carbon atom. Thienamycins are a subgroup of carbapenems which have a sulfur atom as the first constituent of the side chain. [NIH]
Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carboxy: Cannabinoid. [NIH]
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Carboxylic Acids: Organic compounds containing the carboxy group (-COOH). This group of compounds includes amino acids and fatty acids. Carboxylic acids can be saturated, unsaturated, or aromatic. [NIH] Carcinogen: Any substance that causes cancer. [NIH] Carcinogenic: Producing carcinoma. [EU] Cardiac: Having to do with the heart. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from intubation in that the tube here is used to restore or maintain patency in obstructions. [NIH] Catheters: A small, flexible tube that may be inserted into various parts of the body to inject or remove liquids. [NIH] Cathode: An electrode, usually an incandescent filament of tungsten, which emits electrons in an X-ray tube. [NIH] Cations: Postively charged atoms, radicals or groups of atoms which travel to the cathode or negative pole during electrolysis. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Cause of Death: Factors which produce cessation of all vital bodily functions. They can be analyzed from an epidemiologic viewpoint. [NIH] Cefaclor: Semisynthetic, broad-spectrum antibiotic derivative of cephalexin. [NIH] Cefmenoxime: A cephalosporin antibiotic that is administered intravenously or intramuscularly. It is active against most common gram-positive and gram-negative microorganisms, is a potent inhibitor of Enterobacteriaceae, and is highly resistant to hydrolysis by beta-lactamases. The drug has a high rate of efficacy in many types of infection and to date no severe side effects have been noted. [NIH] Cefonicid: A second-generation cephalosporin administered intravenously or intramuscularly. Its bactericidal action results from inhibition of cell wall synthesis. It is effective in the treatment of urinary tract infections, lower respiratory tract infections, and soft tissue and bone infections. [NIH] Cefsulodin: A pyridinium-substituted semisynthetic, broad-spectrum antibacterial used especially for Pseudomonas infections in debilitated patients. [NIH] Ceftazidime: Semisynthetic, broad-spectrum antibacterial derived from cephaloridine and used especially for Pseudomonas and other gram-negative infections in debilitated patients. [NIH]
Ceftriaxone: Broad-spectrum cephalosporin antibiotic with a very long half-life and high penetrability to usually inaccessible infections, including those involving the meninges, eyes, inner ears, and urinary tract. [NIH]
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Cefuroxime: Broad-spectrum cephalosporin antibiotic resistant to beta-lactamase. It has been proposed for infections with gram-negative and gram-positive organisms, gonorrhea, and haemophilus. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH] Cell Differentiation: Progressive restriction of the developmental potential and increasing specialization of function which takes place during the development of the embryo and leads to the formation of specialized cells, tissues, and organs. [NIH] Cell Division: The fission of a cell. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Central Nervous System Infections: Pathogenic infections of the brain, spinal cord, and meninges. DNA virus infections; RNA virus infections; bacterial infections; mycoplasma infections; Spirochaetales infections; fungal infections; protozoan infections; helminthiasis; and prion diseases may involve the central nervous system as a primary or secondary process. [NIH] Cephalexin: A semisynthetic cephalosporin antibiotic with antimicrobial activity similar to that of cephaloridine or cephalothin, but somewhat less potent. It is effective against both gram-positive and gram-negative organisms. [NIH] Cephaloridine: A cephalosporin antibiotic. [NIH] Cephalosporins: A group of broad-spectrum antibiotics first isolated from the Mediterranean fungus Acremonium (Cephalosporium acremonium). They contain the betalactam moiety thia-azabicyclo-octenecarboxylic acid also called 7-aminocephalosporanic acid. [NIH] Cephradine: A semi-synthetic cephalosporin antibiotic. [NIH] Cerebellar: Pertaining to the cerebellum. [EU] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Hemorrhage: Bleeding into a cerebral hemisphere of the brain, including lobar, subcortical white matter, and basal ganglia hemorrhages. Commonly associated conditions include hypertension; intracranial arteriosclerosis; intracranial aneurysm; craniocerebral trauma; intracranial arteriovenous malformations; cerebral amyloid angiopathy; and cerebral infarction. [NIH] Cerebral Infarction: The formation of an area of necrosis in the cerebrum caused by an insufficiency of arterial or venous blood flow. Infarcts of the cerebrum are generally classified by hemisphere (i.e., left vs. right), lobe (e.g., frontal lobe infarction), arterial distribution (e.g., infarction, anterior cerebral artery), and etiology (e.g., embolic infarction). [NIH]
Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH]
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Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Chemoprevention: The use of drugs, vitamins, or other agents to try to reduce the risk of, or delay the development or recurrence of, cancer. [NIH] Chemotactic Factors: Chemical substances that attract or repel cells or organisms. The concept denotes especially those factors released as a result of tissue injury, invasion, or immunologic activity, that attract leukocytes, macrophages, or other cells to the site of infection or insult. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Chest Pain: Pressure, burning, or numbness in the chest. [NIH] Chlamydia: A genus of the family Chlamydiaceae whose species cause a variety of diseases in vertebrates including humans, mice, and swine. Chlamydia species are gram-negative and produce glycogen. The type species is Chlamydia trachomatis. [NIH] Chlorhexidine: Disinfectant and topical anti-infective agent used also as mouthwash to prevent oral plaque. [NIH] Cholera: An acute diarrheal disease endemic in India and Southeast Asia whose causative agent is vibrio cholerae. This condition can lead to severe dehydration in a matter of hours unless quickly treated. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholesterol Esters: Fatty acid esters of cholesterol which constitute about two-thirds of the cholesterol in the plasma. The accumulation of cholesterol esters in the arterial intima is a characteristic feature of atherosclerosis. [NIH] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Chronic Obstructive Pulmonary Disease: Collective term for chronic bronchitis and emphysema. [NIH] Chronic prostatitis: Inflammation of the prostate gland, developing slowly and lasting a long time. [NIH] Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys. [NIH] Chylomicrons: A class of lipoproteins that carry dietary cholesterol and triglycerides from the small intestines to the tissues. [NIH] Cilastatin: A renal dehydropeptidase-I and leukotriene D4 dipeptidase inhibitor. Since the
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antibiotic, imipenem, is hydrolyzed by dehydropeptidase-I, which resides in the brush border of the renal tubule, cilastatin is administered with imipenem to increase its effectiveness. The drug also inhibits the metabolism of leukotriene D4 to leukeotriene E4. [NIH]
Ciprofloxacin: A carboxyfluoroquinoline antimicrobial agent that is effective against a wide range of microorganisms. It has been successfully and safely used in the treatment of resistant respiratory, skin, bone, joint, gastrointestinal, urinary, and genital infections. [NIH] Circumcision: Excision of the prepuce or part of it. [NIH] Citrus: Any tree or shrub of the Rue family or the fruit of these plants. [NIH] C-kit receptor: A protein on the surface of some cells that binds to stem cell factor (a substance that causes certain types of cells to grow). Altered forms of this receptor may be associated with some types of cancer. [NIH] Clamp: A u-shaped steel rod used with a pin or wire for skeletal traction in the treatment of certain fractures. [NIH] Clavulanic Acid: Clavulanic acid (C8H9O5N) and its salts and esters. The acid is a suicide inhibitor of bacterial beta-lactamase enzymes from Streptomyces clavuligerus. Administered alone, it has only weak antibacterial activity against most organisms, but given in combination with beta-lactam antibiotics prevents antibiotic inactivation by microbial lactamase. [NIH] Clindamycin: An antibacterial agent that is a semisynthetic analog of lincomycin. [NIH] Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]
Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Clone: The term "clone" has acquired a new meaning. It is applied specifically to the bits of inserted foreign DNA in the hybrid molecules of the population. Each inserted segment originally resided in the DNA of a complex genome amid millions of other DNA segment. [NIH]
Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coenzyme: An organic nonprotein molecule, frequently a phosphorylated derivative of a water-soluble vitamin, that binds with the protein molecule (apoenzyme) to form the active enzyme (holoenzyme). [EU] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic
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substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Colloidal: Of the nature of a colloid. [EU] Combination Therapy: Association of 3 drugs to treat AIDS (AZT + DDC or DDI + protease inhibitor). [NIH] Commensal: 1. Living on or within another organism, and deriving benefit without injuring or benefiting the other individual. 2. An organism living on or within another, but not causing injury to the host. [EU] Communis: Common tendon of the rectus group of muscles that surrounds the optic foramen and a portion of the superior orbital fissure, to the anterior margin of which it is attached at the spina recti lateralis. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementation: The production of a wild-type phenotype when two different mutations
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are combined in a diploid or a heterokaryon and tested in trans-configuration. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computerized axial tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography (CT scan), or computerized tomography. [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Concretion: Minute, hard, yellow masses found in the palpebral conjunctivae of elderly people or following chronic conjunctivitis, composed of the products of cellular degeneration retained in the depressions and tubular recesses in the conjunctiva. [NIH] Condoms: A sheath that is worn over the penis during sexual behavior in order to prevent pregnancy or spread of sexually transmitted disease. [NIH] Cone: One of the special retinal receptor elements which are presumed to be primarily concerned with perception of light and color stimuli when the eye is adapted to light. [NIH] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Conjugated: Acting or operating as if joined; simultaneous. [EU] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue Cells: A group of cells that includes fibroblasts, cartilage cells, adipocytes, smooth muscle cells, and bone cells. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Continence: The ability to hold in a bowel movement or urine. [NIH] Continuum: An area over which the vegetation or animal population is of constantly changing composition so that homogeneous, separate communities cannot be distinguished. [NIH]
Contraception: Use of agents, devices, methods, or procedures which diminish the
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likelihood of or prevent conception. [NIH] Contraceptive: An agent that diminishes the likelihood of or prevents conception. [EU] Contractility: Capacity for becoming short in response to a suitable stimulus. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH] Cooperative group: A group of physicians, hospitals, or both formed to treat a large number of persons in the same way so that new treatment can be evaluated quickly. Clinical trials of new cancer treatments often require many more people than a single physician or hospital can care for. [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Cornea: The transparent part of the eye that covers the iris and the pupil and allows light to enter the inside. [NIH] Corneum: The superficial layer of the epidermis containing keratinized cells. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Corpus: The body of the uterus. [NIH] Corpus Luteum: The yellow glandular mass formed in the ovary by an ovarian follicle that has ruptured and discharged its ovum. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Cost Savings: Reductions in all or any portion of the costs of providing goods or services. Savings may be incurred by the provider or the consumer. [NIH] Co-trimoxazole: A combination of two anti-infection drugs, sulfamethoxazole and trimethoprim. It is used to fight bacterial and protozoal infections. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH] Creatinine: A compound that is excreted from the body in urine. Creatinine levels are measured to monitor kidney function. [NIH] Criterion: A standard by which something may be judged. [EU]
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Critical Care: Health care provided to a critically ill patient during a medical emergency or crisis. [NIH] Crystallization: The formation of crystals; conversion to a crystalline form. [EU] Cues: Signals for an action; that specific portion of a perceptual field or pattern of stimuli to which a subject has learned to respond. [NIH] Culture Media: Any liquid or solid preparation made specifically for the growth, storage, or transport of microorganisms or other types of cells. The variety of media that exist allow for the culturing of specific microorganisms and cell types, such as differential media, selective media, test media, and defined media. Solid media consist of liquid media that have been solidified with an agent such as agar or gelatin. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cystine: A covalently linked dimeric nonessential amino acid formed by the oxidation of cysteine. Two molecules of cysteine are joined together by a disulfide bridge to form cystine. [NIH]
Cystitis: Inflammation of the urinary bladder. [EU] Cystoscopy: Endoscopic examination, therapy or surgery of the urinary bladder. [NIH] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytotoxic: Cell-killing. [NIH] Cytotoxins: Substances elaborated by microorganisms, plants or animals that are specifically toxic to individual cells; they may be involved in immunity or may be contained in venoms. [NIH]
Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Deamination: The removal of an amino group (NH2) from a chemical compound. [NIH] Decarboxylation: The removal of a carboxyl group, usually in the form of carbon dioxide, from a chemical compound. [NIH] Decompensation: Failure of compensation; cardiac decompensation is marked by dyspnea, venous engorgement, and edema. [EU] Decompression: Decompression external to the body, most often the slow lessening of external pressure on the whole body (especially in caisson workers, deep sea divers, and persons who ascend to great heights) to prevent decompression sickness. It includes also sudden accidental decompression, but not surgical (local) decompression or decompression applied through body openings. [NIH]
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Decompression Sickness: A condition occurring as a result of exposure to a rapid fall in ambient pressure. Gases, nitrogen in particular, come out of solution and form bubbles in body fluid and blood. These gas bubbles accumulate in joint spaces and the peripheral circulation impairing tissue oxygenation causing disorientation, severe pain, and potentially death. [NIH] Decubitus: An act of lying down; also the position assumed in lying down. [EU] Defecation: The normal process of elimination of fecal material from the rectum. [NIH] Defense Mechanisms: Unconscious process used by an individual or a group of individuals in order to cope with impulses, feelings or ideas which are not acceptable at their conscious level; various types include reaction formation, projection and self reversal. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Deletion: A genetic rearrangement through loss of segments of DNA (chromosomes), bringing sequences, which are normally separated, into close proximity. [NIH] Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population. [NIH] Denaturation: Rupture of the hydrogen bonds by heating a DNA solution and then cooling it rapidly causes the two complementary strands to separate. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Dendritic: 1. Branched like a tree. 2. Pertaining to or possessing dendrites. [EU] Dendritic cell: A special type of antigen-presenting cell (APC) that activates T lymphocytes. [NIH]
Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dental Caries: Localized destruction of the tooth surface initiated by decalcification of the enamel followed by enzymatic lysis of organic structures and leading to cavity formation. If left unchecked, the cavity may penetrate the enamel and dentin and reach the pulp. The three most prominent theories used to explain the etiology of the disase are that acids produced by bacteria lead to decalcification; that micro-organisms destroy the enamel protein; or that keratolytic micro-organisms produce chelates that lead to decalcification. [NIH]
Dental Plaque: A film that attaches to teeth, often causing dental caries and gingivitis. It is composed of mucins, secreted from salivary glands, and microorganisms. [NIH] Dentition: The teeth in the dental arch; ordinarily used to designate the natural teeth in position in their alveoli. [EU] Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diabetic Ketoacidosis: Complication of diabetes resulting from severe insulin deficiency coupled with an absolute or relative increase in glucagon concentration. The metabolic acidosis is caused by the breakdown of adipose stores and resulting increased levels of free fatty acids. Glucagon accelerates the oxidation of the free fatty acids producing excess ketone bodies (ketosis). [NIH] Diagnostic Imaging: Any visual display of structural or functional patterns of organs or tissues for diagnostic evaluation. It includes measuring physiologic and metabolic responses
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to physical and chemical stimuli, as well as ultramicroscopy. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diaphragm: The musculofibrous partition that separates the thoracic cavity from the abdominal cavity. Contraction of the diaphragm increases the volume of the thoracic cavity aiding inspiration. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diarrhoea: Abnormal frequency and liquidity of faecal discharges. [EU] Diastolic: Of or pertaining to the diastole. [EU] Dicyclomine: A muscarinic antagonist used as an antispasmodic and in urinary incontinence. It has little effect on glandular secretion or the cardiovascular system. It does have some local anesthetic properties and is used in gastrointestinal, biliary, and urinary tract spasms. [NIH] Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space; a major mechanism of biological transport. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Dihydrotestosterone: Anabolic agent. [NIH] Dilatation: The act of dilating. [NIH] Dilution: A diluted or attenuated medicine; in homeopathy, the diffusion of a given quantity of a medicinal agent in ten or one hundred times the same quantity of water. [NIH] Dimerization: The process by which two molecules of the same chemical composition form a condensation product or polymer. [NIH] Diphosphonates: Organic compounds which contain P-C-P bonds, where P stands for phosphonates or phosphonic acids. These compounds affect calcium metabolism. They inhibit ectopic calcification and slow down bone resorption and bone turnover. Technetium complexes of diphosphonates have been used successfully as bone scanning agents. [NIH] Diploid: Having two sets of chromosomes. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discrimination: The act of qualitative and/or quantitative differentiation between two or more stimuli. [NIH] Disparity: Failure of the two retinal images of an object to fall on corresponding retinal points. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diuresis: Increased excretion of urine. [EU] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH]
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Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Dorsum: A plate of bone which forms the posterior boundary of the sella turcica. [NIH] Doxazosin: A selective alpha-1-adrenergic blocker that lowers serum cholesterol. It is also effective in the treatment of hypertension. [NIH] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Utilization: The utilization of drugs as reported in individual hospital studies, FDA studies, marketing, or consumption, etc. This includes drug stockpiling, and patient drug profiles. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenum: The first part of the small intestine. [NIH] Dura mater: The outermost, toughest, and most fibrous of the three membranes (meninges) covering the brain and spinal cord; called also pachymeninx. [EU] Dyspepsia: Impaired digestion, especially after eating. [NIH] Dysplasia: Cells that look abnormal under a microscope but are not cancer. [NIH] Dyspnea: Difficult or labored breathing. [NIH] Dystrophy: Any disorder arising from defective or faulty nutrition, especially the muscular dystrophies. [EU] Dysuria: Painful or difficult urination. [EU] Ecosystem: A dynamic complex of plant, animal and micro-organism communities and their non-living environment interacting as a functional unit. [NIH] Ectopic: Pertaining to or characterized by ectopia. [EU] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elasticity: Resistance and recovery from distortion of shape. [NIH] Elastin: The protein that gives flexibility to tissues. [NIH] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU] Electrode: Component of the pacing system which is at the distal end of the lead. It is the interface with living cardiac tissue across which the stimulus is transmitted. [NIH] Electrolysis: Destruction by passage of a galvanic electric current, as in disintegration of a chemical compound in solution. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU]
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Electron microscope: A microscope (device used to magnify small objects) that uses electrons (instead of light) to produce an enlarged image. An electron microscopes shows tiny details better than any other type of microscope. [NIH] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Electrophoresis: An electrochemical process in which macromolecules or colloidal particles with a net electric charge migrate in a solution under the influence of an electric current. [NIH]
Eligibility Determination: Criteria to determine eligibility of patients for medical care programs and services. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Embryogenesis: The process of embryo or embryoid formation, whether by sexual (zygotic) or asexual means. In asexual embryogenesis embryoids arise directly from the explant or on intermediary callus tissue. In some cases they arise from individual cells (somatic cell embryoge). [NIH] Emphysema: A pathological accumulation of air in tissues or organs. [NIH] Empiric: Empirical; depending upon experience or observation alone, without using scientific method or theory. [EU] Empirical: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] Emulsion: A preparation of one liquid distributed in small globules throughout the body of a second liquid. The dispersed liquid is the discontinuous phase, and the dispersion medium is the continuous phase. When oil is the dispersed liquid and an aqueous solution is the continuous phase, it is known as an oil-in-water emulsion, whereas when water or aqueous solution is the dispersed phase and oil or oleaginous substance is the continuous phase, it is known as a water-in-oil emulsion. Pharmaceutical emulsions for which official standards have been promulgated include cod liver oil emulsion, cod liver oil emulsion with malt, liquid petrolatum emulsion, and phenolphthalein in liquid petrolatum emulsion. [EU] Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Endocardium: The innermost layer of the heart, comprised of endothelial cells. [NIH] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Endometrium: The layer of tissue that lines the uterus. [NIH] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH]
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Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endothelium-derived: Small molecule that diffuses to the adjacent muscle layer and relaxes it. [NIH] Endotoxins: Toxins closely associated with the living cytoplasm or cell wall of certain microorganisms, which do not readily diffuse into the culture medium, but are released upon lysis of the cells. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] Enoxacin: An orally administered broad-spectrum fluoroquinolone antibacterial agent active against most gram-negative and gram-positive bacteria. Its clinical efficacy has been confirmed in a variety of systemic infections and particularly in urinary tract infections. The drug is well tolerated by adults, but should not be used in children and pregnant women. [NIH]
