Acute pyelonephritis in women (2011 review)

This is a 2011 review from the official journal of the AAFP, American Family Physician:

Acute pyelonephritis is a bacterial infection of the renal pelvis and kidney most often seen in young women.

Symptoms of acute pyelonephritis

Most patients have fever, although it may be absent early in the illness. Flank pain is nearly universal.

Tests for acute pyelonephritis

A positive urinalysis confirms the diagnosis.

Urine culture should be obtained in all patients to guide antibiotic therapy if the patient does not respond to initial empiric antibiotic regimens.

Escherichia coli is the most common pathogen in acute pyelonephritis. In the past decade, there has been an increasing rate of E. coli resistance to extended-spectrum beta-lactam antibiotics.

Imaging, usually with contrast-enhanced CT is not necessary unless there is:

- no improvement in the patient's symptoms
- symptom recurrence after initial improvement

Treatment of acute pyelonephritis

Outpatient treatment is appropriate for most patients.

Oral fluoroquinolone is the initial outpatient therapy if the rate of fluoroquinolone resistance in the community is less than 10%. If the resistance rate exceeds 10%, an initial IV dose of ceftriaxone or gentamicin should be given, followed by an oral fluoroquinolone regimen.

Oral beta-lactam antibiotics and trimethoprim/sulfamethoxazole (TMP-SMX (Bactrim) are inappropriate for therapy because of high resistance rates.

References:

Diagnosis and treatment of acute pyelonephritis in women. Colgan R, Williams M, Johnson JR. Am Fam Physician. 2011 Sep 1;84(5):519-26.
Nephrology Cases

Hirsutism in women - literature review

Here some excerpts from the 2012 review of hirsutism in women in the journal American Family Physician:

Hirsutism is excess terminal hair that commonly appears in a male pattern in women.

Although hirsutism is generally associated with hyperandrogenemia, 50% of women with mild symptoms have normal androgen levels.

Causes of hirsutism

The most common cause of hirsutism is polycystic ovary syndrome (PCOS), which accounts for 3 out of every 4 cases.

Many medications can also cause hirsutism.

In patients whose hirsutism is not related to medication use, evaluation is focused on testing for endocrinopathies and neoplasms, such:

- polycystic ovary syndrome (PCOS)
- adrenal hyperplasia
- thyroid dysfunction
- Cushing syndrome
- androgen-secreting tumors

Symptoms of hirsutism

Symptoms and findings suggestive of neoplasm include rapid onset of symptoms, signs of virilization, and a palpable abdominal or pelvic mass.

Patients without these findings who have mild symptoms and normal menses can be treated empirically.

For patients with moderate or severe symptoms, an early morning total testosterone level should be obtained, and if elevated, it should be followed by a plasma free testosterone level.

A total testosterone level greater than 200 ng per dL (6.94 nmol per L) should prompt evaluation for an androgen-secreting tumor.

Diagnosis of hirsutism

Laboratory workup may include:

- early morning total testosterone level
- plasma free testosterone level
- thyroid function tests
- prolactin level
- 17-hydroxyprogesterone level
- corticotropin stimulation test

Treatment of hirsutism

Treatment includes hair removal and pharmacologic measures.

Shaving is effective but needs to be repeated often. Evidence for the effectiveness of electrolysis and laser therapy is limited.

Laser treatment does not result in complete, permanent hair reduction, but it is more effective than other methods such as shaving, waxing, and electrolysis. It produces hair reduction for up to 6 months. The effect is enhanced with multiple treatments.

In patients who are not planning a pregnancy, first-line pharmacologic treatment should include oral contraceptives. Topical agents, such as eflornithine, may also be used.

Treatment response should be monitored for at least six months before making adjustments.

References:

Hirsutism in women. Bode D, Seehusen DA, Baird D. Am Fam Physician. 2012 Feb 15;85(4):373-80.

Management of Hirsutism (Excess Hair)

Image source: Skin layers. Wikipedia, public domain.

Optimal Waist-to-Hip Ratios in Women (an Hourglass Figure) Activate Neural Reward Centers in Men

Secondary sexual characteristics convey information about reproductive potential:

- Facial symmetry, masculinity, and shoulder-to-hip ratio convey information about reproductive/genetic quality in males.

- Waist-to-hip-ratio (WHR) is a phenotypic cue to fertility, fecundity, neurodevelopmental resources in offspring, and overall health, and is indicative of “good genes” in women.

Researchers in this study used fMRI to show activation in male brain reward centers in response to WHR with redistributed body fat and similar body mass index (BMI). Brain activation to observed in bilateral orbital frontal cortex. Changes in WHR revealed activation in the anterior cingulate cortex, an area associated with reward processing and decision-making.

These findings suggest that an hourglass figure (i.e., an optimal WHR) activates brain centers that drive appetitive sociality/attention toward females that represent the highest-quality reproductive partners.

References:
Platek SM, Singh D (2010) Optimal Waist-to-Hip Ratios in Women Activate Neural Reward Centers in Men. PLoS ONE 5(2): e9042. doi:10.1371/journal.pone.0009042

Image source: openclipart.org, public domain.

Being obese at age 40 reduces life expectancy by 7 years for women and 6 years for men

In Scotland 68.5% of men, 61.8% of women, 36.1% of boys, and 26.9% of girls are classified as overweight or obese.

