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Round Up Email May 2022

This month's Round Up includes updates of the Conn's syndrome (primary aldosteronism) section and information about CRP and cancer risk, and asymptomatic bacteriuria in the elderly.

Question 1
Methenamine Hippurate in the prevention of urinary tract infections (UTIs) – Is methenamine hippurate an antiseptic or an antibiotic? Is it more effective in preventing UTIs in an alkaline or acid environment? How does the use of methenamine Hippurate compare to the current standard care for preventing recurrent UTIs in women?: Methenamine hippurate in the prevention of urinary tract infections (UTIs)
1) With respect to methenamine hippurate, which statement is false?
- in comparison to the use antibiotic prophylaxis for UTIs, decreased rates of antimicrobial resistance development associated with methenamine hippurate were seen
- evidence suggests that methenamine hippurate is more effective than antibiotic prophylaxis for prevention of recurrent UTIs in women
- methenamine hippurate is an antiseptic
Question 2
Raised CRP and possible colorectal cancer – Is a raised CRP associated with increased colorectal cancer risk? Does CRP level help identify the presence of high-risk adenomas? Is CRP level at diagnosis of colorectal cancer of prognostic value?: CRP and colorectal cancer
2) With respect to CRP and colorectal cancer, which statement is false?
- circulating CRP level is positively associated with colorectal cancer risk
- high CRP level is associated with high-risk adenoma in men but not women
- a high CRP was associated with higher mortality in 90% of reports in people with solid tumors primary sites
Question 3
Conn's syndrome – Do most patients with Conn's syndrome have reduced plasma potassium levels? What is the diagnostic investigation of choice? What medications can interfere with this investigation?: Conn's syndrome
3) With respect to Conn's syndrome, which statement is false?
- The minority of patient's with primary aldosteronism have hypokalaemia
- selective-serotonin reuptake inhibitors affect the reliability of plasma aldosterone-to-renin ratio (ARR)
- if on an ACE inhbitor then this should ideally be stopped for 1 week before testing the plasma aldosterone-to-renin ratio (ARR)
Question 4
Prophylactic measures against the development of mountain sickness – an update of this section on GPnotebook.: Prophylactic (preventative) measures against development of mountain sickness
4) With respect to prophylactic measures against mountain sickness, which statement is false?
- acetazolamide prevents acute mountain sickness by mimicking the body naturally adjusting to a change in environment
- if above 2000m (6,500 feet), no more than 300m (1000 feet) should be climbed per 24 hour period
- prescribe acetazolamide one to two days before gradual ascent to high altitude and continue acetazolamide for at least two days after reaching the highest point
Question 5
Asymptomatic bacteriuria in the elderly – is antibiotic therapy indicated? Is there evidence of benefit in any elderly sub-population?: Asymptomatic bacteriuria (ASB)
5) With respect to asymptomatic bacteriuria in the elderly, which statement is false
- a systematic review and meta-analysis found antibiotic therapy was associated with an increased chance of bacteriological cure for asymptomatic bacteriuria in aged care residents
- asymptomatic bacteriuria occurs in 15-20% of women aged 65-70 years
- the most common organism causing asymptomatic bacteriuria is Enterobacteriacea
Question 6
Maternal steroids and premature labour – Are there evidence of benefit for the use of steroids in premature labour to reduce the risk of neonatal respiratory distress syndrome? Is there survival benefit for neonates if a mother has had steroids in this scenario?: Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth
6) With respect to maternal steroids in premature labour, which statement is false?
- there is evidence of benefit for the use of steroids in premature labour to reduce the risk of neonatal respiratory distress syndrome
- NICE state maternal steroids should be offered for women between 24+0 and 33+6 weeks of pregnancy who are in suspected, diagnosed or established preterm labou
- there is no evidence of benefit of a repeat dose of maternal steroids for women still at risk of preterm birth >=7 days after an initial course

Round Up Email May 2022

Question 1

Question 2

Question 3

Question 4

Question 5

Question 6