Enterotoxins: Substances that are toxic to the intestinal tract causing vomiting, diarrhea, etc.; most common enterotoxins are produced by bacteria. [NIH] Enuresis: Involuntary discharge of urine after the age at which urinary control should have been achieved; often used alone with specific reference to involuntary discharge of urine occurring during sleep at night (bed-wetting, nocturnal enuresis). [EU] Environmental Exposure: The exposure to potentially harmful chemical, physical, or biological agents in the environment or to environmental factors that may include ionizing radiation, pathogenic organisms, or toxic chemicals. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]
Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Enzyme-Linked Immunosorbent Assay: An immunoassay utilizing an antibody labeled with an enzyme marker such as horseradish peroxidase. While either the enzyme or the antibody is bound to an immunosorbent substrate, they both retain their biologic activity; the change in enzyme activity as a result of the enzyme-antibody-antigen reaction is proportional to the concentration of the antigen and can be measured spectrophotometrically or with the naked eye. Many variations of the method have been developed. [NIH] Eosinophils: Granular leukocytes with a nucleus that usually has two lobes connected by a slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epidemiologic Factors: Events, characteristics, or other definable entities that have the potential to bring about a change in a health condition or other defined outcome. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum
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lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Epigastric: Having to do with the upper middle area of the abdomen. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Epitope: A molecule or portion of a molecule capable of binding to the combining site of an antibody. For every given antigenic determinant, the body can construct a variety of antibody-combining sites, some of which fit almost perfectly, and others which barely fit. [NIH]
Epitope Mapping: Methods used for studying the interactions of antibodies with specific regions of protein antigens. Important applications of epitope mapping are found within the area of immunochemistry. [NIH] Equipment and Supplies: Expendable and nonexpendable equipment, supplies, apparatus, and instruments that are used in diagnostic, surgical, therapeutic, scientific, and experimental procedures. [NIH] Erectile: The inability to get or maintain an erection for satisfactory sexual intercourse. Also called impotence. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Escherichia: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria whose organisms occur in the lower part of the intestine of warm-blooded animals. The species are either nonpathogenic or opportunistic pathogens. [NIH] Escherichia coli: A species of gram-negative, facultatively anaerobic, rod-shaped bacteria commonly found in the lower part of the intestine of warm-blooded animals. It is usually nonpathogenic, but some strains are known to produce diarrhea and pyogenic infections. [NIH]
Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]
Essential Tremor: A rhythmic, involuntary, purposeless, oscillating movement resulting from the alternate contraction and relaxation of opposing groups of muscles. [NIH] Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Estriol: (16 alpha,17 beta)-Estra-1,3,5(10)-triene-3,16,17-triol. A metabolite of estradiol and usually the predominant estrogenic metabolite in urine. During pregnancy, large amounts of estriol are produced by the placenta. It has also been obtained from plant sources. The 16 beta-isomer has also been isolated from the urine of pregnant women. [NIH] Estrogen: One of the two female sex hormones. [NIH] Ethnic Groups: A group of people with a common cultural heritage that sets them apart from others in a variety of social relationships. [NIH] Eukaryotic Cells: Cells of the higher organisms, containing a true nucleus bounded by a
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nuclear membrane. [NIH] Evacuation: An emptying, as of the bowels. [EU] Excisional: The surgical procedure of removing a tumor by cutting it out. The biopsy is then examined under a microscope. [NIH] Excitability: Property of a cardiac cell whereby, when the cell is depolarized to a critical level (called threshold), the membrane becomes permeable and a regenerative inward current causes an action potential. [NIH] Exfoliation: A falling off in scales or layers. [EU] Exocrine: Secreting outwardly, via a duct. [EU] Exocytosis: Cellular release of material within membrane-limited vesicles by fusion of the vesicles with the cell membrane. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Exotoxins: Toxins produced, especially by bacterial or fungal cells, and released into the culture medium or environment. [NIH] Expeditions: Usually refers to planned scientific data-gathering excursions. [NIH] Expiration: The act of breathing out, or expelling air from the lungs. [EU] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Faecal: Pertaining to or of the nature of feces. [EU] Failure to Thrive: A condition in which an infant or child's weight gain and growth are far below usual levels for age. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]
Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Febrile: Pertaining to or characterized by fever. [EU] Fecal Incontinence: Failure of voluntary control of the anal sphincters, with involuntary passage of feces and flatus. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fetal Death: Death of the young developing in utero. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of the blood clot. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH]
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Finasteride: An orally active testosterone 5-alpha-reductase inhibitor. It is used as a surgical alternative for treatment of benign prostatic hyperplasia. [NIH] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Fixation: 1. The act or operation of holding, suturing, or fastening in a fixed position. 2. The condition of being held in a fixed position. 3. In psychiatry, a term with two related but distinct meanings : (1) arrest of development at a particular stage, which like regression (return to an earlier stage), if temporary is a normal reaction to setbacks and difficulties but if protracted or frequent is a cause of developmental failures and emotional problems, and (2) a close and suffocating attachment to another person, especially a childhood figure, such as one's mother or father. Both meanings are derived from psychoanalytic theory and refer to 'fixation' of libidinal energy either in a specific erogenous zone, hence fixation at the oral, anal, or phallic stage, or in a specific object, hence mother or father fixation. 4. The use of a fixative (q.v.) to preserve histological or cytological specimens. 5. In chemistry, the process whereby a substance is removed from the gaseous or solution phase and localized, as in carbon dioxide fixation or nitrogen fixation. 6. In ophthalmology, direction of the gaze so that the visual image of the object falls on the fovea centralis. 7. In film processing, the chemical removal of all undeveloped salts of the film emulsion, leaving only the developed silver to form a permanent image. [EU] Flagellum: A whiplike appendage of a cell. It can function either as an organ of locomotion or as a device for moving the fluid surrounding the cell. [NIH] Flank Pain: Pain emanating from below the ribs and above the ilium. [NIH] Flatus: Gas passed through the rectum. [NIH] Fleroxacin: A third-generation fluoroquinolone derivative with a broad antimicrobial spectrum. The drug strongly inhibits the DNA-supercoiling activity of DNA gyrase which may account for its antibacterial activity. [NIH] Flexion: In gynaecology, a displacement of the uterus in which the organ is bent so far forward or backward that an acute angle forms between the fundus and the cervix. [EU] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Flush: Transient, episodic redness of the face and neck caused by certain diseases, ingestion of certain drugs or other substances, heat, emotional factors, or physical exertion. [EU] Foetoplacental: Pertaining to the fetus and placenta. [EU] Fold: A plication or doubling of various parts of the body. [NIH] Foramen: A natural hole of perforation, especially one in a bone. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Fosfomycin: An antibiotic produced by Streptomyces fradiae. [NIH] Fovea: The central part of the macula that provides the sharpest vision. [NIH] Fractionation: Dividing the total dose of radiation therapy into several smaller, equal doses delivered over a period of several days. [NIH] Frail Elderly: Older adults or aged individuals who are lacking in general strength and are unusually susceptible to disease or to other infirmity. [NIH] Frameshift: A type of mutation which causes out-of-phase transcription of the base sequence; such mutations arise from the addition or delection of nucleotide(s) in numbers
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other than 3 or multiples of 3. [NIH] Frameshift Mutation: A type of mutation in which a number of nucleotides not divisible by three is deleted from or inserted into a coding sequence, thereby causing an alteration in the reading frame of the entire sequence downstream of the mutation. These mutations may be induced by certain types of mutagens or may occur spontaneously. [NIH] Fungemia: The presence of fungi circulating in the blood. Opportunistic fungal sepsis is seen most often in immunosuppressed patients with severe neutropenia or in postoperative patients with intravenous catheters and usually follows prolonged antibiotic therapy. [NIH] Fungi: A kingdom of eukaryotic, heterotrophic organisms that live as saprobes or parasites, including mushrooms, yeasts, smuts, molds, etc. They reproduce either sexually or asexually, and have life cycles that range from simple to complex. Filamentous fungi refer to those that grow as multicelluar colonies (mushrooms and molds). [NIH] Fungus: A general term used to denote a group of eukaryotic protists, including mushrooms, yeasts, rusts, moulds, smuts, etc., which are characterized by the absence of chlorophyll and by the presence of a rigid cell wall composed of chitin, mannans, and sometimes cellulose. They are usually of simple morphological form or show some reversible cellular specialization, such as the formation of pseudoparenchymatous tissue in the fruiting body of a mushroom. The dimorphic fungi grow, according to environmental conditions, as moulds or yeasts. [EU] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Gangrenous: A circumscribed, deep-seated, suppurative inflammation of the subcutaneous tissue of the eyelid discharging pus from several points. [NIH] Gardnerella: A genus of bacteria found in the human genital and urinary tract. It is considered to be a major cause of bacterial vaginosis. [NIH] Gardnerella vaginalis: The only species in the genus Gardnerella, and previously classed as Haemophilus vaginalis. This bacterium, also isolated from the female genital tract of healthy women, is implicated in the cause of bacterial vaginosis. It occasionally causes postpartum bacteremia and bacteremia following a transurethral resection of the prostate. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gas exchange: Primary function of the lungs; transfer of oxygen from inhaled air into the blood and of carbon dioxide from the blood into the lungs. [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Acid: Hydrochloric acid present in gastric juice. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]
Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as a protein food adjuvant, plasma substitute, hemostatic, suspending agent in pharmaceutical preparations, and in the manufacturing of capsules and suppositories. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein.
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[NIH]
Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Gene Library: A large collection of cloned DNA fragments from a given organism, tissue, organ, or cell type. It may contain complete genomic sequences (genomic library) or complementary DNA sequences, the latter being formed from messenger RNA and lacking intron sequences. [NIH] General practitioner: A medical practitioner who does not specialize in a particular branch of medicine or limit his practice to a specific class of diseases. [NIH] Genetic testing: Analyzing DNA to look for a genetic alteration that may indicate an increased risk for developing a specific disease or disorder. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genital: Pertaining to the genitalia. [EU] Genitourinary: Pertaining to the genital and urinary organs; urogenital; urinosexual. [EU] Genomic Library: A form of gene library containing the complete DNA sequences present in the genome of a given organism. It contrasts with a cDNA library which contains only sequences utilized in protein coding (lacking introns). [NIH] Genomics: The systematic study of the complete DNA sequences (genome) of organisms. [NIH]
Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Geriatric: Pertaining to the treatment of the aged. [EU] Giant Cells: Multinucleated masses produced by the fusion of many cells; often associated with viral infections. In AIDS, they are induced when the envelope glycoprotein of the HIV virus binds to the CD4 antigen of uninfected neighboring T4 cells. The resulting syncytium leads to cell death and thus may account for the cytopathic effect of the virus. [NIH] Giardiasis: An infection of the small intestine caused by the flagellated protozoan Giardia lamblia. It is spread via contaminated food and water and by direct person-to-person contact. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Globosides: Glycosphingolipids containing N-acetylglucosamine (paragloboside) or Nacetylgalactosamine (globoside). Globoside is the P antigen on erythrocytes and paragloboside is an intermediate in the biosynthesis of erythrocyte blood group ABH and P 1 glycosphingolipid antigens. The accumulation of globoside in tissue, due to a defect in hexosaminidases A and B, is the cause of Sandhoff disease. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]
Glomerular Filtration Rate: The volume of water filtered out of plasma through glomerular capillary walls into Bowman's capsules per unit of time. It is considered to be equivalent to inulin clearance. [NIH] Glomeruli: Plural of glomerulus. [NIH] Glomerulus: A tiny set of looping blood vessels in the nephron where blood is filtered in the kidney. [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally
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occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glucuronic Acid: Derivatives of uronic acid found throughout the plant and animal kingdoms. They detoxify drugs and toxins by conjugating with them to form glucuronides in the liver which are more water-soluble metabolites that can be easily eliminated from the body. [NIH] Glutamic Acid: A non-essential amino acid naturally occurring in the L-form. Glutamic acid (glutamate) is the most common excitatory neurotransmitter in the central nervous system. [NIH]
Glutamine: A non-essential amino acid present abundantly throught the body and is involved in many metabolic processes. It is synthesized from glutamic acid and ammonia. It is the principal carrier of nitrogen in the body and is an important energy source for many cells. [NIH] Glycogen: A sugar stored in the liver and muscles. It releases glucose into the blood when cells need it for energy. Glycogen is the chief source of stored fuel in the body. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Glycosaminoglycans: Heteropolysaccharides which contain an N-acetylated hexosamine in a characteristic repeating disaccharide unit. The repeating structure of each disaccharide involves alternate 1,4- and 1,3-linkages consisting of either N-acetylglucosamine or Nacetylgalactosamine. [NIH] Glycosidic: Formed by elimination of water between the anomeric hydroxyl of one sugar and a hydroxyl of another sugar molecule. [NIH] Glycosylation: The chemical or biochemical addition of carbohydrate or glycosyl groups to other chemicals, especially peptides or proteins. Glycosyl transferases are used in this biochemical reaction. [NIH] Gonorrhea: Acute infectious disease characterized by primary invasion of the urogenital tract. The etiologic agent, Neisseria gonorrhoeae, was isolated by Neisser in 1879. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Gp120: 120-kD HIV envelope glycoprotein which is involved in the binding of the virus to its membrane receptor, the CD4 molecule, found on the surface of certain cells in the body. [NIH]
Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Graft Rejection: An immune response with both cellular and humoral components, directed against an allogeneic transplant, whose tissue antigens are not compatible with those of the recipient. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Gram-negative: Losing the stain or decolorized by alcohol in Gram's method of staining, a primary characteristic of bacteria having a cell wall composed of a thin layer of
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peptidoglycan covered by an outer membrane of lipoprotein and lipopolysaccharide. [EU] Gram-Negative Bacteria: Bacteria which lose crystal violet stain but are stained pink when treated by Gram's method. [NIH] Gram-positive: Retaining the stain or resisting decolorization by alcohol in Gram's method of staining, a primary characteristic of bacteria whose cell wall is composed of a thick layer of peptidologlycan with attached teichoic acids. [EU] Gram-Positive Bacteria: Bacteria which retain the crystal violet stain when treated by Gram's method. [NIH] Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Guanylate Cyclase: An enzyme that catalyzes the conversion of GTP to 3',5'-cyclic GMP and pyrophosphate. It also acts on ITP and dGTP. (From Enzyme Nomenclature, 1992) EC 4.6.1.2. [NIH] Gynecology: A medical-surgical specialty concerned with the physiology and disorders primarily of the female genital tract, as well as female endocrinology and reproductive physiology. [NIH] Gyrase: An enzyme that causes negative supercoiling of E. coli DNA during replication. [NIH]
Haemophilus: A genus of Pasteurellaceae that consists of several species occurring in animals and humans. Its organisms are described as gram-negative, facultatively anaerobic, coccobacillus or rod-shaped, and nonmotile. [NIH] Half-Life: The time it takes for a substance (drug, radioactive nuclide, or other) to lose half of its pharmacologic, physiologic, or radiologic activity. [NIH] Haploid: An organism with one basic chromosome set, symbolized by n; the normal condition of gametes in diploids. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Headache Disorders: Common conditions characterized by persistent or recurrent headaches. Headache syndrome classification systems may be based on etiology (e.g., vascular headache, post-traumatic headaches, etc.), temporal pattern (e.g., cluster headache, paroxysmal hemicrania, etc.), and precipitating factors (e.g., cough headache). [NIH] Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost. [NIH] Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (health care costs) and may or may not be shared among the patient, insurers, and/or employers. [NIH] Health Services: Services for the diagnosis and treatment of disease and the maintenance of health. [NIH]
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Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Hematuria: Presence of blood in the urine. [NIH] Hemodiafiltration: The combination of hemodialysis and hemofiltration either simultaneously or sequentially. Convective transport (hemofiltration) may be better for removal of larger molecular weight substances and diffusive transport (hemodialysis) for smaller molecular weight solutes. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemodynamics: The movements of the blood and the forces involved in systemic or regional blood circulation. [NIH] Hemofiltration: Extracorporeal ultrafiltration technique without hemodialysis for treatment of fluid overload and electrolyte disturbances affecting renal, cardiac, or pulmonary function. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemoglobinuria: The presence of free hemoglobin in the urine. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Heparin: Heparinic acid. A highly acidic mucopolysaccharide formed of equal parts of sulfated D-glucosamine and D-glucuronic acid with sulfaminic bridges. The molecular weight ranges from six to twenty thousand. Heparin occurs in and is obtained from liver, lung, mast cells, etc., of vertebrates. Its function is unknown, but it is used to prevent blood clotting in vivo and vitro, in the form of many different salts. [NIH] Hepatic: Refers to the liver. [NIH] Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]
Heterotrophic: Pertaining to organisms that are consumers and dependent on other organisms for their source of energy (food). [NIH] Hexosaminidases: Enzymes that catalyze the hydrolysis of N-acylhexosamine residues in N-acylhexosamides. Hexosaminidases also act on glucosides, galactosides, and several oligosaccharides. [NIH] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH]
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Histamine Release: The secretion of histamine from mast cell and basophil granules by exocytosis. This can be initiated by a number of factors, all of which involve binding of IgE, cross-linked by antigen, to the mast cell or basophil's Fc receptors. Once released, histamine binds to a number of different target cell receptors and exerts a wide variety of effects. [NIH] Histidine: An essential amino acid important in a number of metabolic processes. It is required for the production of histamine. [NIH] Homogeneous: Consisting of or composed of similar elements or ingredients; of a uniform quality throughout. [EU] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Horny layer: The superficial layer of the epidermis containing keratinized cells. [NIH] Horseradish Peroxidase: An enzyme isolated from horseradish which is able to act as an antigen. It is frequently used as a histochemical tracer for light and electron microscopy. Its antigenicity has permitted its use as a combined antigen and marker in experimental immunology. [NIH] Host: Any animal that receives a transplanted graft. [NIH] Humoral: Of, relating to, proceeding from, or involving a bodily humour - now often used of endocrine factors as opposed to neural or somatic. [EU] Humour: 1. A normal functioning fluid or semifluid of the body (as the blood, lymph or bile) especially of vertebrates. 2. A secretion that is itself an excitant of activity (as certain hormones). [EU] Hybrid: Cross fertilization between two varieties or, more usually, two species of vines, see also crossing. [NIH] Hybridization: The genetic process of crossbreeding to produce a hybrid. Hybrid nucleic acids can be formed by nucleic acid hybridization of DNA and RNA molecules. Protein hybridization allows for hybrid proteins to be formed from polypeptide chains. [NIH] Hydrogel: A network of cross-linked hydrophilic macromolecules used in biomedical applications. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrogen Peroxide: A strong oxidizing agent used in aqueous solution as a ripening agent, bleach, and topical anti-infective. It is relatively unstable and solutions deteriorate over time unless stabilized by the addition of acetanilide or similar organic materials. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydronephrosis: Abnormal enlargement of a kidney, which may be caused by blockage of the ureter (such as by a kidney stone) or chronic kidney disease that prevents urine from draining into the bladder. [NIH] Hydrophilic: Readily absorbing moisture; hygroscopic; having strongly polar groups that
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readily interact with water. [EU] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hydroxylysine: A hydroxylated derivative of the amino acid lysine that is present in certain collagens. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hyperbilirubinemia: Pathologic process consisting of an abnormal increase in the amount of bilirubin in the circulating blood, which may result in jaundice. [NIH] Hypercalciuria: Abnormally large amounts of calcium in the urine. [NIH] Hyperplasia: An increase in the number of cells in a tissue or organ, not due to tumor formation. It differs from hypertrophy, which is an increase in bulk without an increase in the number of cells. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hypoglycemia: Abnormally low blood sugar [NIH] Hypoplasia: Incomplete development or underdevelopment of an organ or tissue. [EU] Hysterectomy: Excision of the uterus. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Iguanas: Large herbivorous tropical American lizards. [NIH] Ileostomy: Surgical creation of an external opening into the ileum for fecal diversion or drainage. Loop or tube procedures are most often employed. [NIH] Imipenem: Semisynthetic thienamycin that has a wide spectrum of antibacterial activity against gram-negative and gram-positive aerobic and anaerobic bacteria, including many multiresistant strains. It is stable to beta-lactamases. Clinical studies have demonstrated high efficacy in the treatment of infections of various body systems. Its effectiveness is enhanced when it is administered in combination with cilastatin, a renal dipeptidase inhibitor. [NIH] Immersion: The placing of a body or a part thereof into a liquid. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]
