Can benign prostatic hyperplasia be identified in the primary care setting using only simple tests? Results of the Diagnosis IMprovement in PrimAry Care Trial

AIMS

Diagnosis IMprovement in PrimAry Care Trial (D-IMPACT) was a prospective, multicentre epidemiological study in three European countries to identify the optimal subset of simple tests applied in primary care to diagnose benign prostatic hyperplasia (BPH) in men who spontaneously present with lower urinary tract symptoms (LUTS).

METHODS

Consecutive male patients aged ≥ 50 years who spontaneously attended their regular general practitioner (GP) office with LUTS were eligible for inclusion if they had not previously undergone BPH diagnostic tests or received treatment for BPH. Patients were assessed on three occasions, twice by their regular GP (visits 1 and 2) and once by a urologist (visit 3). The diagnostic accuracy of each variable was determined using the urologists' final BPH diagnosis (at visit 3) as gold-standard. Independent variables analysed were as follows: age; BPH diagnosis performed by GP in visit 1 (yes/no); probability of BPH diagnosis assessed by GP in visit 1; urinalysis (normal/abnormal); prostate-specific antigen (PSA); International Prostate Symptom Score (IPSS); diagnosis of BPH performed by GP in visit 2 (yes/no); and probability of BPH diagnosis assessed by GP in visit 2. Statistically significant variables (p < 0.1) were included in a logistic regression model to identify the best algorithm and describe each test contribution.

RESULTS

The most frequent spontaneously reported LUTS were nocturia and weak urinary stream. BPH study prevalence was 66.0% (95%CI: 62.3-69.5) and 32% of patients were at risk of BPH progression (PSA > 1.5 ng/ml and prostate volume ≥ 30 cm(3)). Among the independent variables analysed, only age, IPSS and PSA showed a statistically significant relationship with BPH diagnosis. In a logistic regression model including age, IPSS, PSA and probability of BPH (based on physical examination and symptoms), positive predictive value (PPV) was 77.1%. Exclusion of BPH probability resulted in a PPV of 75.7%.

CONCLUSIONS

A diagnostic algorithm including only objective variables (age, IPSS and PSA), easily implemented in any GP office, allows GPs to accurately diagnose BPH in approximately three-quarters of patients spontaneously reporting LUTS.

[Resistance of bacteria and antibiotic prescription in Fann University Teaching Hospital, Dakar]

The objective of this study conducted in Fann University Teaching Hospital in Dakar, is to establish correlation beetwen the prescription and consummation of antibiotics in the one hand, and the susceptibility of strains isolated in this hospital on the other hand. An interview of medical practitioners and pharmacists was realised to appreciate the antibiotics used in the clinics, the bacteria taken aim, the criteria of choice, the place of antibiogram, the place of antibiotics in orders of medicines and pharmacists, the consummest family of antibiotics. In the lab, all of pathogen bacteria were tested by disc diffusion test (antibiogram) to appreciate the susceptibility to antibiotics. The results show that Enterobacteria represented 60.8% of isolates and among them, Escherichia coli (30.6%) was the most representative specie in hospitalized and non hospitalized patients. 52% of the strains of E. coli were susceptible to aminopenicillins in external patients, versus less than 35% in hospitalized. In Neurosurgery, Pseudomonas aeruginosa was the most frequent bacteria and all of the strains were susceptible to imipenem, dibekacin and ciprofloxacin. Beta-lactams were the most used drugs in the first place (78.8%), related to habits of prescription of medical staff and to avaibility of antibiotics. The choice of antibiotics must take the susceptibility of strains into account.

Photorefractive keratectomy in 176 eyes: one year follow-up

Beginning in March 1992, 176 eyes from 176 patients underwent photorefractive keratectomy with the Summit Technology Eximed UV200LA. This study was designed to evaluate the efficacy of this method.

Thyroid function in patients with Parkinson's disease

Many of the symptoms of Parkinson's disease are similar to those seen in patients with hypothyroidism. The diagnosis of myxoedema may easily be overlooked when occurring together with Parkinson's disease. We studied 52 patients with Parkinson's disease and found normal thyroid values and TSH-levels in all patients except one, who turned out to have an incipient hypothyroidism.