"Fungal CPPS" -- Bad Science

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webslave
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"Fungal CPPS" -- Bad Science

Post by webslave »

It's discouraging when bad science gets published. Here's an example:

Chronic prostatitis/chronic pelvic pain syndrome: the role of an antifungal regimen
  • No evidence of fungal infection in any of the patients
  • No control group, no randomization
  • Inclusion of patients who do not have CP/CPPS ("Patients were mainly complaining of irritative lower urinary tract symptoms – mainly frequency and urgency. Discomfort and vague pain related to the genital area was usually an associated complaint.")
  • Multiple treatments tried concurrently: carbohydrate restriction (which in Egypt means gluten avoidance), urinary alkalinizers, fluconazole
  • Fluconazole is an immunomodulator (suppresses neutrophil activity), so concluding its actions are purely antifungal is absurd
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Re: "Fungal CPPS" -- Bad Science

Post by webslave »

More bad science (from the same journal!).

Mental status in patients with chronic bacterial prostatitis

Here we have CPPS patients categorised as CBP patients:
The diagnosis of CBP was confirmed if prostatic fluid contained more than 10 leucocytes per high–power microscopic field and a pathogen was concomitantly identified
How many times have CPPS patients been told that they have "bacterial prostatitis" because of contamination of cultures with skin flora from the end of the urethra? Or because cultures magnify one bacterium into an "infection"? Answer: many times.
Very often in daily practice, urologists encounter the situation in which the application of long–term antibacterial therapy in patients with chronic prostatitis does not yield adequate results. Some patients still complain of a variety of disorders despite the use of all standard treatment options, some of them even lose faith in the ability to remedy after years of futile treatment. Such disappointment hurts the patient's mentality and even confuses urologists to the point of perplexity, which is why a deeper insight into the essence of the problem is required for a more complete understanding of psychological state of patients with CBP, as well as the mechanisms that influence it.

The chronic pain syndrome, caused by antibiotic–resistant prostatic inflammation, reduces the working capacity of patients and worsens their quality of life and their ability to interact socially.
In true CBP, pain is not a stand-out feature. So wrong patient group, wrong conclusions. No wonder uros are confused! :62_58_40:

This is one of the worst studies I've seen in terms of blurring definitions and getting basic assumptions wrong. It should never have been published!

(Note to self: treat anything published in the Polish "Central European Journal of Urology (CEJU)" with great caution)
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Re: "Fungal CPPS" -- Bad Science

Post by dshoskes »

webslave wrote:It's discouraging when bad science gets published. Here's an example:

Chronic prostatitis/chronic pelvic pain syndrome: the role of an antifungal regimen
  • No evidence of fungal infection in any of the patients
  • No control group, no randomization
  • Inclusion of patients who do not have CP/CPPS ("Patients were mainly complaining of irritative lower urinary tract symptoms – mainly frequency and urgency. Discomfort and vague pain related to the genital area was usually an associated complaint.")
  • Multiple treatments tried concurrently: carbohydrate restriction (which in Egypt means gluten avoidance), urinary alkalinizers, fluconazole
  • Fluconazole is an immunomodulator (suppresses neutrophil activity), so concluding its actions are purely antifungal is absurd
1000 consecutive patients in a year. That's 4 a day (if they close weekends and take no vacation). Not all CPPS patients but those who fit their criteria. And had 100% compliance for therapy and coming back for follow up and repeat rectal exam and PSA. Of course I have no knowledge or information about this group or the paper, but in general when you see unbelievable numbers like that, concern for data fabrication is high.

Also, primary endpoint is patient self reported "I'm better" without any validation.

BTW, there is an incredible proliferation of open source "Pay to play" journals around the world. Just like 24 hr cable news needing to fill air time, they are going to be filled with studies that all the major journals have rejected, but to the casual google searcher (aka "I know more than you doctor because I've done my research) their conclusions appear equally valid to a paper in JAMA or NEJM.
Daniel Shoskes MD
www.dshoskes.com
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