Immune Sera: Serum that contains antibodies. It is obtained from an animal that has been immunized either by antigen injection or infection with microorganisms containing the antigen. [NIH] Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunity: Nonsusceptibility to the invasive or pathogenic microorganisms or to the toxic effect of antigenic substances. [NIH]
effects
of
foreign
Immunization: Deliberate stimulation of the host's immune response. Active immunization
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involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunoassay: Immunochemical assay or detection of a substance by serologic or immunologic methods. Usually the substance being studied serves as antigen both in antibody production and in measurement of antibody by the test substance. [NIH] Immunochemistry: Field of chemistry that pertains to immunological phenomena and the study of chemical reactions related to antigen stimulation of tissues. It includes physicochemical interactions between antigens and antibodies. [NIH] Immunocompromised: Having a weakened immune system caused by certain diseases or treatments. [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunogen: A substance that is capable of causing antibody formation. [NIH] Immunogenic: Producing immunity; evoking an immune response. [EU] Immunoglobulin: A protein that acts as an antibody. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Immunosuppressive therapy: Therapy used to decrease the body's immune response, such as drugs given to prevent transplant rejection. [NIH] Immunotherapy: Manipulation of the host's immune system in treatment of disease. It includes both active and passive immunization as well as immunosuppressive therapy to prevent graft rejection. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In Situ Hybridization: A technique that localizes specific nucleic acid sequences within intact chromosomes, eukaryotic cells, or bacterial cells through the use of specific nucleic acid-labeled probes. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Incubated: Grown in the laboratory under controlled conditions. (For instance, white blood cells can be grown in special conditions so that they attack specific cancer cells when returned to the body.) [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators
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or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infancy: The period of complete dependency prior to the acquisition of competence in walking, talking, and self-feeding. [NIH] Infant, Newborn: An infant during the first month after birth. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]
Infection Control: Programs of disease surveillance, generally within health care facilities, designed to investigate, prevent, and control the spread of infections and their causative microorganisms. [NIH] Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Information Science: The field of knowledge, theory, and technology dealing with the collection of facts and figures, and the processes and methods involved in their manipulation, storage, dissemination, publication, and retrieval. It includes the fields of communication, publishing, library science and informatics. [NIH] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Ingestion: Taking into the body by mouth [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Inlay: In dentistry, a filling first made to correspond with the form of a dental cavity and then cemented into the cavity. [NIH] Inner ear: The labyrinth, comprising the vestibule, cochlea, and semicircular canals. [NIH] Inorganic: Pertaining to substances not of organic origin. [EU] Inpatients: Persons admitted to health facilities which provide board and room, for the purpose of observation, care, diagnosis or treatment. [NIH] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Insomnia: Difficulty in going to sleep or getting enough sleep. [NIH] Instillation: . [EU] Institutionalization: The caring for individuals in institutions and their adaptation to
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routines characteristic of the institutional environment, and/or their loss of adaptation to life outside the institution. [NIH] Insulator: Material covering the metal conductor of the lead. It is usually polyurethane or silicone. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Intensive Care: Advanced and highly specialized care provided to medical or surgical patients whose conditions are life-threatening and require comprehensive care and constant monitoring. It is usually administered in specially equipped units of a health care facility. [NIH]
Intensive Care Units: Hospital units providing continuous surveillance and care to acutely ill patients. [NIH] Interferon: A biological response modifier (a substance that can improve the body's natural response to disease). Interferons interfere with the division of cancer cells and can slow tumor growth. There are several types of interferons, including interferon-alpha, -beta, and gamma. These substances are normally produced by the body. They are also made in the laboratory for use in treating cancer and other diseases. [NIH] Interferon-alpha: One of the type I interferons produced by peripheral blood leukocytes or lymphoblastoid cells when exposed to live or inactivated virus, double-stranded RNA, or bacterial products. It is the major interferon produced by virus-induced leukocyte cultures and, in addition to its pronounced antiviral activity, it causes activation of NK cells. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestinal: Having to do with the intestines. [NIH] Intestinal Flora: The bacteria, yeasts, and fungi that grow normally in the intestines. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intracellular Membranes: Membranes of subcellular structures. [NIH] Intracranial Aneurysm: A saclike dilatation of the walls of a blood vessel, usually an artery. [NIH]
Intracranial Arteriosclerosis: Vascular diseases characterized by thickening, hardening, and remodeling of the walls of intracranial arteries. There are three subtypes: (1) atherosclerosis, marked by fatty depositions in the innermost layer of the arterial walls, (2) Monckeberg's sclerosis, which features calcium deposition in the media and (3) arteriolosclerosis, which refers to sclerosis of small caliber arteries. Clinically, this process may be associated with transient ischemic attack, brain infarction, intracranial embolism and thrombosis, or intracranial aneurysm. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intravenous: IV. Into a vein. [NIH] Intravenous pyelogram: IVP. A series of x-rays of the kidneys, ureters, and bladder. The x-
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rays are taken after a dye is injected into a blood vessel. The dye is concentrated in the urine, which outlines the kidneys, ureters, and bladder on the x-rays. [NIH] Intravenous pyelography: IVP. X-ray study of the kidneys, ureters, and bladder. The x-rays are taken after a dye is injected into a blood vessel. The dye is concentrated in the urine, which outlines the kidneys, ureters, and bladder on the x-rays. [NIH] Intravesical: Within the bladder. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Introns: Non-coding, intervening sequences of DNA that are transcribed, but are removed from within the primary gene transcript and rapidly degraded during maturation of messenger RNA. Most genes in the nuclei of eukaryotes contain introns, as do mitochondrial and chloroplast genes. [NIH] Intubation: Introduction of a tube into a hollow organ to restore or maintain patency if obstructed. It is differentiated from catheterization in that the insertion of a catheter is usually performed for the introducing or withdrawing of fluids from the body. [NIH] Inulin: A starch found in the tubers and roots of many plants. Since it is hydrolyzable to fructose, it is classified as a fructosan. It has been used in physiologic investigation for determination of the rate of glomerular function. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]
Involuntary: Reaction occurring without intention or volition. [NIH] Ion Channels: Gated, ion-selective glycoproteins that traverse membranes. The stimulus for channel gating can be a membrane potential, drug, transmitter, cytoplasmic messenger, or a mechanical deformation. Ion channels which are integral parts of ionotropic neurotransmitter receptors are not included. [NIH] Ion Exchange: Reversible chemical reaction between a solid, often an ION exchange resin, and a fluid whereby ions may be exchanged from one substance to another. This technique is used in water purification, in research, and in industry. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Iris: The most anterior portion of the uveal layer, separating the anterior chamber from the posterior. It consists of two layers - the stroma and the pigmented epithelium. Color of the iris depends on the amount of melanin in the stroma on reflection from the pigmented epithelium. [NIH] Irrigation: The washing of a body cavity or surface by flowing solution which is inserted and then removed. Any drug in the irrigation solution may be absorbed. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH]
Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH]
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Ketone Bodies: Chemicals that the body makes when there is not enough insulin in the blood and it must break down fat for its energy. Ketone bodies can poison and even kill body cells. When the body does not have the help of insulin, the ketones build up in the blood and then "spill" over into the urine so that the body can get rid of them. The body can also rid itself of one type of ketone, called acetone, through the lungs. This gives the breath a fruity odor. Ketones that build up in the body for a long time lead to serious illness and coma. [NIH] Ketosis: A condition of having ketone bodies build up in body tissues and fluids. The signs of ketosis are nausea, vomiting, and stomach pain. Ketosis can lead to ketoacidosis. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Kidney Pelvis: The flattened, funnel-shaped expansion connecting the ureter to the kidney calices. [NIH] Kidney stone: A stone that develops from crystals that form in urine and build up on the inner surfaces of the kidney, in the renal pelvis, or in the ureters. [NIH] Kidney Transplantation: The transference of a kidney from one human or animal to another. [NIH] Killer Cells: Lymphocyte-like effector cells which mediate antibody-dependent cell cytotoxicity. They kill antibody-coated target cells which they bind with their Fc receptors. [NIH]
Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU] Labyrinth: The internal ear; the essential part of the organ of hearing. It consists of an osseous and a membranous portion. [NIH] Lactation: The period of the secretion of milk. [EU] Lactobacillus: A genus of gram-positive, microaerophilic, rod-shaped bacteria occurring widely in nature. Its species are also part of the many normal flora of the mouth, intestinal tract, and vagina of many mammals, including humans. Pathogenicity from this genus is rare. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Latent: Phoria which occurs at one distance or another and which usually has no troublesome effect. [NIH] Lavage: A cleaning of the stomach and colon. Uses a special drink and enemas. [NIH] Lectin: A complex molecule that has both protein and sugars. Lectins are able to bind to the outside of a cell and cause biochemical changes in it. Lectins are made by both animals and plants. [NIH] Length of Stay: The period of confinement of a patient to a hospital or other health facility. [NIH]
Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Lesion: An area of abnormal tissue change. [NIH] Lethal: Deadly, fatal. [EU]
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Leucine: An essential branched-chain amino acid important for hemoglobin formation. [NIH] Leucocyte: All the white cells of the blood and their precursors (myeloid cell series, lymphoid cell series) but commonly used to indicate granulocytes exclusive of lymphocytes. [NIH]
Leukemia: Cancer of blood-forming tissue. [NIH] Leukocyte Count: A count of the number of white blood cells per unit volume in venous blood. A differential leukocyte count measures the relative numbers of the different types of white cells. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Leukocytosis: A transient increase in the number of leukocytes in a body fluid. [NIH] Levofloxacin: A substance used to treat bacterial infections. It belongs to the family of drugs called quinolone antibiotics. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]
Life cycle: The successive stages through which an organism passes from fertilized ovum or spore to the fertilized ovum or spore of the next generation. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Ligands: A RNA simulation method developed by the MIT. [NIH] Lincomycin: (2S-trans)-Methyl 6,8-dideoxy-6-(((1-methyl-4-propyl-2pyrrolidinyl)carbonyl)amino)-1-thio-D-erythro-alpha-D-galacto-octopyranoside. An antibiotic produced by Streptomyces lincolnensis var. lincolnensis. It has been used in the treatment of staphylococcal, streptococcal, and Bacteroides fragilis infections. [NIH] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lipid: Fat. [NIH] Lipophilic: Having an affinity for fat; pertaining to or characterized by lipophilia. [EU] Lipopolysaccharide: Substance consisting of polysaccaride and lipid. [NIH] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Liposomes: Artificial, single or multilaminar vesicles (made from lecithins or other lipids) that are used for the delivery of a variety of biological molecules or molecular complexes to cells, for example, drug delivery and gene transfer. They are also used to study membranes and membrane proteins. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver scan: An image of the liver created on a computer screen or on film. A radioactive substance is injected into a blood vessel and travels through the bloodstream. It collects in the liver, especially in abnormal areas, and can be detected by the scanner. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or
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site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Locomotion: Movement or the ability to move from one place or another. It can refer to humans, vertebrate or invertebrate animals, and microorganisms. [NIH] Long-Term Care: Care over an extended period, usually for a chronic condition or disability, requiring periodic, intermittent, or continuous care. [NIH] Low-density lipoprotein: Lipoprotein that contains most of the cholesterol in the blood. LDL carries cholesterol to the tissues of the body, including the arteries. A high level of LDL increases the risk of heart disease. LDL typically contains 60 to 70 percent of the total serum cholesterol and both are directly correlated with CHD risk. [NIH] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Lumen: The cavity or channel within a tube or tubular organ. [EU] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]
Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphocele: Cystic mass containing lymph from diseased lymphatic channels or following surgical trauma or other injury. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lymphoma: A general term for various neoplastic diseases of the lymphoid tissue. [NIH] Lysine: An essential amino acid. It is often added to animal feed. [NIH] Lytic: 1. Pertaining to lysis or to a lysin. 2. Producing lysis. [EU] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malaise: A vague feeling of bodily discomfort. [EU] Malignancy: A cancerous tumor that can invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant tumor: A tumor capable of metastasizing. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]
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Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Mastitis: Inflammatory disease of the breast, or mammary gland. [NIH] Matrilysin: The smallest member of the matrix metalloproteinases. It plays a role in tumor progression. EC 3.4.24.23. [NIH] Matrix metalloproteinase: A member of a group of enzymes that can break down proteins, such as collagen, that are normally found in the spaces between cells in tissues (i.e., extracellular matrix proteins). Because these enzymes need zinc or calcium atoms to work properly, they are called metalloproteinases. Matrix metalloproteinases are involved in wound healing, angiogenesis, and tumor cell metastasis. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical Informatics: The field of information science concerned with the analysis and dissemination of medical data through the application of computers to various aspects of health care and medicine. [NIH] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] Medicament: A medicinal substance or agent. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Melanocytes: Epidermal dendritic pigment cells which control long-term morphological color changes by alteration in their number or in the amount of pigment they produce and store in the pigment containing organelles called melanosomes. Melanophores are larger cells which do not exist in mammals. [NIH] Melanoma: A form of skin cancer that arises in melanocytes, the cells that produce pigment. Melanoma usually begins in a mole. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Membrane Proteins: Proteins which are found in membranes including cellular and intracellular membranes. They consist of two types, peripheral and integral proteins. They include most membrane-associated enzymes, antigenic proteins, transport proteins, and drug, hormone, and lectin receptors. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Meningitis: Inflammation of the meninges. When it affects the dura mater, the disease is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called leptomeningitis, or meningitis proper. [EU] Menopause: Permanent cessation of menstruation. [NIH] Menstrual Cycle: The period of the regularly recurring physiologic changes in the endometrium occurring during the reproductive period in human females and some primates and culminating in partial sloughing of the endometrium (menstruation). [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the
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adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mental Retardation: Refers to sub-average general intellectual functioning which originated during the developmental period and is associated with impairment in adaptive behavior. [NIH]
Meta-Analysis: A quantitative method of combining the results of independent studies (usually drawn from the published literature) and synthesizing summaries and conclusions which may be used to evaluate therapeutic effectiveness, plan new studies, etc., with application chiefly in the areas of research and medicine. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] Metronidazole: Antiprotozoal used in amebiasis, trichomoniasis, giardiasis, and as treponemacide in livestock. It has also been proposed as a radiation sensitizer for hypoxic cells. According to the Fourth Annual Report on Carcinogens (NTP 85-002, 1985, p133), this substance may reasonably be anticipated to be a carcinogen (Merck, 11th ed). [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microbiological: Pertaining to microbiology : the science that deals with microorganisms, including algae, bacteria, fungi, protozoa and viruses. [EU] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Micro-organism: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Microspheres: Small uniformly-sized spherical particles frequently radioisotopes or various reagents acting as tags or markers. [NIH]
labeled
with
Micturition: The passage of urine; urination. [EU] Milliliter: A measure of volume for a liquid. A milliliter is approximately 950-times smaller than a quart and 30-times smaller than a fluid ounce. A milliliter of liquid and a cubic centimeter (cc) of liquid are the same. [NIH] Mitochondria: Parts of a cell where aerobic production (also known as cell respiration) takes place. [NIH] Mitochondrial Swelling: Increase in volume of mitochondria due to an influx of fluid; it occurs in hypotonic solutions due to osmotic pressure and in isotonic solutions as a result of
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altered permeability of the membranes of respiring mitochondria. [NIH] Mitosis: A method of indirect cell division by means of which the two daughter nuclei normally receive identical complements of the number of chromosomes of the somatic cells of the species. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Monoclonal antibodies: Laboratory-produced substances that can locate and bind to cancer cells wherever they are in the body. Many monoclonal antibodies are used in cancer detection or therapy; each one recognizes a different protein on certain cancer cells. Monoclonal antibodies can be used alone, or they can be used to deliver drugs, toxins, or radioactive material directly to a tumor. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Multicenter study: A clinical trial that is carried out at more than one medical institution. [NIH]
Multiple sclerosis: A disorder of the central nervous system marked by weakness, numbness, a loss of muscle coordination, and problems with vision, speech, and bladder control. Multiple sclerosis is thought to be an autoimmune disease in which the body's immune system destroys myelin. Myelin is a substance that contains both protein and fat (lipid) and serves as a nerve insulator and helps in the transmission of nerve signals. [NIH] Muscle Fibers: Large single cells, either cylindrical or prismatic in shape, that form the basic unit of muscle tissue. They consist of a soft contractile substance enclosed in a tubular sheath. [NIH]
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Muscular Atrophy: Derangement in size and number of muscle fibers occurring with aging, reduction in blood supply, or following immobilization, prolonged weightlessness, malnutrition, and particularly in denervation. [NIH] Muscular Dystrophies: A general term for a group of inherited disorders which are characterized by progressive degeneration of skeletal muscles. [NIH] Mutagenesis: Process of generating genetic mutations. It may occur spontaneously or be induced by mutagens. [NIH] Mutagens: Chemical agents that increase the rate of genetic mutation by interfering with the function of nucleic acids. A clastogen is a specific mutagen that causes breaks in chromosomes. [NIH] Mutate: To change the genetic material of a cell. Then changes (mutations) can be harmful, beneficial, or have no effect. [NIH] Mycoplasma: A genus of gram-negative, facultatively anaerobic bacteria bounded by a plasma membrane only. Its organisms are parasites and pathogens, found on the mucous membranes of humans, animals, and birds. [NIH] Myelin: The fatty substance that covers and protects nerves. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myotonic Dystrophy: A condition presenting muscle weakness and wasting which may be progressive. [NIH] Nalidixic Acid: Synthetic antimicrobial agent used in urinary tract infections. It is active against gram-negative bacteria but has little activity against gram-positive organisms or Pseudomonas. [NIH] Natural killer cells: NK cells. A type of white blood cell that contains granules with enzymes that can kill tumor cells or microbial cells. Also called large granular lymphocytes (LGL). [NIH] Natural selection: A part of the evolutionary process resulting in the survival and reproduction of the best adapted individuals. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Necrotizing Enterocolitis: A condition in which part of the tissue in the intestines is destroyed. Occurs mainly in under-weight newborn babies. A temporary ileostomy may be necessary. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Negative Staining: The technique of washing tissue specimens with a concentrated solution of a heavy metal salt and letting it dry. The specimen will be covered with a very thin layer
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of the metal salt, being excluded in areas where an adsorbed macromolecule is present. The macromolecules allow electrons from the beam of an electron microscope to pass much more readily than the heavy metal; thus, a reversed or negative image of the molecule is created. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nephritis: Inflammation of the kidney; a focal or diffuse proliferative or destructive process which may involve the glomerulus, tubule, or interstitial renal tissue. [EU] Nephropathy: Disease of the kidneys. [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nerve Fibers: Slender processes of neurons, especially the prolonged axons that conduct nerve impulses. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Nervousness: Excessive excitability and irritability, with mental and physical unrest. [EU] Netilmicin: Semisynthetic 1-N-ethyl derivative of sisomycin, an aminoglycoside antibiotic with action similar to gentamicin, but less ear and kidney toxicity. [NIH] Networks: Pertaining to a nerve or to the nerves, a meshlike structure of interlocking fibers or strands. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neurogenic: Loss of bladder control caused by damage to the nerves controlling the bladder. [NIH] Neurology: A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Neutropenia: An abnormal decrease in the number of neutrophils, a type of white blood cell. [NIH] Neutrophil: A type of white blood cell. [NIH] Nitric Oxide: A free radical gas produced endogenously by a variety of mammalian cells. It is synthesized from arginine by a complex reaction, catalyzed by nitric oxide synthase.