Being obese at age 40 reduces life expectancy by 7.1 years for women and 5.8 years for men.

The article summarises the most recent recommendations from the Scottish Intercollegiate Guidelines Network (SIGN) on the management of obesity.

References:
Management of obesity: summary of SIGN guideline. Logue et al. 340: c154. BMJ, 2010.

Comments from Google Buzz:

Luke Rosenberger - thanks! looks like original source of the life expectancy data (according to footnote) is actually a 2003 article from annals of internal medicine - http://www.ncbi.nlm.nih.gov/pubmed/12513041

Ves Dimov, M.D. - Looks correct. That's why I always say that we need a medical librarian on board... :)

For Google Buzz and Twitter, I typically link to the source where the text appeared when I first saw it. It's very nice to trace it back to the original source however. Thank you so much.

Luke Rosenberger - makes sense to me. you know us librarians, always reading the footnotes first ;-)

Image source: Wikipedia, public domain.

Sexual life expectancy is longer for men than women

A BMJ study of middle aged and older adults showed that men were more likely than women to be sexually active, report a good quality sex life, and be interested in sex.

These gender differences increased with age and were greatest among the 75 to 85 year old group: 38.9% of men compared with 16.8% of women were sexually active, 70.8% versus 50.9% of those who were sexually active had a good quality sex life, and 41.2% versus 11.4% were interested in sex.

People in very good or excellent health were 1.5 to 1.8 times more likely to report an interest in sex than those in poorer health. At age 30, sexually active life expectancy was 34.7 years for men and 30.7 years for women compared with 14.9 to 15.3 years for men and 10.6 years for women at age 55.

At age 55, men in very good or excellent health on average gained 5-7 years of sexually active life compared with their peers in poor or fair health. Women in very good or excellent health gained 3-6 years compared with women in poor or fair health.

References:

Sex, health, and years of sexually active life gained due to good health: evidence from two US population based cross sectional surveys of ageing. BMJ 2010;340:c810.

Image source: OpenClipart.org, public domain.

Women in US academic medicine earn $13,000 less than male peers

A survey of 3,000 faculty members at the top 50 US medical schools has shown that women members earned $13,000 less than their male counterparts with the equivalent career position and professional activity.

There were no obvious reasons for the difference.

According to the study authors, "despite increased national attention to gender inequalities in salary, women in the life sciences at all academic ranks, both PhDs and MDs, continued in 2007 to receive lower annual salaries than did their male counterparts."

References:

Women in US academic medicine earn less than male peers. BMJ, 2010.

Image source: OpenClipArt.org, public domain.

Cleverest women are the heaviest drinkers, according to Telegraph newspaper

Not sure if this is the best choice for a headline... This is the original source: Education, alcohol use and abuse among young adults in Britain. Soc Sci Med. 2010 Jul.

The findings come from a study carried out at the London School of Economics in which researchers tracked the lives of thousands of 34-year-old women and men, all born in the UK during the same week in 1970.

The report states: "The more educated women are, the more likely they are to drink alcohol on most days and to report having problems due to their drinking patterns.

"The better-educated appear to be the ones who engage the most in problematic patterns of alcohol consumption."

They may have more active social lives or work in male-dominated workplaces with a drinking culture. As girls, they may have grown up in middle-class families and seen their parents drink regularly.

According to the researchers, higher educational attainment is associated with increased odds of daily alcohol consumption and problem drinking. The relationship is stronger for females than males. Individuals who achieved high educational test scores in childhood are at a significantly higher risk of abusing alcohol across all dimensions.

References:
Cleverest women are the heaviest drinkers. Telegraph.

Education, alcohol use and abuse among young adults in Britain. Huerta MC, Borgonovi F. Soc Sci Med. 2010 Jul;71(1):143-51. Epub 2010 Mar 31.

Image source: Wikipedia.

Women in medicine: Why are so few female doctors in leadership positions?

From Germany (a report from Germany's equivalent of BBC World Service):

Two thirds of medical students are women. But there are very few female doctors in leadership positions. Just ten percent make it to the top of their profession.

Chief physician Doris Henne-Bruns says that should be changed:



Comments from Twitter:

Lyall Furphy RN @Lyall: I know another profession that has a 91% 'quota' in favour of a dominant sex according to her logic. Would that chief surgeon let a junior doctor leave on time if he was a new dad with child care responsibilities? #justpondering

Ves Dimov, M.D. @DrVes: Yes, these are good questions. There is a tendency to oversimplify sometimes.

Promoting women in science and medicine to become a priority

The University of Tromsø in Norway - the world's northernmost university - has adopted new recommendations designed to increase the number of female full professors from the current 23% to 30% by 2014.

Women spend longer as Associate Professors than men, partly because “men apply as soon as they think they have a chance of promotion, while women tend to wait until they are very confident”.

The panel developed 13 recommendations, among them:

- re-advertising positions if there are no women in the applicant pool
- ensuring that women receive training in salary negotiation
- assessing research quality rather than quantity
- improving the visibility of women within institutions
- encouraging diversity in leadership style

References:

Promoting women in science and medicine. The Lancet, Volume 376, Issue 9754, Page 1712, 20 November 2010.

Image source: OpenClipArt.org, public domain.