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Nitric oxide is endothelium-derived relaxing factor. It is released by the vascular endothelium and mediates the relaxation induced by some vasodilators such as acetylcholine and bradykinin. It also inhibits platelet aggregation, induces disaggregation of aggregated platelets, and inhibits platelet adhesion to the vascular endothelium. Nitric oxide activates cytosolic guanylate cyclase and thus elevates intracellular levels of cyclic GMP. [NIH]
Nitroblue Tetrazolium: Colorless to yellow dye that is reducible to blue or black formazan crystals by certain cells; formerly used to distinguish between nonbacterial and bacterial diseases, the latter causing neutrophils to reduce the dye; used to confirm diagnosis of chronic granulomatous disease. [NIH] Nitrofurantoin: A urinary anti-infective agent effective against most gram-positive and gram-negative organisms. Although sulfonamides and antibiotics are usually the agents of choice for urinary tract infections, nitrofurantoin is widely used for prophylaxis and longterm suppression. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Norfloxacin: Quinoline-derived synthetic antibacterial agent with a very broad spectrum of action. Oral administration yields highly bactericidal plasma, tissue, and urine levels. Norfloxacin inhibits bacterial DNA-gyrase and is used in gastrointestinal, eye, and urinary infections. [NIH] Nosocomial: Pertaining to or originating in the hospital, said of an infection not present or incubating prior to admittance to the hospital, but generally occurring 72 hours after admittance; the term is usually used to refer to patient disease, but hospital personnel may also acquire nosocomial infection. [EU] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleic Acid Hybridization: The process whereby two single-stranded polynucleotides form a double-stranded molecule, with hydrogen bonding between the complementary bases in the two strains. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nursing Care: Care given to patients by nursing service personnel. [NIH] Nursing Process: The sum total of nursing activities which includes assessment (identifying needs), intervention (ministering to needs), and evaluation (validating the effectiveness of the help given). [NIH] Nursing Staff: Personnel who provide nursing service to patients in an organized facility, institution, or agency. [NIH]
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Observational study: An epidemiologic study that does not involve any intervention, experimental or otherwise. Such a study may be one in which nature is allowed to take its course, with changes in one characteristic being studied in relation to changes in other characteristics. Analytical epidemiologic methods, such as case-control and cohort study designs, are properly called observational epidemiology because the investigator is observing without intervention other than to record, classify, count, and statistically analyze results. [NIH] Obstetrics: A medical-surgical specialty concerned with management and care of women during pregnancy, parturition, and the puerperium. [NIH] Occult: Obscure; concealed from observation, difficult to understand. [EU] Oestrogen: A generic term for oestrus-producing steroid compounds; the female sex hormones. In humans, oestrogen is formed in the ovary, possibly the adrenal cortex, the testis, and the foetoplacental unit; it has various functions in both sexes. It is responsible for the development of the female secondary sex characteristics, and during the menstrual cycle it acts on the female genitalia to produce an environment suitable for the fertilization, implantation, and nutrition of the early embryo. Oestrogen is used in oral contraceptives and as a palliative in cancer of the breast after menopause and cancer of the prostate; other uses include the relief of the discomforts of menopause, inhibition of lactation, and treatment of osteoporosis, threatened abortion, and various functional ovarian disorders. [EU]
Office Visits: Visits made by patients to health service providers' offices for diagnosis, treatment, and follow-up. [NIH] Ofloxacin: An orally administered broad-spectrum quinolone antibacterial drug active against most gram-negative and gram-positive bacteria. [NIH] Oligosaccharides: Carbohydrates consisting of between two and ten monosaccharides connected by either an alpha- or beta-glycosidic link. They are found throughout nature in both the free and bound form. [NIH] Oncogene: A gene that normally directs cell growth. If altered, an oncogene can promote or allow the uncontrolled growth of cancer. Alterations can be inherited or caused by an environmental exposure to carcinogens. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Operon: The genetic unit consisting of a feedback system under the control of an operator gene, in which a structural gene transcribes its message in the form of mRNA upon blockade of a repressor produced by a regulator gene. Included here is the attenuator site of bacterial operons where transcription termination is regulated. [NIH] Ophthalmology: A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases. [NIH] Orbital: Pertaining to the orbit (= the bony cavity that contains the eyeball). [EU] Orderly: A male hospital attendant. [NIH] Organ Culture: The growth in aseptic culture of plant organs such as roots or shoots, beginning with organ primordia or segments and maintaining the characteristics of the organ. [NIH] Organelles: Specific particles of membrane-bound organized living substances present in eukaryotic cells, such as the mitochondria; the golgi apparatus; endoplasmic reticulum; lysomomes; plastids; and vacuoles. [NIH] Osmolarity: The concentration of osmotically active particles expressed in terms of osmoles of solute per litre of solution. [EU]
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Osmoles: The standard unit of osmotic pressure. [NIH] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Ostomy: Surgical construction of an artificial opening (stoma) for external fistulization of a duct or vessel by insertion of a tube with or without a supportive stent. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Oxalate: A chemical that combines with calcium in urine to form the most common type of kidney stone (calcium oxalate stone). [NIH] Oxazolidinones: Derivatives of oxazolidin-2-one. They represent an important class of synthetic antibiotic agents. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]
Pachymeningitis: Inflammation of the dura mater of the brain, the spinal cord or the optic nerve. [NIH] Paediatric: Of or relating to the care and medical treatment of children; belonging to or concerned with paediatrics. [EU] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Pancreatic cancer: Cancer of the pancreas, a salivary gland of the abdomen. [NIH] Pancreatitis: Acute or chronic inflammation of the pancreas, which may be asymptomatic or symptomatic, and which is due to autodigestion of a pancreatic tissue by its own enzymes. It is caused most often by alcoholism or biliary tract disease; less commonly it may be associated with hyperlipaemia, hyperparathyroidism, abdominal trauma (accidental or operative injury), vasculitis, or uraemia. [EU] Paralysis: Loss of ability to move all or part of the body. [NIH] Parasite: An animal or a plant that lives on or in an organism of another species and gets at least some of its nutrition from that other organism. [NIH] Parasitic: Having to do with or being a parasite. A parasite is an animal or a plant that lives on or in an organism of another species and gets at least some of its nutrients from it. [NIH]
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Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Particle: A tiny mass of material. [EU] Parturition: The act or process of given birth to a child. [EU] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathogen: Any disease-producing microorganism. [EU] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]
Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologic Processes: The abnormal mechanisms and forms involved in the dysfunctions of tissues and organs. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Care Management: Generating, planning, organizing, and administering medical and nursing care and services for patients. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]
Peer Review: An organized procedure carried out by a select committee of professionals in evaluating the performance of other professionals in meeting the standards of their specialty. Review by peers is used by editors in the evaluation of articles and other papers submitted for publication. Peer review is used also in the evaluation of grant applications. It is applied also in evaluating the quality of health care provided to patients. [NIH] Pelvic: Pertaining to the pelvis. [EU] Pelvic inflammatory disease: A bacteriological disease sometimes associated with intrauterine device (IUD) usage. [NIH] Penicillin: An antibiotic drug used to treat infection. [NIH] Penis: The external reproductive organ of males. It is composed of a mass of erectile tissue enclosed in three cylindrical fibrous compartments. Two of the three compartments, the corpus cavernosa, are placed side-by-side along the upper part of the organ. The third compartment below, the corpus spongiosum, houses the urethra. [NIH] Pentosan polysulfate: A drug used to relieve pain or discomfort associated with chronic inflammation of the bladder. It is also being evaluated for its protective effects on the gastrointestinal tract in people undergoing radiation therapy. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Peptide T: N-(N-(N(2)-(N-(N-(N-(N-D-Alanyl L-seryl)-L-threonyl)-L-threonyl) L-threonyl)L-asparaginyl)-L-tyrosyl) L-threonine. Octapeptide sharing sequence homology with HIV envelope protein gp120. It is potentially useful as antiviral agent in AIDS therapy. The core pentapeptide sequence, TTNYT, consisting of amino acids 4-8 in peptide T, is the HIV envelope sequence required for attachment to the CD4 receptor. [NIH] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood
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vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Perineal: Pertaining to the perineum. [EU] Perineum: The area between the anus and the sex organs. [NIH] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Periodontitis: Inflammation of the periodontal membrane; also called periodontitis simplex. [NIH]
Peripheral blood: Blood circulating throughout the body. [NIH] Peroxide: Chemical compound which contains an atom group with two oxygen atoms tied to each other. [NIH] PH: The symbol relating the hydrogen ion (H+) concentration or activity of a solution to that of a given standard solution. Numerically the pH is approximately equal to the negative logarithm of H+ concentration expressed in molarity. pH 7 is neutral; above it alkalinity increases and below it acidity increases. [EU] Phagocytosis: The engulfing of microorganisms, other cells, and foreign particles by phagocytic cells. [NIH] Phallic: Pertaining to the phallus, or penis. [EU] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphonic Acids: Inorganic or organic derivatives of phosphonic acid with the general formula ROP(OH)2. This includes phosphonates and phosphonic acid esters. The tautomeric form of this compound (P(OH)3) = phosphorous acids. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Photodynamic therapy: Treatment with drugs that become active when exposed to light. These drugs kill cancer cells. [NIH] Photosensitizer: A drug used in photodynamic therapy. When absorbed by cancer cells and exposed to light, the drug becomes active and kills the cancer cells. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physical Fitness: A state of well-being in which performance is optimal, often as a result of physical conditioning which may be prescribed for disease therapy. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]
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Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pigment: A substance that gives color to tissue. Pigments are responsible for the color of skin, eyes, and hair. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Pipemidic Acid: Antimicrobial against gram-negative and some gram-positive bacteria. It is protein bound and concentrated in bile and urine and used for gastrointestinal, biliary, and urinary infections. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Plasma protein: One of the hundreds of different proteins present in blood plasma, including carrier proteins ( such albumin, transferrin, and haptoglobin), fibrinogen and other coagulation factors, complement components, immunoglobulins, enzyme inhibitors, precursors of substances such as angiotension and bradykinin, and many other types of proteins. [EU] Plasmids: Any extrachromosomal hereditary determinant. Plasmids are self-replicating circular molecules of DNA that are found in a variety of bacterial, archaeal, fungal, algal, and plant species. [NIH] Plastids: Self-replicating cytoplasmic organelles of plant and algal cells that contain pigments and may synthesize and accumulate various substances. Plastids are used in phylogenetic studies. [NIH] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Pneumonitis: A disease caused by inhaling a wide variety of substances such as dusts and molds. Also called "farmer's disease". [NIH] Point Mutation: A mutation caused by the substitution of one nucleotide for another. This results in the DNA molecule having a change in a single base pair. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polycystic: An inherited disorder characterized by many grape-like clusters of fluid-filled cysts that make both kidneys larger over time. These cysts take over and destroy working
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kidney tissue. PKD may cause chronic renal failure and end-stage renal disease. [NIH] Polyethylene: A vinyl polymer made from ethylene. It can be branched or linear. Branched or low-density polyethylene is tough and pliable but not to the same degree as linear polyethylene. Linear or high-density polyethylene has a greater hardness and tensile strength. Polyethylene is used in a variety of products, including implants and prostheses. [NIH]
Polymerase: An enzyme which catalyses the synthesis of DNA using a single DNA strand as a template. The polymerase copies the template in the 5'-3'direction provided that sufficient quantities of free nucleotides, dATP and dTTP are present. [NIH] Polymerase Chain Reaction: In vitro method for producing large amounts of specific DNA or RNA fragments of defined length and sequence from small amounts of short oligonucleotide flanking sequences (primers). The essential steps include thermal denaturation of the double-stranded target molecules, annealing of the primers to their complementary sequences, and extension of the annealed primers by enzymatic synthesis with DNA polymerase. The reaction is efficient, specific, and extremely sensitive. Uses for the reaction include disease diagnosis, detection of difficult-to-isolate pathogens, mutation analysis, genetic testing, DNA sequencing, and analyzing evolutionary relationships. [NIH] Polymers: Compounds formed by the joining of smaller, usually repeating, units linked by covalent bonds. These compounds often form large macromolecules (e.g., polypeptides, proteins, plastics). [NIH] Polymorphism: The occurrence together of two or more distinct forms in the same population. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Porins: Protein molecules situated in the outer membrane of gram-negative bacteria that, in dimeric or trimeric form, constitute a water-filled transmembrane channel allowing passage of ions and other small molecules. Porins are also found in bacterial cell walls, and in plant, fungal, mammalian and other vertebrate cell and mitochondrial membranes. [NIH] Port: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port-a-cath. [NIH] Port-a-cath: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Postoperative: After surgery. [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Potentiate: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH] Practicability: A non-standard characteristic of an analytical procedure. It is dependent on the scope of the method and is determined by requirements such as sample throughout and
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costs. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Prazosin: A selective adrenergic alpha-1 antagonist used in the treatment of heart failure, hypertension, pheochromocytoma, Raynaud's syndrome, prostatic hypertrophy, and urinary retention. [NIH] Precipitation: The act or process of precipitating. [EU] Preclinical: Before a disease becomes clinically recognizable. [EU] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Premenopausal: Refers to the time before menopause. Menopause is the time of life when a women's menstrual periods stop permanently; also called "change of life." [NIH] Premenstrual: Occurring before menstruation. [EU] Premenstrual Syndrome: A syndrome occurring most often during the last week of the menstrual cycle and ending soon after the onset of menses. Some of the symptoms are emotional instability, insomnia, headache, nausea, vomiting, abdominal distension, and painful breasts. [NIH] Prepuce: A covering fold of skin; often used alone to designate the preputium penis. [EU] Presumptive: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Prolapse: The protrusion of an organ or part of an organ into a natural or artificial orifice. [NIH]
Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH]
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Promoter: A chemical substance that increases the activity of a carcinogenic process. [NIH] Prone: Having the front portion of the body downwards. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Proportional: Being in proportion : corresponding in size, degree, or intensity, having the same or a constant ratio; of, relating to, or used in determining proportions. [EU] Prospective Studies: Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostaglandin: Any of a group of components derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway that are extremely potent mediators of a diverse group of physiologic processes. The abbreviation for prostaglandin is PG; specific compounds are designated by adding one of the letters A through I to indicate the type of substituents found on the hydrocarbon skeleton and a subscript (1, 2 or 3) to indicate the number of double bonds in the hydrocarbon skeleton e.g., PGE2. The predominant naturally occurring prostaglandins all have two double bonds and are synthesized from arachidonic acid (5,8,11,14-eicosatetraenoic acid) by the pathway shown in the illustration. The 1 series and 3 series are produced by the same pathway with fatty acids having one fewer double bond (8,11,14-eicosatrienoic acid or one more double bond (5,8,11,14,17-eicosapentaenoic acid) than arachidonic acid. The subscript a or ß indicates the configuration at C-9 (a denotes a substituent below the plane of the ring, ß, above the plane). The naturally occurring PGF's have the a configuration, e.g., PGF2a. All of the prostaglandins act by binding to specific cell-surface receptors causing an increase in the level of the intracellular second messenger cyclic AMP (and in some cases cyclic GMP also). The effect produced by the cyclic AMP increase depends on the specific cell type. In some cases there is also a positive feedback effect. Increased cyclic AMP increases prostaglandin synthesis leading to further increases in cyclic AMP. [EU] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19hydroxy derivatives are found in many organs and tissues. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostate gland: A gland in the male reproductive system just below the bladder. It surrounds part of the urethra, the canal that empties the bladder, and produces a fluid that forms part of semen. [NIH] Prostatectomy: Complete or partial surgical removal of the prostate. Three primary approaches are commonly employed: suprapubic - removal through an incision above the pubis and through the urinary bladder; retropubic - as for suprapubic but without entering the urinary bladder; and transurethral (transurethral resection of prostate). [NIH] Prostatic Hyperplasia: Enlargement or overgrowth of the prostate gland as a result of an increase in the number of its constituent cells. [NIH]
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Prostatism: A symptom complex resulting from compression or obstruction of the urethra, due most commonly to hyperplasia of the prostate; symptoms include diminution in the calibre and force of the urinary stream, hesitancy in initiating voiding, inability to terminate micturition abruptly (with postvoiding dribbling), a sensation of incomplete bladder emptying, and, occasionally, urinary retention. [EU] Prostatitis: Inflammation of the prostate. [EU] Prosthesis: An artificial replacement of a part of the body. [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Protein Binding: The process in which substances, either endogenous or exogenous, bind to proteins, peptides, enzymes, protein precursors, or allied compounds. Specific proteinbinding measures are often used as assays in diagnostic assessments. [NIH] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein Conformation: The characteristic 3-dimensional shape of a protein, including the secondary, supersecondary (motifs), tertiary (domains) and quaternary structure of the peptide chain. Quaternary protein structure describes the conformation assumed by multimeric proteins (aggregates of more than one polypeptide chain). [NIH] Protein Folding: A rapid biochemical reaction involved in the formation of proteins. It begins even before a protein has been completely synthesized and proceeds through discrete intermediates (primary, secondary, and tertiary structures) before the final structure (quaternary structure) is developed. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Protein Subunits: Single chains of amino acids that are the units of a multimeric protein. They can be identical or non-identical subunits. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteinuria: The presence of protein in the urine, indicating that the kidneys are not working properly. [NIH] Proteoglycan: A molecule that contains both protein and glycosaminoglycans, which are a type of polysaccharide. Proteoglycans are found in cartilage and other connective tissues. [NIH]
Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Proteus: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria that occurs in the intestines of humans and a wide variety of animals, as well as in manure, soil, and polluted waters. Its species are pathogenic, causing urinary tract infections and are also considered secondary invaders, causing septic lesions at other sites of the body. [NIH] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus
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of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Protozoa: A subkingdom consisting of unicellular organisms that are the simplest in the animal kingdom. Most are free living. They range in size from submicroscopic to macroscopic. Protozoa are divided into seven phyla: Sarcomastigophora, Labyrinthomorpha, Apicomplexa, Microspora, Ascetospora, Myxozoa, and Ciliophora. [NIH] Protozoal: Having to do with the simplest organisms in the animal kingdom. Protozoa are single-cell organisms, such as ameba, and are different from bacteria, which are not members of the animal kingdom. Some protozoa can be seen without a microscope. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychogenic: Produced or caused by psychic or mental factors rather than organic factors. [EU]
Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]
Puerperium: Period from delivery of the placenta until return of the reproductive organs to their normal nonpregnant morphologic state. In humans, the puerperium generally lasts for six to eight weeks. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary Emphysema: Condition of the lungs characterized by increase beyond normal in the size of air spaces distal to the terminal bronchioles, either from dilatation of the alveoli or from destruction of their walls. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]
Pupil: The aperture in the iris through which light passes. [NIH] Purulent: Consisting of or containing pus; associated with the formation of or caused by pus. [EU] Pyelitis: Inflammation of the pelvis of the kidney. It is attended by pain and tenderness in the loins, irritability of the bladder, remittent fever, bloody or purulent urine, diarrhoea, vomiting, and a peculiar pain on flexion of the thigh. [EU] Pyelonephritis: Inflammation of the kidney and its pelvis, beginning in the interstitium and rapidly extending to involve the tubules, glomeruli, and blood vessels; due to bacterial infection. [EU] Pyogenic: Producing pus; pyopoietic (= liquid inflammation product made up of cells and a thin fluid called liquor puris). [EU] Quality of Life: A generic concept reflecting concern with the modification and
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enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Quaternary: 1. Fourth in order. 2. Containing four elements or groups. [EU] Quinolones: Quinolines which are substituted in any position by one or more oxo groups. These compounds can have any degree of hydrogenation, any substituents, and fused ring systems. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radical prostatectomy: Surgery to remove the entire prostate. The two types of radical prostatectomy are retropubic prostatectomy and perineal prostatectomy. [NIH] Radioactive: Giving off radiation. [NIH] Radiography: Examination of any part of the body for diagnostic purposes by means of roentgen rays, recording the image on a sensitized surface (such as photographic film). [NIH] Random Allocation: A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate objects. [NIH] Randomization: Also called random allocation. Is allocation of individuals to groups, e.g., for experimental and control regimens, by chance. Within the limits of chance variation, random allocation should make the control and experimental groups similar at the start of an investigation and ensure that personal judgment and prejudices of the investigator do not influence allocation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Reconstitution: 1. A type of regeneration in which a new organ forms by the rearrangement of tissues rather than from new formation at an injured surface. 2. The restoration to original form of a substance previously altered for preservation and storage, as the restoration to a liquid state of blood serum or plasma that has been dried and stored. [EU] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH]
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Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Red Nucleus: A pinkish-yellow portion of the midbrain situated in the rostral mesencephalic tegmentum. It receives a large projection from the contralateral half of the cerebellum via the superior cerebellar peduncle and a projection from the ipsilateral motor cortex. [NIH] Reductase: Enzyme converting testosterone to dihydrotestosterone. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reference Standards: A basis of value established for the measure of quantity, weight, extent or quality, e.g. weight standards, standard solutions, methods, techniques, and procedures used in diagnosis and therapy. [NIH] Reflective: Capable of throwing back light, images, sound waves : reflecting. [EU] Reflux: The term used when liquid backs up into the esophagus from the stomach. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Refractory: Not readily yielding to treatment. [EU] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regulon: In eukaryotes, a genetic unit consisting of a noncontiguous group of genes under the control of a single regulator gene. In bacteria, regulons are global regulatory systems involved in the interplay of pleiotropic regulatory domains. These regulatory systems consist of several operons. [NIH] Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [NIH]
Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH] Renal pelvis: The area at the center of the kidney. Urine collects here and is funneled into the ureter, the tube that connects the kidney to the bladder. [NIH] Repressor: Any of the specific allosteric protein molecules, products of regulator genes, which bind to the operator of operons and prevent RNA polymerase from proceeding into the operon to transcribe messenger RNA. [NIH] Research Personnel: Those individuals engaged in research. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Residual Volume: The volume of air remaining in the lungs at the end of a maximal expiration. Common abbreviation is RV. [NIH] Resolving: The ability of the eye or of a lens to make small objects that are close together, separately visible; thus revealing the structure of an object. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which
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contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Response rate: The percentage of patients whose cancer shrinks or disappears after treatment. [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retinoblastoma: An eye cancer that most often occurs in children younger than 5 years. It occurs in hereditary and nonhereditary (sporadic) forms. [NIH] Retinopathy: 1. Retinitis (= inflammation of the retina). 2. Retinosis (= degenerative, noninflammatory condition of the retina). [EU] Retropubic: A potential space between the urinary bladder and the symphisis and body of the pubis. [NIH] Retropubic prostatectomy: Surgery to remove the prostate through an incision made in the abdominal wall. [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Reversion: A return to the original condition, e. g. the reappearance of the normal or wild type in previously mutated cells, tissues, or organisms. [NIH] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH] Rhinitis: Inflammation of the mucous membrane of the nose. [NIH] Ribosome: A granule of protein and RNA, synthesized in the nucleolus and found in the cytoplasm of cells. Ribosomes are the main sites of protein synthesis. Messenger RNA attaches to them and there receives molecules of transfer RNA bearing amino acids. [NIH] Ribotyping: Restriction fragment length polymorphism analysis of rRNA genes that is used for differentiating between species or strains. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Ristocetin: An antibiotic mixture of two components, A and B, obtained from Nocardia
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lurida (or the same substance produced by any other means). It is no longer used clinically because of its toxicity. It causes platelet agglutination and blood coagulation and is used to assay those functions in vitro. [NIH] Rod: A reception for vision, located in the retina. [NIH] Saccule: The smaller of the 2 sacs within the vestibule of the ear. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Saponification: The hydrolysis of an ester into an alcohol and acid. [NIH] Scans: Pictures of structures inside the body. Scans often used in diagnosing, staging, and monitoring disease include liver scans, bone scans, and computed tomography (CT) or computerized axial tomography (CAT) scans and magnetic resonance imaging (MRI) scans. In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed pictures of organs inside the body. MRI scans use a large magnet connected to a computer to create pictures of areas inside the body. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Secretory: Secreting; relating to or influencing secretion or the secretions. [NIH] Sediment: A precipitate, especially one that is formed spontaneously. [EU] Segregation: The separation in meiotic cell division of homologous chromosome pairs and their contained allelomorphic gene pairs. [NIH] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Self Care: Performance of activities or tasks traditionally performed by professional health care providers. The concept includes care of oneself or one's family and friends. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Semisynthetic: Produced by chemical manipulation of naturally occurring substances. [EU]
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Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Sepsis: The presence of bacteria in the bloodstream. [NIH] Septic: Produced by or due to decomposition by microorganisms; putrefactive. [EU] Septicaemia: A term originally used to denote a putrefactive process in the body, but now usually referring to infection with pyogenic micro-organisms; a genus of Diptera; the severe type of infection in which the blood stream is invaded by large numbers of the causal. [NIH] Septicemia: Systemic disease associated with the presence and persistence of pathogenic microorganisms or their toxins in the blood. Called also blood poisoning. [EU] Sequence Homology: The degree of similarity between sequences. Studies of amino acid and nucleotide sequences provide useful information about the genetic relatedness of certain species. [NIH] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH] Serologic: Analysis of a person's serum, especially specific immune or lytic serums. [NIH] Serotypes: A cause of haemorrhagic septicaemia (in cattle, sheep and pigs), fowl cholera of birds, pasteurellosis of rabbits, and gangrenous mastitis of ewes. It is also commonly found in atrophic rhinitis of pigs. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Sex Determination: The biological characteristics which distinguish human beings as female or male. [NIH] Sex Ratio: The number of males per 100 females. [NIH] Sexually Transmitted Diseases: Diseases due to or propagated by sexual contact. [NIH] Shedding: Release of infectious particles (e. g., bacteria, viruses) into the environment, for example by sneezing, by fecal excretion, or from an open lesion. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]
Sialic Acids: A group of naturally occurring N-and O-acyl derivatives of the deoxyamino sugar neuraminic acid. They are ubiquitously distributed in many tissues. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH]
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Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]
Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Sonogram: A computer picture of areas inside the body created by bouncing sound waves off organs and other tissues. Also called ultrasonogram or ultrasound. [NIH] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Spatial disorientation: Loss of orientation in space where person does not know which way is up. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sperm: The fecundating fluid of the male. [NIH] Spermatozoa: Mature male germ cells that develop in the seminiferous tubules of the testes. Each consists of a head, a body, and a tail that provides propulsion. The head consists mainly of chromatin. [NIH] Spermicide: An agent that is destructive to spermatozoa. [EU] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spices: The dried seeds, bark, root, stems, buds, leaves, or fruit of aromatic plants used to season food. [NIH] Spina bifida: A defect in development of the vertebral column in which there is a central deficiency of the vertebral lamina. [NIH]
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Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinal Cord Injuries: Penetrating and non-penetrating injuries to the spinal cord resulting from traumatic external forces (e.g., wounds, gunshot; whiplash injuries; etc.). [NIH] Spinal Injuries: Injuries involving the vertebral column. [NIH] Spinous: Like a spine or thorn in shape; having spines. [NIH] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Sputum: The material expelled from the respiratory passages by coughing or clearing the throat. [NIH] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]
Standardize: To compare with or conform to a standard; to establish standards. [EU] Stasis: A word termination indicating the maintenance of (or maintaining) a constant level; preventing increase or multiplication. [EU] Statistically significant: Describes a mathematical measure of difference between groups. The difference is said to be statistically significant if it is greater than what might be expected to happen by chance alone. [NIH] Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH] Stem Cell Factor: Hematopoietic growth factor and the ligand of the c-kit receptor CD117 (proto-oncogene protein C-kit). It is expressed during embryogenesis and provides a key signal in multiple aspects of mast-cell differentiation and function. [NIH] Stent: A device placed in a body structure (such as a blood vessel or the gastrointestinal tract) to provide support and keep the structure open. [NIH] Sterile: Unable to produce children. [NIH] Sterility: 1. The inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. The state of being aseptic, or free from microorganisms. [EU] Sterilization: The destroying of all forms of life, especially microorganisms, by heat, chemical, or other means. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]
Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stoma: A surgically created opening from an area inside the body to the outside. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH]
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Stool: The waste matter discharged in a bowel movement; feces. [NIH] Strand: DNA normally exists in the bacterial nucleus in a helix, in which two strands are coiled together. [NIH] Streptococcal: Caused by infection due to any species of streptococcus. [NIH] Streptococci: A genus of spherical Gram-positive bacteria occurring in chains or pairs. They are widely distributed in nature, being important pathogens but often found as normal commensals in the mouth, skin, and intestine of humans and other animals. [NIH] Streptococcus: A genus of gram-positive, coccoid bacteria whose organisms occur in pairs or chains. No endospores are produced. Many species exist as commensals or parasites on man or animals with some being highly pathogenic. A few species are saprophytes and occur in the natural environment. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stress urinary: Leakage of urine caused by actions--such as coughing, laughing, sneezing, running, or lifting--that place pressure on the bladder from inside the body. Stress urinary incontinence can result from either a fallen bladder or weak sphincter muscles. [NIH] Stricture: The abnormal narrowing of a body opening. Also called stenosis. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Stromal: Large, veil-like cell in the bone marrow. [NIH] Struvite: A type of kidney stone caused by infection. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]
Substrate: A substance upon which an enzyme acts. [EU] Substrate Specificity: A characteristic feature of enzyme activity in relation to the kind of substrate on which the enzyme or catalytic molecule reacts. [NIH] Sulfur: An element that is a member of the chalcogen family. It has an atomic symbol S, atomic number 16, and atomic weight 32.066. It is found in the amino acids cysteine and methionine. [NIH] Suppositories: A small cone-shaped medicament having cocoa butter or gelatin at its basis and usually intended for the treatment of local conditions in the rectum. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH]
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Symphysis: A secondary cartilaginous joint. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Syncytium: A living nucleated tissue without apparent cellular structure; a tissue composed of a mass of nucleated protoplasm without cell boundaries. [NIH] Systemic: Affecting the entire body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Tachycardia: Excessive rapidity in the action of the heart, usually with a heart rate above 100 beats per minute. [NIH] Tachypnea: Rapid breathing. [NIH] Teichoic Acids: Bacterial polysaccharides that are rich in phosphodiester linkages. They are the major components of the cell walls and membranes of many bacteria. [NIH] Telangiectasia: The permanent enlargement of blood vessels, causing redness in the skin or mucous membranes. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] Tetracycline: An antibiotic originally produced by Streptomyces viridifaciens, but used mostly in synthetic form. It is an inhibitor of aminoacyl-tRNA binding during protein synthesis. [NIH] Thalamic: Cell that reaches the lateral nucleus of amygdala. [NIH] Thalamic Diseases: Disorders of the centrally located thalamus, which integrates a wide range of cortical and subcortical information. Manifestations include sensory loss, movement disorders; ataxia, pain syndromes, visual disorders, a variety of neuropsychological conditions, and coma. Relatively common etiologies include cerebrovascular disorders; craniocerebral trauma; brain neoplasms; brain hypoxia; intracranial hemorrhages; and infectious processes. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thermoregulation: Heat regulation. [EU] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Thoracic: Having to do with the chest. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threonine: An essential amino acid occurring naturally in the L-form, which is the active form. It is found in eggs, milk, gelatin, and other proteins. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin.
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(Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombomodulin: A cell surface glycoprotein of endothelial cells that binds thrombin and serves as a cofactor in the activation of protein C and its regulation of blood coagulation. [NIH]
Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thymus: An organ that is part of the lymphatic system, in which T lymphocytes grow and multiply. The thymus is in the chest behind the breastbone. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tissue Culture: Maintaining or growing of tissue, organ primordia, or the whole or part of an organ in vitro so as to preserve its architecture and/or function (Dorland, 28th ed). Tissue culture includes both organ culture and cell culture. [NIH] Tissue Distribution: Accumulation of a drug or chemical substance in various organs (including those not relevant to its pharmacologic or therapeutic action). This distribution depends on the blood flow or perfusion rate of the organ, the ability of the drug to penetrate organ membranes, tissue specificity, protein binding. The distribution is usually expressed as tissue to plasma ratios. [NIH] Toilet Training: Conditioning to defecate and urinate in culturally acceptable places. [NIH] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Tonsils: Small masses of lymphoid tissue on either side of the throat. [NIH] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [NIH] Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Traction: The act of pulling. [NIH] Tractus: A part of some structure, usually that part along which something passes. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transfer Factor: Factor derived from leukocyte lysates of immune donors which can transfer both local and systemic cellular immunity to nonimmune recipients. [NIH] Transferases: Transferases are enzymes transferring a group, for example, the methyl group or a glycosyl group, from one compound (generally regarded as donor) to another compound (generally regarded as acceptor). The classification is based on the scheme
294 Urinary Tract Infections
"donor:acceptor group transferase". (Enzyme Nomenclature, 1992) EC 2. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Translational: The cleavage of signal sequence that directs the passage of the protein through a cell or organelle membrane. [NIH] Translocating: The attachment of a fragment of one chromosome to a non-homologous chromosome. [NIH] Translocation: The movement of material in solution inside the body of the plant. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Transrectal ultrasound: A procedure used to examine the prostate. An instrument is inserted into the rectum, and sound waves bounce off the prostate. These sound waves create echoes, which a computer uses to create a picture called a sonogram. [NIH] Transurethral: Performed through the urethra. [EU] Transurethral Resection of Prostate: Resection of the prostate using a cystoscope passed through the urethra. [NIH] Transurethral resection of the prostate: Surgical procedure to remove tissue from the prostate using an instrument inserted through the urethra. Also called TURP. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, practicability, etc., of these interventions in individual cases or series. [NIH]
Trichomonas: A genus of parasitic flagellate protozoans distinguished by the presence of four anterior flagella, an undulating membrane, and a trailing flagellum. [NIH] Trichomonas vaginalis: A species of trichomonas that produces a refractory vaginal discharge in females, as well as bladder and urethral infections in males. [NIH] Trichomonas Vaginitis: Inflammation of the vagina, marked by a purulent discharge. This disease is caused by the protozoan Trichomonas vaginalis. [NIH] Trichomoniasis: An infection with the protozoan parasite Trichomonas vaginalis. [NIH] Trimethoprim-sulfamethoxazole: An antibiotic drug used to treat infection and prevent pneumocystis carinii pneumonia. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH] Tuberous Sclerosis: A rare congenital disease in which the essential pathology is the appearance of multiple tumors in the cerebrum and in other organs, such as the heart or kidneys. [NIH] Tumor marker: A substance sometimes found in an increased amount in the blood, other body fluids, or tissues and which may mean that a certain type of cancer is in the body.
Dictionary 295
Examples of tumor markers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and gastrointestinal tract cancers), and PSA (prostate cancer). Also called biomarker. [NIH] Type 2 diabetes: Usually characterized by a gradual onset with minimal or no symptoms of metabolic disturbance and no requirement for exogenous insulin. The peak age of onset is 50 to 60 years. Obesity and possibly a genetic factor are usually present. [NIH] Typhimurium: Microbial assay which measures his-his+ reversion by chemicals which cause base substitutions or frameshift mutations in the genome of this organism. [NIH] Ultrafiltration: The separation of particles from a suspension by passage through a filter with very fine pores. In ultrafiltration the separation is accomplished by convective transport; in dialysis separation relies instead upon differential diffusion. Ultrafiltration occurs naturally and is a laboratory procedure. Artificial ultrafiltration of the blood is referred to as hemofiltration or hemodiafiltration (if combined with hemodialysis). [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Uraemia: 1. An excess in the blood of urea, creatinine, and other nitrogenous end products of protein and amino acids metabolism; more correctly referred to as azotemia. 2. In current usage the entire constellation of signs and symptoms of chronic renal failure, including nausea, vomiting anorexia, a metallic taste in the mouth, a uraemic odour of the breath, pruritus, uraemic frost on the skin, neuromuscular disorders, pain and twitching in the muscles, hypertension, edema, mental confusion, and acid-base and electrolyte imbalances. [EU]
Urea: A compound (CO(NH2)2), formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. [NIH] Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Ureter: One of a pair of thick-walled tubes that transports urine from the kidney pelvis to the bladder. [NIH] Ureterocele: Cystic dilatation of the ureter with ballooning of the ureteral orifice into the lumen of the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]
Urethritis: Inflammation of the urethra. [EU] Urinalysis: Examination of urine by chemical, physical, or microscopic means. Routine urinalysis usually includes performing chemical screening tests, determining specific gravity, observing any unusual color or odor, screening for bacteriuria, and examining the sediment microscopically. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary Calculi: Calculi in any part of the urinary tract. According to their composition or pattern of chemical composition distribution, urinary calculi types may include alternating
296 Urinary Tract Infections
or combination, cystine, decubitus, encysted, fibrin, hemp seed, matrix, mulberry, oxalate, struvite, urostealith, and xanthic calculi. [NIH] Urinary Retention: Inability to urinate. The etiology of this disorder includes obstructive, neurogenic, pharmacologic, and psychogenic causes. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urinary tract infection: An illness caused by harmful bacteria growing in the urinary tract. [NIH]
Urinary urgency: Inability to delay urination. [NIH] Urinate: To release urine from the bladder to the outside. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urodynamic: Measures of the bladder's ability to hold and release urine. [NIH] Urogenital: Pertaining to the urinary and genital apparatus; genitourinary. [EU] Urography: Radiography of any part of the urinary tract. [NIH] Urolithiasis: Stones in the urinary system. [NIH] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Urothelium: The epithelial lining of the urinary tract. [NIH] Uterine Prolapse: Downward displacement of the uterus. It is classified in various degrees: in the first degree the cervix is within the vaginal orifice; in the second degree the cervix is outside the orifice; in the third degree the entire uterus is outside the orifice. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccination: Administration of vaccines to stimulate the host's immune response. This includes any preparation intended for active immunological prophylaxis. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vacuoles: Any spaces or cavities within a cell. They may function in digestion, storage, secretion, or excretion. [NIH] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Vaginal Discharge: A common gynecologic disorder characterized by an abnormal, nonbloody discharge from the genital tract. [NIH] Vaginitis: Inflammation of the vagina characterized by pain and a purulent discharge. [NIH] Vaginosis: A condition caused by the overgrowth of anaerobic bacteria (e. g., Gardnerella vaginalis), resulting in vaginal irritation and discharge. [NIH] Valves: Flap-like structures that control the direction of blood flow through the heart. [NIH] Vancomycin: Antibacterial obtained from Streptomyces orientalis. It is a glycopeptide related to ristocetin that inhibits bacterial cell wall assembly and is toxic to kidneys and the inner ear. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU]
Dictionary 297
Vasculitis: Inflammation of a blood vessel. [NIH] Vasodilator: An agent that widens blood vessels. [NIH] VE: The total volume of gas either inspired or expired in one minute. [NIH] Vegetative: 1. Concerned with growth and with nutrition. 2. Functioning involuntarily or unconsciously, as the vegetative nervous system. 3. Resting; denoting the portion of a cell cycle during which the cell is not involved in replication. 4. Of, pertaining to, or characteristic of plants. [EU] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venoms: Poisonous animal secretions forming fluid mixtures of many different enzymes, toxins, and other substances. These substances are produced in specialized glands and secreted through specialized delivery systems (nematocysts, spines, fangs, etc.) for disabling prey or predator. [NIH] Venous: Of or pertaining to the veins. [EU] Venous blood: Blood that has given up its oxygen to the tissues and carries carbon dioxide back for gas exchange. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vertebral: Of or pertaining to a vertebra. [EU] Vesicoureteral: An abnormal condition in which urine backs up into the ureters, and occasionally into the kidneys, raising the risk of infection. [NIH] Vestibule: A small, oval, bony chamber of the labyrinth. The vestibule contains the utricle and saccule, organs which are part of the balancing apparatus of the ear. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virulent: A virus or bacteriophage capable only of lytic growth, as opposed to temperate phages establishing the lysogenic response. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Void: To urinate, empty the bladder. [NIH] Voiding cystourethrogram: An x-ray image of the bladder and urethra made during voiding. The bladder and urethra are filled with a special fluid to make the urethra clearly visible. [NIH] Volition: Voluntary activity without external compulsion. [NIH] War: Hostile conflict between organized groups of people. [NIH] Watchful waiting: Closely monitoring a patient's condition but withholding treatment until symptoms appear or change. Also called observation. [NIH]
298 Urinary Tract Infections
Weight Gain: Increase in body weight over existing weight. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]
Whole cell vaccine: Vaccine made from whole tumor cells that have been changed in the laboratory. [NIH] Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Wound Healing: Restoration of integrity to traumatized tissue. [NIH] Wound Infection: Invasion of the site of trauma by pathogenic microorganisms. [NIH] Wounds, Gunshot: Disruption of structural continuity of the body as a result of the discharge of firearms. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH] Zymogen: Inactive form of an enzyme which can then be converted to the active form, usually by excision of a polypeptide, e. g. trypsinogen is the zymogen of trypsin. [NIH]
299
INDEX 5 5-alpha, 40, 41, 227, 253 A Abdomen, 158, 164, 227, 235, 236, 251, 263, 266, 275, 290, 292 Abdominal, 16, 76, 151, 161, 210, 212, 214, 227, 247, 275, 280, 286 Abdominal Pain, 151, 210, 214, 227 Ablate, 61, 227 Abscess, 4, 179, 227 Acculturation, 145, 227 Acetylcholine, 227, 240, 273 Acetylgalactosamine, 227, 255, 256 Acetylglucosamine, 38, 227, 255, 256 Acidosis, 227, 246 Acremonium, 227, 239 Actin, 58, 227 Acyl, 227, 288 Adaptability, 227, 239 Adaptation, 43, 227, 262 Adenine, 30, 227 Adenosine, 227, 237, 277 Adjustment, 227 Adolescence, 4, 228 Adrenal Cortex, 228, 244, 251, 274, 280 Adrenergic, 41, 47, 228, 248, 251, 280 Adverse Effect, 5, 15, 53, 76, 180, 228, 288 Aerobic, 228, 260, 269 Aeroembolism, 228, 234 Aerosol, 51, 162, 228 Afferent, 47, 228 Affinity, 228, 266 Agar, 228, 245, 278 Age Groups, 186, 228 Age of Onset, 228, 295 Age-Adjusted, 31, 53, 228 Aged, 80 and Over, 228 Airway, 156, 228 Albumin, 75, 228, 278 Alertness, 229, 237 Algorithms, 48, 229, 235 Alimentary, 229, 276 Alkaline, 152, 227, 229, 230, 237 Alleles, 34, 64, 229 Allograft, 94, 95, 229 Alpha Particles, 229, 284 Alpha-1, 40, 41, 229, 248, 280
Alternative medicine, 127, 140, 145, 185, 229, 242 Aluminum, 162, 229 Alveoli, 229, 246, 283 Amebiasis, 229, 269 Ameliorating, 169, 229 Amine, 229, 258 Amino Acid Sequence, 158, 229, 231 Amino Acids, 30, 229, 230, 238, 276, 279, 282, 286, 291, 294, 295 Ammonia, 28, 45, 166, 229, 230, 256, 295 Amoxicillin, 7, 10, 16, 70, 71, 78, 186, 230 Ampicillin, 5, 130, 230 Ampulla, 230, 249 Amputation, 159, 230 Amyloid, 230, 239 Anaerobic, 63, 230, 251, 257, 260, 271, 282, 296 Anaesthesia, 230, 262 Anal, 5, 15, 155, 230, 252, 253, 276 Analgesics, 158, 230 Analog, 51, 230, 241 Analytes, 206, 230 Anaphylatoxins, 230, 242 Anaplasia, 230, 272 Anatomical, 19, 28, 209, 215, 230, 261, 287 Anemia, 202, 230 Anesthesia, 228, 230 Angiopathy, 230, 239 Animal model, 35, 38, 44, 47, 52, 58, 60, 61, 65, 66, 184, 231 Anionic, 38, 231 Anions, 229, 231, 264 Annealing, 231, 279 Anode, 231 Anomalies, 4, 215, 231 Antagonism, 231, 237 Antibiotic Prophylaxis, 11, 18, 23, 177, 198, 231 Antibodies, 53, 59, 64, 111, 162, 168, 169, 231, 251, 260, 261, 267, 270, 278 Antibody, 10, 25, 53, 58, 66, 168, 228, 231, 242, 250, 251, 259, 261, 262, 265, 268, 270, 284, 289 Anticholinergics, 8, 231 Anticoagulant, 231, 282 Antifungal, 62, 231
300 Urinary Tract Infections
Antigen, 58, 83, 101, 162, 228, 231, 232, 242, 246, 250, 255, 259, 260, 261, 262, 268 Antigen-Antibody Complex, 231, 242 Antigen-presenting cell, 232, 246 Anti-infective, 96, 232, 240, 259, 273 Anti-inflammatory, 232, 233 Anti-Inflammatory Agents, 232, 233 Antioxidant, 232 Antiseptic, 157, 232 Antiviral, 232, 263, 276 Anus, 211, 213, 230, 232, 236, 277, 284 Anxiety, 186, 232 Apolipoproteins, 232, 266 Apoptosis, 59, 232 Approximate, 51, 232 Aqueous, 232, 234, 245, 249, 259, 265 Arachidonic Acid, 232, 281 Arginine, 48, 150, 230, 232, 272 Aromatic, 232, 238, 289 Arterial, 104, 232, 239, 240, 260, 263, 282, 292 Arteries, 230, 232, 236, 244, 263, 267, 269 Arteriovenous, 232, 239 Ascorbic Acid, 124, 232, 260 Aseptic, 232, 274, 290 Aspiration, 29, 164, 232 Aspirin, 187, 232 Assay, 51, 71, 89, 156, 233, 250, 261, 287, 295 Ataxia, 201, 233, 292 Atrophy, 201, 233, 271 Attenuated, 233, 247 Autodigestion, 233, 275 Autoimmune disease, 233, 270 Autonomic, 47, 227, 233, 273 Autonomic Dysreflexia, 47, 233 Axons, 233, 272 B Back Pain, 118, 212, 214, 233 Bacteraemia, 114, 233 Bacteremia, 9, 32, 58, 60, 65, 80, 169, 233, 254 Bacterial Adhesion, 68, 154, 233 Bacterial Infections, 5, 37, 54, 62, 150, 154, 159, 187, 233, 239, 266 Bacterial Physiology, 227, 233 Bacterial toxin, 25, 58, 233 Bactericidal, 233, 238, 273 Bacteriophage, 233, 278, 297 Bacterium, 45, 53, 54, 234, 254 Basal Ganglia, 233, 234, 239 Basal Ganglia Diseases, 233, 234
Base, 30, 57, 159, 160, 163, 227, 234, 246, 253, 264, 278, 292, 295 Basophil, 234, 259 Baths, 212, 213, 234 Bends, 28, 234 Benign, 6, 24, 37, 40, 41, 52, 54, 112, 134, 144, 234, 253, 257, 272 Benign prostatic hyperplasia, 6, 24, 40, 41, 42, 52, 54, 234, 253 Beta-Lactamases, 234, 238, 260 Bifida, 4, 234, 289 Bile, 234, 254, 259, 264, 266, 278, 290 Bile Pigments, 234, 264 Biliary, 234, 237, 247, 275, 278 Biliary Tract, 234, 237, 275 Bilirubin, 229, 234, 260 Binding Sites, 28, 234 Bioassay, 68, 234 Bioavailability, 51, 74, 235 Biochemical, 27, 38, 58, 59, 68, 82, 89, 229, 235, 256, 265, 282 Biofilms, 60, 81, 109, 235 Biogenesis, 40, 235 Biological Factors, 30, 235 Biological response modifier, 116, 235, 263 Biological Transport, 235, 247 Biomarkers, 40, 235 Biomass, 158, 235 Biopsy, 53, 89, 90, 235, 252 Biosynthesis, 58, 232, 235, 255 Biotechnology, 69, 77, 175, 185, 197, 200, 201, 202, 235 Biotic, 57, 235 Bloating, 151, 235 Blood Coagulation, 235, 237, 287, 293 Blood Glucose, 31, 235, 258 Blood pressure, 31, 47, 177, 235, 260, 270 Body Fluids, 157, 164, 235, 236, 248, 294 Bone Marrow, 63, 236, 261, 267, 270, 291 Bone Resorption, 236, 247 Bone scan, 236, 247, 287 Bowel, 17, 32, 187, 212, 230, 236, 243, 247, 263, 291 Bowel Movement, 32, 187, 212, 236, 243, 247, 291 Bradykinin, 236, 273, 278 Branch, 180, 223, 236, 255, 276, 283, 289, 292 Breakdown, 28, 47, 236, 246, 247, 254 Breeding, 122, 236 Broad-spectrum, 18, 230, 236, 238, 239, 250, 274
Index 301
Bronchi, 236, 251 Bronchial, 236, 258 Bronchioles, 229, 236, 283 Bronchiolitis, 80, 236 Bronchitis, 74, 131, 236, 240 Buccal, 236, 267 Burns, 52, 57, 169, 236 Burns, Electric, 236 Bypass, 166, 236 C Caffeine, 210, 236 Calcification, 237, 247 Calcium, 28, 45, 237, 242, 247, 260, 263, 268, 275 Calculi, 14, 22, 118, 159, 174, 237, 295 Candidiasis, 49, 237 Candidosis, 237 Capillary, 236, 237, 255 Capsular, 58, 237 Capsules, 237, 254, 255 Carbapenems, 10, 237 Carbohydrate, 44, 237, 256, 279 Carbon Dioxide, 237, 245, 253, 254, 278, 286, 297 Carboxy, 58, 237, 238 Carboxylic Acids, 148, 238 Carcinogen, 238, 269 Carcinogenic, 238, 262, 281, 290 Cardiac, 237, 238, 245, 248, 249, 251, 252, 258, 271, 290 Case report, 83, 87, 238, 241 Case series, 12, 238, 241 Catheterization, 5, 7, 9, 22, 45, 54, 151, 160, 161, 181, 198, 238, 264 Cathode, 231, 238, 249 Cations, 238, 264 Caudal, 238, 279 Cause of Death, 198, 238 Cefaclor, 70, 73, 75, 78, 104, 238 Cefmenoxime, 85, 238 Cefonicid, 115, 238 Cefsulodin, 85, 238 Ceftazidime, 70, 72, 74, 238 Ceftriaxone, 72, 78, 91, 238 Cefuroxime, 70, 75, 84, 239 Cell Death, 58, 232, 239, 255, 271 Cell Differentiation, 239, 290 Cell Division, 201, 233, 239, 270, 278, 287 Cellulose, 239, 254, 278 Central Nervous System, 227, 228, 237, 239, 254, 256, 257, 270
Central Nervous System Infections, 239, 257 Cephalexin, 238, 239 Cephaloridine, 238, 239 Cephalosporins, 7, 10, 109, 234, 239 Cephradine, 70, 239 Cerebellar, 233, 239, 285 Cerebral, 160, 233, 234, 239, 251, 253 Cerebral Hemorrhage, 160, 239 Cerebral Infarction, 239 Cerebrum, 239, 294 Cervical, 14, 155, 240 Cervix, 240, 253, 296 Chemoprevention, 41, 240 Chemotactic Factors, 240, 242 Chest Pain, 152, 240 Chlamydia, 43, 210, 240 Chlorhexidine, 75, 240 Cholera, 240, 288 Cholesterol, 234, 240, 248, 266, 267, 290 Cholesterol Esters, 240, 266 Cholinergic, 47, 240 Chromatin, 232, 240, 250, 289 Chromosomal, 43, 240 Chromosome, 37, 240, 257, 266, 287, 294 Chronic, 7, 20, 22, 23, 27, 41, 44, 45, 52, 69, 70, 74, 79, 131, 151, 156, 160, 161, 163, 168, 176, 177, 179, 180, 201, 229, 233, 240, 243, 250, 259, 262, 265, 267, 273, 275, 276, 279, 291, 295 Chronic Disease, 23, 176, 240 Chronic Obstructive Pulmonary Disease, 79, 240 Chronic prostatitis, 7, 180, 240 Chronic renal, 180, 240, 279, 295 Chylomicrons, 240, 266 Cilastatin, 110, 123, 240, 260 Ciprofloxacin, 10, 20, 71, 74, 75, 76, 81, 84, 85, 88, 89, 98, 102, 109, 110, 186, 241 Circumcision, 5, 85, 86, 100, 130, 133, 241 Citrus, 210, 232, 241 C-kit receptor, 241, 290 Clamp, 46, 241 Clavulanic Acid, 71, 78, 241 Clindamycin, 63, 241 Clinical Medicine, 175, 241, 280 Clinical study, 122, 241, 244 Clinical trial, 9, 22, 24, 25, 33, 38, 40, 41, 48, 53, 63, 74, 110, 143, 144, 145, 197, 241, 244, 270, 282, 284 Clone, 66, 241 Cloning, 235, 241
302 Urinary Tract Infections
Coenzyme, 232, 241 Cofactor, 241, 282, 293 Cohort Studies, 12, 241 Collagen, 23, 156, 241, 254, 268, 278, 280 Collapse, 236, 242 Colloidal, 229, 242, 249 Combination Therapy, 63, 242 Commensal, 37, 39, 242 Communis, 138, 242 Complement, 58, 230, 242, 278 Complementary and alternative medicine, 127, 140, 145, 242 Complementary medicine, 127, 242 Complementation, 31, 242 Computational Biology, 197, 200, 243 Computed tomography, 243, 287 Computerized axial tomography, 243, 287 Conception, 243, 244, 252, 290 Concomitant, 21, 55, 159, 243 Concretion, 237, 243 Condoms, 12, 63, 243 Cone, 243, 291 Confounding, 4, 43, 243 Conjugated, 38, 158, 243 Connective Tissue, 156, 232, 236, 241, 243, 252, 254, 267, 282, 286 Connective Tissue Cells, 243 Consciousness, 230, 243 Constipation, 22, 209, 243 Consultation, 40, 243 Consumption, 243, 248, 286 Contamination, 111, 152, 154, 164, 243 Continence, 47, 122, 128, 243 Continuum, 67, 243 Contraception, 14, 243 Contraceptive, 35, 244 Contractility, 15, 244 Contraindications, ii, 244 Control group, 12, 35, 244, 284 Controlled clinical trial, 24, 144, 244 Cooperative group, 24, 244 Coordination, 244, 270 Cornea, 57, 244 Corneum, 244, 251 Coronary, 244, 269 Coronary Thrombosis, 244, 269 Corpus, 244, 276, 280 Corpus Luteum, 244, 280 Cortex, 228, 233, 244, 251, 253, 274, 280, 285 Cortical, 13, 18, 21, 244, 287, 292 Cortisol, 229, 244
Cost Savings, 63, 244 Co-trimoxazole, 84, 101, 108, 130, 244 Cranial, 244, 257 Craniocerebral Trauma, 234, 239, 244, 257, 292 Creatinine, 31, 53, 55, 244, 295 Criterion, 163, 244 Critical Care, 108, 170, 245 Crystallization, 28, 159, 245 Cues, 57, 245 Culture Media, 156, 228, 245 Curative, 160, 162, 245, 292 Cutaneous, 237, 245, 267 Cyclic, 20, 48, 165, 166, 237, 245, 257, 273, 281 Cystine, 245, 296 Cystoscopy, 16, 206, 212, 214, 245 Cytokine, 48, 59, 64, 245 Cytoplasm, 57, 232, 245, 250, 257, 270, 286 Cytotoxic, 52, 58, 94, 245 Cytotoxins, 57, 245 D Data Collection, 25, 40, 48, 245 Databases, Bibliographic, 197, 245 Deamination, 245, 295 Decarboxylation, 245, 258 Decompensation, 41, 245 Decompression, 100, 228, 245, 246 Decompression Sickness, 245, 246 Decubitus, 246, 296 Defecation, 32, 246 Defense Mechanisms, 6, 23, 61, 66, 97, 246 Degenerative, 246, 286 Deletion, 43, 232, 246 Delivery of Health Care, 246, 257 Denaturation, 246, 279 Dendrites, 246, 272 Dendritic, 63, 78, 246, 268 Dendritic cell, 63, 78, 246 Density, 31, 34, 43, 246, 266, 267, 274, 279, 289 Dental Caries, 246 Dental Plaque, 159, 246 Dentition, 159, 246 Deuterium, 246, 259 Diabetes Mellitus, 4, 104, 158, 177, 246, 256, 258, 263 Diabetic Ketoacidosis, 31, 246 Diagnostic Imaging, 15, 120, 246 Diagnostic procedure, 16, 147, 185, 247 Diaphragm, 12, 14, 164, 211, 212, 247
Index 303
Diarrhea, 130, 151, 162, 210, 229, 247, 250, 251 Diarrhoea, 247, 283 Diastolic, 247, 260 Dicyclomine, 231, 247 Diffusion, 56, 235, 247, 295 Digestion, 156, 229, 234, 236, 247, 248, 263, 266, 290, 296 Digestive system, 146, 247 Digestive tract, 212, 247, 289 Dihydrotestosterone, 227, 247, 285 Dilatation, 247, 263, 280, 283, 295 Dilution, 62, 247 Dimerization, 28, 247 Diphosphonates, 159, 247 Diploid, 243, 247, 278 Direct, iii, 30, 33, 47, 50, 56, 60, 69, 71, 77, 189, 241, 247, 255, 285 Discrimination, 33, 247 Disparity, 49, 247 Distal, 30, 152, 161, 163, 247, 248, 283 Diuresis, 237, 247 Dizziness, 210, 247 Dorsal, 47, 248, 279 Dorsum, 248 Doxazosin, 40, 41, 55, 248 Drive, ii, vi, 10, 11, 17, 22, 28, 36, 121, 177, 178, 248 Drug Interactions, 180, 191, 248 Drug Utilization, 85, 248 Duct, 230, 238, 248, 252, 275, 287 Duodenum, 234, 248, 249, 290 Dura mater, 248, 268, 275 Dyspepsia, 75, 248 Dysplasia, 11, 202, 248 Dyspnea, 245, 248 Dystrophy, 201, 248, 271 Dysuria, 4, 5, 160, 171, 178, 248 E Ecosystem, 43, 248 Ectopic, 247, 248 Edema, 245, 248, 295 Effector, 227, 242, 248, 265 Elasticity, 160, 248 Elastin, 156, 242, 248 Elective, 170, 248 Electrode, 47, 231, 238, 248 Electrolysis, 231, 238, 248 Electrolyte, 248, 258, 279, 295 Electron microscope, 249, 272 Electrons, 232, 234, 238, 249, 264, 272, 275, 284
Electrophoresis, 27, 32, 91, 249 Eligibility Determination, 53, 249 Embryo, 239, 249, 261, 274 Embryogenesis, 249, 290 Emphysema, 156, 240, 249, 283 Empiric, 5, 17, 19, 20, 38, 56, 90, 249 Empirical, 5, 14, 90, 249 Emulsion, 249, 253 Endemic, 116, 240, 249, 290 Endocarditis, 60, 237, 249 Endocardium, 249 Endocrinology, 249, 257 Endometrium, 249, 268 Endoscope, 249 Endoscopic, 100, 130, 245, 249 Endothelium, 250, 273 Endothelium-derived, 250, 273 Endotoxins, 242, 250 End-stage renal, 240, 250, 279 Enoxacin, 74, 99, 250 Enterotoxins, 96, 250 Enuresis, 186, 250 Environmental Exposure, 250, 274 Environmental Health, 196, 198, 250 Enzymatic, 48, 237, 242, 246, 250, 258, 279, 286 Enzyme-Linked Immunosorbent Assay, 89, 250 Eosinophils, 250, 257, 266 Epidemic, 250, 290 Epidemiologic Factors, 7, 250 Epidemiological, 36, 37, 58, 60, 63, 64, 176, 250 Epidermis, 152, 244, 250, 259 Epigastric, 251, 275 Epinephrine, 228, 251, 273 Epithelial, 23, 26, 30, 34, 39, 42, 45, 50, 61, 64, 71, 150, 213, 235, 251, 296 Epithelial Cells, 23, 26, 30, 34, 39, 45, 50, 61, 64, 71, 150, 213, 251 Epithelium, 11, 23, 38, 42, 64, 250, 251, 264 Epitope, 40, 168, 251 Epitope Mapping, 40, 251 Equipment and Supplies, 181, 251 Erectile, 251, 276 Erythrocytes, 230, 236, 251, 255 Esophagus, 247, 251, 285, 290 Essential Tremor, 201, 251 Estradiol, 251 Estriol, 109, 123, 251 Estrogen, 8, 10, 18, 20, 36, 65, 187, 251, 274 Ethnic Groups, 55, 251
304 Urinary Tract Infections
Eukaryotic Cells, 25, 37, 57, 251, 261, 274 Evacuation, 47, 243, 252 Excisional, 52, 252 Excitability, 252, 272 Exfoliation, 23, 45, 252 Exocrine, 104, 252, 275 Exocytosis, 252, 259 Exogenous, 43, 65, 252, 282, 295 Exotoxins, 53, 252 Expeditions, 36, 252 Expiration, 252, 285 Extracellular, 52, 64, 230, 235, 243, 252, 268 Extracellular Matrix, 243, 252, 268 F Faecal, 89, 247, 252 Failure to Thrive, 22, 252 Family Planning, 197, 252 Fat, 230, 232, 236, 252, 265, 266, 270, 286, 289 Fatigue, 212, 252, 258 Fatty acids, 229, 238, 246, 252, 281 Febrile, 6, 16, 18, 80, 115, 179, 180, 198, 216, 252 Fecal Incontinence, 7, 252, 261 Feces, 162, 243, 252, 291 Fetal Death, 184, 252 Fetus, 106, 252, 253, 278, 296 Fibrin, 235, 252, 292, 296 Fibrosis, 25, 54, 57, 202, 252, 287 Finasteride, 40, 41, 55, 253 Fissure, 242, 253 Fixation, 58, 253 Flagellum, 71, 253, 294 Flank Pain, 4, 253 Flatus, 252, 253, 254 Fleroxacin, 71, 74, 93, 131, 253 Flexion, 253, 283 Fluorescence, 31, 37, 66, 253 Flush, 166, 253 Foetoplacental, 253, 274 Fold, 57, 253, 280 Foramen, 242, 253 Forearm, 236, 253 Fosfomycin, 94, 95, 124, 190, 253 Fovea, 253 Fractionation, 68, 253 Frail Elderly, 67, 253 Frameshift, 253, 254, 295 Frameshift Mutation, 254, 295 Fungemia, 62, 254 Fungi, 62, 157, 231, 254, 263, 269, 298 Fungus, 237, 239, 254
G Gallbladder, 227, 234, 247, 254 Ganglia, 227, 233, 234, 239, 254, 272 Gangrenous, 254, 288 Gardnerella, 36, 95, 100, 254, 296 Gardnerella vaginalis, 36, 95, 100, 254, 296 Gas, 25, 228, 230, 234, 237, 246, 247, 253, 254, 259, 272, 273, 297 Gas exchange, 25, 254, 297 Gastric, 157, 230, 233, 254, 258 Gastric Acid, 230, 254 Gastrin, 254, 259 Gastrointestinal, 27, 236, 241, 247, 251, 254, 273, 276, 278, 290, 291, 295 Gastrointestinal tract, 27, 254, 276, 290, 295 Gelatin, 245, 254, 291, 292 Gene Expression, 30, 33, 34, 37, 50, 60, 77, 202, 255 Gene Library, 255 General practitioner, 95, 119, 255 Genetic testing, 255, 279 Genetics, 35, 39, 91, 255 Genital, 18, 43, 47, 63, 76, 211, 213, 241, 254, 255, 257, 296 Genitourinary, 5, 7, 9, 22, 76, 130, 255, 296 Genomic Library, 34, 255 Genomics, 33, 255 Genotype, 255, 277 Geriatric, 87, 113, 255 Giant Cells, 46, 255 Giardiasis, 255, 269 Gland, 228, 240, 255, 267, 268, 275, 281, 287, 290, 293 Globosides, 149, 255 Glomerular, 130, 255, 264, 285 Glomerular Filtration Rate, 130, 255 Glomeruli, 255, 283 Glomerulus, 255, 272 Glucose, 31, 49, 201, 232, 235, 239, 246, 255, 256, 258, 263 Glucose Intolerance, 246, 256 Glucuronic Acid, 256, 258 Glutamic Acid, 256, 280 Glutamine, 58, 256 Glycogen, 240, 256 Glycoprotein, 128, 255, 256, 293 Glycosaminoglycans, 256, 282 Glycosidic, 256, 274 Glycosylation, 61, 256 Gonorrhea, 210, 239, 256 Governing Board, 256, 280
Index 305
Gp120, 256, 276 Grade, 23, 256 Graft, 111, 116, 256, 259, 261 Graft Rejection, 256, 261 Grafting, 256, 261 Gram-Negative Bacteria, 59, 63, 257, 271, 279 Gram-positive, 26, 33, 56, 60, 98, 169, 238, 239, 250, 257, 260, 265, 271, 273, 274, 278, 291 Gram-Positive Bacteria, 250, 257, 274, 278 Granulocytes, 156, 234, 257, 266, 298 Guanylate Cyclase, 257, 273 Gynecology, 106, 160, 257 Gyrase, 253, 257, 273 H Haemophilus, 51, 239, 254, 257 Half-Life, 238, 257 Haploid, 50, 257, 278 Headache, 151, 237, 257, 280 Headache Disorders, 257 Health Care Costs, 50, 65, 257 Health Expenditures, 257 Health Services, iv, 24, 29, 98, 199, 246, 257 Heart failure, 258, 280 Hematuria, 171, 206, 258 Hemodiafiltration, 258, 295 Hemodialysis, 258, 295 Hemodynamics, 25, 258 Hemofiltration, 258, 295 Hemoglobin, 230, 251, 258, 266 Hemoglobinuria, 201, 258 Hemorrhage, 160, 239, 244, 257, 258, 291 Heparin, 38, 258 Hepatic, 229, 258 Hereditary, 258, 278, 286 Heredity, 254, 255, 258 Heterogeneity, 61, 228, 258 Heterotrophic, 254, 258 Hexosaminidases, 255, 258 Histamine, 151, 230, 258, 259 Histamine Release, 151, 230, 259 Histidine, 258, 259 Homogeneous, 177, 243, 259 Homologous, 75, 229, 259, 287, 294 Hormonal, 233, 259 Hormone, 24, 65, 235, 244, 251, 254, 259, 263, 268, 280, 286, 292 Horny layer, 251, 259 Horseradish Peroxidase, 250, 259 Humoral, 91, 256, 259
Humour, 259 Hybrid, 31, 241, 259 Hybridization, 33, 34, 259, 261, 273 Hydrogel, 56, 69, 259 Hydrogen, 50, 227, 229, 234, 237, 246, 259, 270, 272, 273, 275, 277, 283 Hydrogen Peroxide, 50, 259 Hydrolysis, 234, 238, 258, 259, 279, 282, 287 Hydronephrosis, 17, 259 Hydrophilic, 46, 259 Hydrophobic, 260, 266 Hydroxylysine, 242, 260 Hydroxyproline, 242, 260 Hyperbilirubinemia, 260, 264 Hypercalciuria, 123, 124, 260 Hyperplasia, 134, 260, 281, 282 Hypersensitivity, 260, 286 Hypertension, 11, 17, 20, 21, 104, 118, 172, 177, 179, 239, 248, 257, 260, 280, 295 Hypertrophy, 234, 260, 280 Hypoglycemia, 31, 260 Hypoplasia, 11, 260 Hysterectomy, 65, 260 I Id, 125, 134, 206, 207, 216, 217, 222, 224, 260 Idiopathic, 98, 124, 260 Iguanas, 132, 260 Ileostomy, 260, 271 Imipenem, 79, 98, 110, 123, 241, 260 Immersion, 234, 260 Immune response, 46, 57, 64, 65, 166, 168, 231, 232, 233, 256, 260, 261, 291, 296, 297 Immune Sera, 260, 261 Immune system, 63, 150, 158, 209, 232, 260, 261, 267, 270, 296, 298 Immunity, 7, 60, 65, 91, 95, 150, 166, 245, 260, 261, 293 Immunization, 7, 8, 19, 38, 53, 161, 162, 260, 261 Immunoassay, 155, 156, 250, 261 Immunochemistry, 251, 261 Immunocompromised, 39, 95, 161, 261 Immunodeficiency, 27, 63, 201, 261 Immunogen, 7, 38, 168, 261 Immunogenic, 166, 168, 261 Immunoglobulin, 75, 231, 261, 270 Immunologic, 22, 38, 43, 240, 261 Immunosuppressive, 21, 261 Immunosuppressive therapy, 261 Immunotherapy, 162, 261
306 Urinary Tract Infections
Impairment, 17, 233, 261, 269 Implantation, 99, 243, 261, 274 In situ, 33, 261 In Situ Hybridization, 33, 261 In vivo, 31, 37, 44, 51, 52, 56, 58, 59, 60, 64, 66, 73, 158, 258, 261 Incision, 261, 264, 281, 286 Incontinence, 7, 8, 20, 24, 30, 33, 40, 41, 42, 47, 53, 55, 65, 119, 135, 160, 186, 247, 252, 261, 291 Incubated, 67, 261 Indicative, 119, 148, 173, 261, 276, 296 Induction, 31, 37, 48, 57, 64, 66, 111, 261 Infancy, 15, 86, 112, 152, 262 Infant, Newborn, 228, 262 Infarction, 239, 244, 262, 263, 269 Infection Control, 29, 56, 82, 92, 99, 101, 181, 262 Infertility, 262, 296 Information Science, 262, 268 Infusion, 164, 262 Ingestion, 64, 253, 262, 278 Inhalation, 162, 228, 262, 278 Initiation, 48, 262 Inlay, 262, 286 Inner ear, 238, 262, 296 Inorganic, 262, 270, 277 Inpatients, 79, 262 Insight, 27, 37, 50, 55, 262 Insomnia, 151, 262, 280 Instillation, 8, 25, 262 Institutionalization, 65, 262 Insulator, 263, 270 Insulin, 246, 263, 265, 295 Intensive Care, 62, 108, 263 Intensive Care Units, 62, 263 Interferon, 35, 263 Interferon-alpha, 263 Intermittent, 15, 165, 198, 263, 267 Internal Medicine, 4, 5, 8, 9, 25, 29, 96, 100, 114, 160, 249, 263 Interstitial, 23, 38, 47, 61, 210, 263, 272, 285 Intestinal, 84, 157, 163, 250, 263, 265, 267 Intestinal Flora, 163, 263 Intestine, 157, 231, 236, 248, 251, 255, 259, 263, 265, 284, 285, 289, 291 Intoxication, 263, 298 Intracellular, 23, 50, 51, 52, 64, 237, 262, 263, 268, 273, 279, 281 Intracellular Membranes, 263, 268 Intracranial Aneurysm, 239, 263 Intracranial Arteriosclerosis, 239, 263
Intramuscular, 263, 276 Intravenous, 16, 18, 29, 74, 76, 100, 101, 212, 214, 215, 254, 262, 263, 264, 276 Intravenous pyelogram, 212, 214, 215, 263 Intravenous pyelography, 18, 264 Intravesical, 38, 83, 264 Intrinsic, 58, 228, 264 Introns, 255, 264 Intubation, 238, 264 Inulin, 255, 264 Invasive, 8, 17, 30, 52, 86, 148, 260, 264, 267 Involuntary, 186, 234, 250, 251, 252, 264, 271, 289 Ion Channels, 46, 264 Ion Exchange, 56, 239, 264 Ions, 234, 248, 259, 264, 279 Iris, 244, 264, 283 Irrigation, 82, 164, 264 Ischemia, 233, 264 J Jaundice, 107, 260, 264 Joint, 228, 241, 246, 264, 292 K Kb, 196, 264 Ketone Bodies, 246, 265 Ketosis, 246, 265 Kidney Disease, 40, 143, 146, 151, 172, 176, 196, 202, 206, 207, 212, 216, 217, 259, 265 Kidney Pelvis, 265, 295 Kidney stone, 28, 214, 259, 265, 275, 291 Kidney Transplantation, 104, 265 Killer Cells, 65, 265, 271 L Labile, 242, 265 Labyrinth, 262, 265, 297 Lactation, 265, 274 Lactobacillus, 8, 36, 43, 50, 69, 74, 128, 132, 138, 265 Large Intestine, 247, 263, 265, 284, 285, 289 Latent, 265, 280 Lavage, 155, 265 Lectin, 265, 268 Length of Stay, 21, 265 Lens, 237, 265, 285 Lesion, 52, 133, 151, 265, 266, 288 Lethal, 25, 233, 265 Leucine, 30, 266 Leucocyte, 229, 266 Leukemia, 201, 266 Leukocyte Count, 4, 266
Index 307
Leukocytes, 59, 64, 236, 240, 250, 257, 263, 266, 270 Leukocytosis, 4, 266 Levofloxacin, 9, 20, 184, 266 Library Services, 222, 266 Life cycle, 254, 266 Ligament, 266, 281 Ligands, 38, 266 Lincomycin, 241, 266 Linkage, 65, 266 Lipid, 31, 61, 232, 263, 266, 270 Lipophilic, 47, 266 Lipopolysaccharide, 58, 59, 73, 257, 266 Lipoprotein, 31, 257, 266, 267 Liposomes, 40, 46, 266 Liver, 151, 227, 229, 232, 234, 247, 249, 252, 254, 256, 258, 266, 287, 295 Liver scan, 266, 287 Localization, 48, 266 Localized, 52, 74, 227, 246, 253, 262, 267, 278 Locomotion, 253, 267, 278 Long-Term Care, 10, 19, 29, 48, 267 Low-density lipoprotein, 266, 267 Lumbar, 233, 267 Lumen, 160, 267, 295 Lupus, 151, 267 Lymph, 240, 250, 259, 267 Lymph node, 240, 267 Lymphatic, 250, 262, 267, 293 Lymphocele, 105, 267 Lymphocyte, 231, 265, 267, 268 Lymphoid, 231, 266, 267, 293 Lymphoma, 201, 267 Lysine, 52, 260, 267 Lytic, 267, 288, 297 M Magnetic Resonance Imaging, 267, 287 Malabsorption, 201, 267 Malaise, 104, 152, 267 Malignancy, 9, 267 Malignant, 159, 201, 267, 272 Malignant tumor, 159, 267 Malnutrition, 229, 233, 267, 271 Manifest, 55, 209, 268 Mastitis, 268, 288 Matrilysin, 34, 268 Matrix metalloproteinase, 268 Mediate, 26, 44, 48, 60, 63, 64, 66, 265, 268 Mediator, 48, 268 Medical Informatics, 26, 268 Medical Records, 9, 65, 268
Medicament, 268, 291 MEDLINE, 197, 200, 202, 268 Melanocytes, 268 Melanoma, 201, 268 Membrane Proteins, 26, 61, 266, 268 Meninges, 238, 239, 244, 248, 268 Meningitis, 58, 80, 268 Menopause, 65, 268, 274, 279, 280 Menstrual Cycle, 151, 268, 274, 280 Menstruation, 268, 280 Mental Disorders, 146, 268, 283 Mental Health, iv, 24, 146, 196, 199, 269, 283 Mental Retardation, 184, 203, 269 Meta-Analysis, 111, 269 Metabolite, 251, 269 Metastasis, 268, 269, 272 Methionine, 138, 269, 291 Metronidazole, 63, 269 MI, 107, 169, 225, 269 Microbe, 269, 293 Microbiological, 5, 9, 27, 63, 85, 156, 269 Microorganism, 46, 241, 269, 276, 297 Micro-organism, 159, 246, 248, 269, 288 Microscopy, 44, 45, 67, 259, 269 Microspheres, 75, 269 Micturition, 47, 61, 269, 282 Milliliter, 4, 163, 269 Mitochondria, 269, 274 Mitochondrial Swelling, 269, 271 Mitosis, 232, 270 Mobility, 159, 270 Modeling, 28, 159, 270 Modification, 22, 82, 148, 270, 283 Monitor, 33, 91, 158, 244, 270, 273 Monoclonal, 25, 53, 59, 270, 284 Monoclonal antibodies, 53, 59, 270 Monocytes, 266, 270 Morphology, 156, 270 Motion Sickness, 270, 271 Mucins, 246, 270 Mucosa, 6, 59, 64, 168, 214, 267, 270 Mucus, 83, 155, 160, 270 Multicenter study, 32, 77, 91, 102, 270 Multiple sclerosis, 198, 270 Muscle Fibers, 270, 271 Muscular Atrophy, 201, 271 Muscular Dystrophies, 248, 271 Mutagenesis, 44, 45, 46, 50, 66, 68, 271 Mutagens, 254, 271 Mutate, 61, 271 Mycoplasma, 63, 94, 239, 271
308 Urinary Tract Infections
Myelin, 270, 271 Myocardium, 269, 271 Myotonic Dystrophy, 201, 271 N Nalidixic Acid, 10, 271 Natural killer cells, 65, 271 Natural selection, 235, 271 Nausea, 151, 210, 265, 271, 280, 295 NCI, 1, 41, 145, 195, 271 Necrosis, 25, 232, 239, 262, 269, 271 Necrotizing Enterocolitis, 132, 271 Need, 3, 4, 5, 6, 10, 14, 16, 35, 46, 49, 51, 53, 62, 101, 151, 153, 158, 159, 164, 167, 169, 171, 172, 175, 176, 180, 181, 185, 186, 198, 207, 209, 210, 211, 214, 218, 228, 240, 256, 268, 271 Negative Staining, 61, 271 Neonatal, 58, 100, 102, 107, 272 Neoplasia, 201, 272 Neoplasms, 158, 272, 292 Neoplastic, 230, 267, 272 Nephritis, 179, 272 Nephropathy, 4, 171, 265, 272 Nerve, 47, 228, 230, 233, 246, 268, 270, 272, 275, 286, 287, 290, 294 Nerve Fibers, 47, 272 Nervous System, 201, 213, 227, 228, 233, 237, 239, 254, 256, 257, 268, 270, 272, 291, 297 Nervousness, 152, 272 Netilmicin, 74, 272 Networks, 145, 272 Neural, 47, 228, 230, 259, 272 Neurogenic, 4, 12, 198, 272, 296 Neurology, 49, 83, 272 Neuromuscular, 7, 227, 272, 295 Neurons, 47, 246, 254, 272 Neutrons, 229, 272, 284 Neutropenia, 9, 254, 272 Neutrophil, 48, 272 Nitric Oxide, 34, 47, 272 Nitroblue Tetrazolium, 87, 273 Nitrofurantoin, 7, 94, 122, 149, 172, 180, 184, 190, 273 Nitrogen, 229, 246, 253, 256, 273, 294 Norepinephrine, 228, 273 Norfloxacin, 10, 15, 62, 71, 74, 76, 80, 89, 90, 103, 108, 273 Nosocomial, 4, 9, 25, 29, 33, 54, 56, 57, 66, 68, 72, 73, 94, 97, 98, 102, 108, 113, 273 Nuclear, 131, 215, 234, 249, 252, 271, 273 Nucleic acid, 259, 261, 271, 273
Nucleic Acid Hybridization, 259, 273 Nucleus, 232, 233, 234, 240, 245, 246, 250, 251, 270, 272, 273, 282, 285, 291, 292 Nursing Care, 273, 276 Nursing Process, 27, 273 Nursing Staff, 67, 92, 273 O Observational study, 62, 274 Obstetrics, 104, 106, 160, 274 Occult, 115, 274 Oestrogen, 104, 274 Office Visits, 9, 274 Ofloxacin, 9, 20, 69, 76, 77, 84, 85, 98, 109, 184, 274 Oligosaccharides, 46, 258, 274 Oncogene, 201, 274, 290 Opacity, 246, 274 Operon, 29, 274, 285 Ophthalmology, 253, 274 Orbital, 242, 274 Orderly, 161, 274 Organ Culture, 274, 293 Organelles, 26, 40, 245, 268, 270, 274, 278 Osmolarity, 46, 274 Osmoles, 274, 275 Osmotic, 229, 269, 275 Osteoporosis, 145, 274, 275 Ostomy, 122, 128, 167, 275 Outpatient, 5, 8, 9, 17, 20, 65, 275 Ovary, 244, 251, 274, 275 Ovum, 244, 266, 275, 280 Oxalate, 275, 296 Oxazolidinones, 169, 275 Oxidation, 232, 245, 246, 275 P Pachymeningitis, 268, 275 Paediatric, 99, 275 Palliative, 274, 275, 292 Pancreas, 104, 227, 235, 247, 263, 275, 295 Pancreatic, 201, 275 Pancreatic cancer, 201, 275 Pancreatitis, 169, 275 Paralysis, 198, 275 Parasite, 173, 275, 294 Parasitic, 275, 294 Parenteral, 35, 99, 108, 276 Paroxysmal, 201, 257, 276 Particle, 61, 276, 289 Parturition, 274, 276 Patch, 46, 276 Pathogen, 5, 9, 17, 23, 26, 46, 57, 60, 89, 161, 167, 177, 276
Index 309
Pathologic, 47, 227, 232, 235, 237, 244, 260, 276 Pathologic Processes, 232, 276 Pathophysiology, 38, 176, 276 Patient Care Management, 178, 276 Patient Education, 208, 213, 220, 222, 225, 276 Peer Review, 18, 121, 276 Pelvic, 8, 27, 43, 63, 65, 113, 116, 117, 122, 124, 131, 135, 211, 276, 281 Pelvic inflammatory disease, 27, 43, 63, 276 Penicillin, 230, 231, 237, 276 Penis, 209, 243, 276, 277, 280 Pentosan polysulfate, 38, 276 Peptide, 51, 165, 168, 276, 279, 282 Peptide T, 168, 276 Perfusion, 276, 293 Perineal, 18, 277, 284 Perineum, 277 Periodontal disease, 159, 277 Periodontitis, 159, 277 Peripheral blood, 64, 263, 277 Peroxide, 50, 259, 277 PH, 6, 24, 40, 41, 42, 52, 54, 119, 277 Phagocytosis, 48, 58, 277 Phallic, 253, 277 Pharmacokinetic, 76, 94, 277 Pharmacologic, 55, 230, 257, 277, 293, 296 Phenotype, 14, 42, 64, 242, 277 Phospholipids, 252, 266, 277 Phosphonic Acids, 247, 277 Phosphorus, 237, 277 Photodynamic therapy, 52, 277 Photosensitizer, 52, 277 Physical Examination, 16, 22, 24, 178, 215, 277 Physical Fitness, 31, 277 Physiologic, 55, 173, 235, 246, 257, 264, 268, 277, 281, 284 Physiology, 65, 210, 227, 233, 249, 257, 278 Pigment, 234, 268, 278 Pilot study, 32, 40, 278 Pipemidic Acid, 122, 124, 278 Placenta, 251, 253, 278, 280, 283 Plants, 51, 236, 237, 241, 245, 256, 264, 265, 270, 273, 278, 289, 293, 297 Plaque, 61, 159, 240, 246, 278 Plasma, 229, 231, 240, 254, 255, 256, 258, 271, 273, 278, 284, 287, 293 Plasma cells, 231, 278 Plasma protein, 229, 278
Plasmids, 88, 278 Plastids, 274, 278 Platelet Aggregation, 230, 273, 278 Platelets, 273, 278 Pneumonitis, 53, 278 Point Mutation, 43, 278 Poisoning, 263, 271, 278, 288 Polycystic, 202, 278 Polyethylene, 163, 279 Polymerase, 67, 279, 285 Polymerase Chain Reaction, 67, 279 Polymers, 46, 235, 279, 282 Polymorphism, 72, 93, 279, 286 Polypeptide, 166, 229, 241, 259, 279, 282, 298 Polysaccharide, 38, 58, 231, 239, 279, 282 Porins, 46, 279 Port, 152, 164, 279 Port-a-cath, 279 Posterior, 111, 230, 233, 248, 264, 275, 279 Postmenopausal, 10, 36, 69, 92, 109, 275, 279 Postoperative, 21, 104, 111, 254, 279 Potassium, 186, 279 Potentiate, 153, 279 Practicability, 279, 294 Practice Guidelines, 179, 199, 215, 280 Prazosin, 41, 280 Precipitation, 45, 280 Preclinical, 52, 280 Precursor, 58, 232, 248, 250, 273, 280, 294 Predisposition, 91, 280 Premenopausal, 22, 36, 280 Premenstrual, 150, 280 Premenstrual Syndrome, 150, 280 Prepuce, 241, 280 Presumptive, 14, 48, 156, 280 Prevalence, 4, 5, 7, 11, 19, 27, 29, 32, 36, 82, 84, 90, 97, 179, 186, 280 Probe, 36, 40, 280 Progesterone, 65, 280, 290 Progression, 24, 40, 41, 42, 55, 163, 231, 268, 280 Progressive, 41, 177, 239, 240, 257, 271, 280, 285 Projection, 246, 273, 280, 285 Prolapse, 7, 18, 65, 280, 296 Proline, 51, 242, 260, 280 Promoter, 30, 58, 66, 281 Prone, 6, 168, 212, 216, 281
310 Urinary Tract Infections
Prophylaxis, 6, 8, 11, 12, 13, 18, 19, 21, 22, 23, 72, 74, 84, 89, 104, 122, 127, 144, 163, 177, 198, 231, 273, 281, 296 Proportional, 250, 281 Prospective Studies, 15, 63, 281 Prospective study, 4, 14, 16, 97, 111, 281 Prostaglandin, 48, 111, 170, 281 Prostaglandins A, 281 Prostate gland, 240, 281 Prostatectomy, 24, 111, 281, 284, 286 Prostatic Hyperplasia, 6, 24, 40, 41, 42, 52, 54, 134, 234, 253, 281 Prostatism, 7, 41, 282 Prostatitis, 7, 55, 58, 76, 135, 180, 214, 240, 282 Prosthesis, 47, 282 Protease, 242, 282 Protein Binding, 31, 282, 293 Protein C, 27, 44, 166, 229, 232, 233, 255, 266, 282, 295 Protein Conformation, 229, 282 Protein Folding, 51, 282 Protein S, 39, 60, 175, 202, 235, 282, 286, 292 Protein Subunits, 60, 282 Proteinuria, 31, 118, 171, 282 Proteoglycan, 156, 282 Proteolytic, 229, 242, 282 Proteus, 4, 26, 28, 44, 45, 62, 70, 71, 72, 75, 76, 77, 152, 153, 162, 163, 282 Protocol, 20, 21, 24, 36, 40, 53, 54, 78, 91, 211, 282 Protons, 229, 259, 282, 284 Protozoa, 269, 283 Protozoal, 244, 283 Proximal, 30, 152, 247, 283 Psychiatry, 253, 283 Psychogenic, 283, 296 Public Health, 12, 37, 50, 78, 114, 116, 123, 128, 133, 182, 199, 283 Public Policy, 197, 283 Publishing, 19, 20, 21, 69, 262, 283 Puerperium, 274, 283 Pulmonary, 79, 156, 236, 240, 243, 258, 283 Pulmonary Artery, 236, 283 Pulmonary Emphysema, 156, 283 Pulse, 270, 283 Pupil, 244, 283 Purulent, 283, 294, 296 Pyelitis, 113, 160, 163, 283 Pyogenic, 251, 283, 288
Q Quality of Life, 24, 33, 35, 40, 47, 49, 54, 65, 283 Quaternary, 282, 284 Quinolones, 62, 99, 107, 284 R Radiation, 18, 250, 253, 269, 276, 284, 287, 298 Radiation therapy, 253, 276, 284 Radical prostatectomy, 111, 284 Radioactive, 236, 257, 259, 261, 266, 270, 273, 284, 287 Radiography, 76, 284, 296 Random Allocation, 284 Randomization, 40, 284 Randomized, 8, 12, 24, 31, 40, 41, 43, 48, 53, 54, 71, 72, 74, 76, 78, 91, 122, 127, 144, 248, 284 Randomized clinical trial, 53, 74, 284 Receptor, 26, 34, 41, 44, 55, 59, 60, 63, 64, 169, 170, 227, 231, 241, 243, 256, 276, 284, 290 Recombinant, 25, 27, 28, 61, 64, 284 Reconstitution, 40, 64, 284 Rectal, 42, 72, 78, 143, 284 Rectum, 158, 210, 232, 236, 246, 247, 253, 254, 261, 265, 281, 284, 285, 291, 294 Recurrence, 12, 18, 22, 27, 42, 63, 128, 153, 163, 167, 168, 186, 210, 211, 240, 285 Red Nucleus, 233, 285 Reductase, 40, 41, 55, 253, 285 Refer, 1, 236, 242, 247, 253, 254, 266, 267, 272, 273, 285 Reference Standards, 36, 285 Reflective, 57, 285 Refraction, 285, 289 Refractory, 285, 294 Regeneration, 284, 285 Regimen, 5, 21, 248, 285 Regulon, 57, 285 Reliability, 15, 285 Remission, 285 Renal failure, 24, 41, 179, 279, 285, 295 Renal pelvis, 265, 285 Repressor, 274, 285 Research Personnel, 41, 285 Resection, 164, 254, 281, 285, 294 Residual Volume, 24, 30, 285 Resolving, 211, 285 Respiration, 237, 269, 270, 285 Response rate, 16, 286 Restoration, 47, 284, 286, 298
Index 311
Retina, 265, 286, 287 Retinal, 243, 247, 286 Retinoblastoma, 201, 286 Retinopathy, 31, 286 Retropubic, 281, 284, 286 Retropubic prostatectomy, 284, 286 Retrospective, 21, 65, 286 Reversion, 286, 295 Rheumatism, 286 Rheumatoid, 4, 286 Rheumatoid arthritis, 4, 286 Rhinitis, 286, 288 Ribosome, 286, 294 Ribotyping, 51, 286 Rigidity, 278, 286 Ristocetin, 286, 296 Rod, 234, 241, 251, 257, 265, 282, 287 S Saccule, 287, 297 Salivary, 246, 247, 275, 287 Salivary glands, 246, 247, 287 Saponification, 148, 287 Scans, 6, 215, 287 Schizoid, 287, 298 Schizophrenia, 287, 298 Schizotypal Personality Disorder, 287, 298 Sclerosis, 198, 201, 263, 270, 287, 294 Screening, 13, 18, 42, 72, 113, 154, 156, 241, 287, 295 Secretion, 30, 39, 57, 247, 258, 259, 265, 270, 287, 296 Secretory, 53, 287 Sediment, 287, 295 Segregation, 234, 287 Seizures, 276, 287 Self Care, 215, 287 Semen, 281, 287 Semisynthetic, 230, 238, 239, 241, 260, 272, 287 Sensor, 32, 57, 158, 288 Sepsis, 9, 25, 54, 68, 102, 132, 160, 161, 169, 170, 254, 288 Septic, 170, 232, 282, 288 Septicaemia, 288 Septicemia, 25, 288 Sequence Homology, 50, 276, 288 Sequencing, 35, 279, 288 Serologic, 261, 288 Serotypes, 32, 288 Serum, 24, 49, 55, 57, 65, 75, 89, 166, 229, 230, 242, 248, 260, 267, 284, 288 Sex Characteristics, 228, 274, 288, 292
Sex Determination, 201, 288 Sex Ratio, 86, 288 Sexually Transmitted Diseases, 3, 27, 63, 211, 288 Shedding, 59, 288 Shock, 51, 151, 170, 288, 294 Sialic Acids, 58, 288 Side effect, 12, 55, 151, 189, 210, 212, 228, 238, 288, 293 Signs and Symptoms, 210, 213, 285, 288, 295 Skeletal, 241, 271, 288 Skeleton, 227, 264, 281, 288, 289 Skull, 244, 289, 292 Small intestine, 240, 248, 255, 259, 263, 289 Smooth muscle, 54, 230, 237, 243, 258, 289, 291 Sneezing, 288, 289, 291 Social Environment, 284, 289 Soft tissue, 52, 94, 236, 238, 288, 289 Somatic, 228, 249, 259, 270, 289 Sonogram, 209, 289, 294 Sound wave, 285, 289, 294 Spatial disorientation, 247, 289 Specialist, 49, 218, 289 Specificity, 36, 156, 179, 228, 289, 291, 293 Spectrum, 5, 18, 32, 44, 51, 62, 84, 114, 230, 236, 238, 239, 250, 253, 260, 273, 274, 289 Sperm, 7, 240, 289 Spermatozoa, 287, 289 Spermicide, 12, 14, 289 Sphincter, 47, 289, 291 Spices, 210, 289 Spina bifida, 4, 289 Spinal cord, 47, 54, 89, 109, 133, 174, 198, 239, 240, 248, 268, 272, 275, 290 Spinal Cord Injuries, 174, 290 Spinal Injuries, 118, 290 Spinous, 250, 290 Sporadic, 35, 150, 286, 290 Sputum, 155, 157, 162, 290 Staging, 287, 290 Standardize, 28, 290 Stasis, 153, 290 Statistically significant, 67, 290 Steel, 241, 290 Stem Cell Factor, 39, 241, 290 Stent, 275, 290 Sterile, 9, 56, 161, 232, 290 Sterility, 6, 18, 262, 290 Sterilization, 156, 290 Steroid, 244, 274, 290
312 Urinary Tract Infections
Stimulant, 237, 258, 290 Stimulus, 244, 248, 264, 290, 292 Stoma, 275, 290 Stomach, 151, 157, 227, 233, 247, 251, 254, 259, 265, 271, 285, 289, 290 Stool, 261, 265, 291 Strand, 100, 279, 291 Streptococcal, 95, 266, 291 Streptococci, 62, 291 Streptococcus, 68, 162, 163, 291 Stress, 5, 16, 18, 20, 22, 58, 151, 244, 271, 280, 286, 291 Stress urinary, 20, 291 Stricture, 21, 291 Stroke, 49, 146, 196, 291 Stromal, 64, 291 Struvite, 45, 153, 166, 291, 296 Subacute, 262, 291 Subarachnoid, 257, 291 Subclinical, 262, 287, 291 Subcutaneous, 51, 248, 254, 276, 291 Subspecies, 289, 291 Substance P, 269, 284, 287, 291 Substrate, 156, 250, 291 Substrate Specificity, 156, 291 Sulfur, 237, 269, 291 Suppositories, 8, 254, 291 Suppression, 273, 291 Symphysis, 281, 292 Symptomatic, 4, 7, 10, 14, 15, 17, 18, 26, 27, 42, 43, 54, 63, 66, 75, 78, 144, 177, 275, 292 Syncytium, 255, 292 Systolic, 260, 292 T Tachycardia, 233, 292 Tachypnea, 233, 292 Teichoic Acids, 257, 292 Telangiectasia, 201, 292 Temporal, 33, 42, 55, 257, 292 Testis, 251, 274, 292 Testosterone, 227, 253, 285, 292 Tetracycline, 51, 80, 292 Thalamic, 233, 292 Thalamic Diseases, 233, 292 Therapeutics, 27, 37, 53, 88, 191, 292 Thermal, 272, 279, 292 Thermoregulation, 58, 292 Thigh, 283, 292 Thoracic, 233, 247, 292 Thorax, 227, 267, 292 Threonine, 276, 292
Threshold, 148, 252, 260, 292 Thrombin, 252, 278, 282, 292, 293 Thrombomodulin, 282, 293 Thrombosis, 244, 263, 269, 282, 291, 293 Thymus, 261, 267, 293 Thyroxine, 229, 293 Tissue Culture, 44, 65, 293 Tissue Distribution, 51, 293 Toilet Training, 23, 215, 293 Tomography, 74, 131, 243, 287, 293 Tonsils, 162, 293 Tooth Preparation, 227, 293 Topical, 63, 240, 259, 293 Toxic, iv, 51, 52, 233, 245, 250, 260, 293, 296 Toxicity, 51, 74, 248, 272, 287, 293 Toxicology, 198, 293 Toxins, 25, 53, 57, 59, 231, 250, 252, 256, 262, 270, 288, 293, 297 Traction, 241, 293 Tractus, 293 Transfection, 235, 293 Transfer Factor, 261, 293 Transferases, 256, 293 Translation, 68, 294 Translational, 48, 294 Translocating, 25, 294 Translocation, 30, 53, 57, 294 Transmitter, 227, 264, 268, 273, 294 Transplantation, 21, 92, 94, 99, 104, 116, 118, 172, 182, 213, 240, 261, 265, 294 Transrectal ultrasound, 90, 294 Transurethral, 254, 281, 294 Transurethral Resection of Prostate, 281, 294 Transurethral resection of the prostate, 254, 294 Trauma, 169, 170, 234, 239, 244, 257, 267, 271, 275, 292, 294, 298 Treatment Outcome, 15, 294 Trichomonas, 35, 294 Trichomonas vaginalis, 36, 294 Trichomonas Vaginitis, 35, 294 Trichomoniasis, 43, 269, 294 Trimethoprim-sulfamethoxazole, 5, 10, 11, 20, 70, 74, 85, 90, 111, 294 Tryptophan, 242, 294 Tuberculosis, 179, 243, 267, 294 Tuberous Sclerosis, 201, 294 Tumor marker, 235, 294 Type 2 diabetes, 30, 295 Typhimurium, 51, 295
Index 313
U Ultrafiltration, 67, 258, 295 Ultrasonography, 17, 76, 295 Unconscious, 233, 246, 260, 295 Uraemia, 275, 295 Urea, 28, 45, 152, 295 Uremia, 285, 295 Ureter, 45, 99, 163, 214, 259, 265, 285, 295 Ureterocele, 100, 295 Urethra, 143, 151, 152, 158, 161, 163, 172, 209, 211, 212, 214, 234, 276, 281, 282, 294, 295, 296, 297 Urethritis, 20, 160, 211, 214, 295 Urinalysis, 4, 6, 14, 16, 24, 206, 211, 212, 214, 215, 295 Urinary Calculi, 159, 295 Urinary Retention, 21, 24, 40, 41, 42, 53, 55, 280, 282, 296 Urinary urgency, 22, 296 Urinate, 151, 187, 209, 210, 211, 212, 214, 293, 296, 297 Urodynamic, 8, 14, 296 Urogenital, 65, 78, 122, 150, 163, 255, 256, 296 Urography, 16, 76, 101, 296 Urolithiasis, 4, 18, 72, 180, 296 Urothelium, 38, 59, 61, 214, 296 Uterine Prolapse, 7, 296 Uterus, 240, 244, 249, 253, 260, 268, 280, 296 V Vaccination, 38, 45, 58, 117, 158, 166, 296 Vacuoles, 274, 296 Vagina, 43, 152, 162, 172, 211, 213, 237, 240, 265, 268, 294, 296 Vaginal Discharge, 8, 27, 63, 294, 296 Vaginitis, 35, 237, 294, 296 Vaginosis, 27, 35, 43, 63, 254, 296 Valves, 111, 296 Vancomycin, 70, 84, 296 Vascular, 111, 250, 257, 262, 263, 273, 278, 296 Vasculitis, 275, 297
Vasodilator, 236, 258, 297 VE, 123, 297 Vegetative, 235, 297 Vein, 111, 232, 263, 273, 297 Venoms, 245, 297 Venous, 232, 239, 245, 266, 282, 297 Venous blood, 239, 266, 297 Vertebrae, 290, 297 Vertebral, 234, 289, 290, 297 Vestibule, 163, 262, 287, 297 Veterinary Medicine, 197, 297 Viral, 4, 255, 297 Virulent, 7, 25, 33, 39, 46, 297 Virus, 27, 63, 157, 233, 239, 255, 256, 263, 278, 297 Vitro, 5, 31, 36, 37, 48, 50, 51, 52, 58, 59, 60, 62, 64, 65, 66, 70, 73, 75, 76, 98, 99, 258, 261, 279, 287, 293, 297 Vivo, 31, 37, 44, 51, 52, 56, 58, 60, 61, 64, 66, 73, 158, 159, 258, 261, 297 Void, 5, 24, 297 Voiding cystourethrogram, 6, 18, 20, 23, 119, 215, 297 Volition, 264, 297 W War, 51, 297 Watchful waiting, 55, 297 Weight Gain, 151, 252, 298 White blood cell, 9, 17, 154, 231, 234, 261, 266, 267, 270, 271, 272, 278, 298 Whole cell vaccine, 8, 298 Withdrawal, 186, 298 Wound Healing, 61, 268, 298 Wound Infection, 169, 298 Wounds, Gunshot, 290, 298 X Xenograft, 231, 298 X-ray, 44, 46, 209, 238, 243, 253, 263, 264, 273, 284, 287, 297, 298 Y Yeasts, 237, 254, 263, 277, 298 Z Zymogen, 282, 298
314 Urinary Tract Infections
Index 315
316 Urinary Tract Infections
