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Biomedical subjects

B D Reed

Publications and source records attributed to B D Reed.

At least 37 records · Page 2Linked to original sources
PubMed1993

Cefaclor vs amoxicillin in the treatment of acute, recurrent, and chronic sinusitis.

BACKGROUND: The treatment of acute, recurrent, and chronic sinusitis remains controversial because of the presence of a wide variety of aerobic and anaerobic bacteria in the sinuses. DESIGN: This double-blind, randomized trial compared cefaclor with amoxicillin in the treatment of acute, recurrent, and chronic maxillary sinusitis using clinical evaluation, roentgenography, and microbiologic evaluation of antral aspirates. SETTING: Outpatient office of five otorhinolaryngologists in Salt Lake City, Utah. PATIENTS: One hundred eight adult patients with acute, recurrent, or chronic maxillary sinusitis. INTERVENTION: Oral treatment with cefaclor (500 mg) twice daily or amoxicillin (500 mg) three times daily for 10 days. MAIN OUTCOME MEASURE: Clinical response to treatment with cefaclor vs amoxicillin. RESULTS: Fifty-six patients with acute sinusitis, 25 with recurrent sinusitis, and 15 with chronic sinusitis were evaluable. Although multiple organisms were common in each group, patients with acute sinusitis were more likely to have Haemophilus influenzae or Streptococcus pneumoniae, and patients with recurrent or chronic sinusitis were more likely to have anaerobes in sinus aspirate. Whether treated with cefaclor or amoxicillin, clinical improvement occurred in 86% of patients with acute sinusitis and 56% of patients with recurrent sinusitis. Patients with chronic sinusitis were too few to allow statistical analysis of the differences in outcome between them and patients with recurrent or acute sinusitis. Resistance of the cultured organisms to the study drug used was unrelated to treatment outcome. CONCLUSIONS: The rate of clinical improvement was high in patients with acute sinusitis but was less favorable in those with recurrent and chronic disease regardless of the study drug used. The susceptibility of organisms isolated to the study drugs was unrelated to outcome.

Acute Disease↗
PubMed1993

Vaginal infections: diagnosis and management.

Three common infections account for most vaginal symptoms. Successful management depends on accurate identification of the etiologic agent and appropriate treatment. Clinical examination and office laboratory tests are usually adequate to diagnose bacterial vaginosis. Diagnosis of Candida vulvovaginitis and vaginitis caused by Trichomonas may require culture. Bacterial vaginosis is usually treated with a one-week course of metronidazole; treatment during pregnancy and the benefit of concomitant treatment of sexual partners remain points of controversy. Intravaginal application of imidazoles is the recommended initial treatment of Candida vulvovaginitis, although several effective alternative treatments are available. Trichomonas vaginitis usually responds to oral metronidazole, and treatment of sexual partners is recommended. Treatment during pregnancy should be limited because of concern about teratogenic effects. Recurrent or persistent vaginal symptoms require exclusion of the possibility of reinfection or the presence of other conditions (particularly cervicitis); symptoms may respond to prolonged or prophylactic regimens.

Antifungal Agents↗
PubMed1992

Risk factors for Candida vulvovaginitis.

Although Candida vulvovaginitis occurs commonly, the reasons for its occurrence and recurrence are often unclear. Several potential risk factors have been described, including the recent use of antibiotics and oral contraceptives, the presence of diabetes mellitus, dietary practices, gastrointestinal colonization by the organism, clothing and sanitary protection practices, sexual communicability of the organism, and specific immunological defects. However, the data supporting each of these factors are conflicting, and to date none are predictive of infection. In this review, the data evaluating these potential risk factors are described. From this information, implications for clinical practice are discussed.

Candidiasis, Vulvovaginal↗
PubMed1991

Treatment of beta-hemolytic streptococcal pharyngitis with cefaclor or penicillin. Efficacy and interaction with beta-lactamase-producing organisms in the pharynx.

The recommended treatment for group A beta-hemolytic streptococcal pharyngitis has continued to be penicillin given in parenteral or oral form. Treatment failures, as determined by the continued presence of the streptococcal organism in the pharynx, however, do occur in 6% to 25% of patients treated with penicillin. Furthermore, beta-lactamase produced by other bacteria in the pharynx could potentially inactivate the penicillin, resulting in increased treatment failures or infection relapses. A study was undertaken to compare the efficacy of cefaclor, which is relatively resistant to inactivation by beta-lactamase, with penicillin for eradicating the group A beta-hemolytic streptococcal organism from the throats of 93 patients with pharyngitis. Additionally, extensive cultures for potential beta-lactamase-producing organisms were conducted on 37 patients; 27% of these had one or more pharyngeal organisms that were producing beta-lactamase. No statistically significant difference was found between the clinical responses or the bacteriological cure rates of those treated with cefaclor and those treated with penicillin when stratified by the presence or absence of beta-lactamase-producing organisms. The prevalence of beta-lactamase-producing organisms in the pharynx, however, was increased after treatment with penicillin, whereas no change was noted following treatment with cefaclor.

Adolescent↗
PubMed1991

Genital human papillomavirus infection.

Human papillomavirus is one of the most common causes of sexually transmitted diseases. In the past ten years, 60 different types of papillomavirus have been identified. Although the virus often causes asymptomatic genital infection, it has been strongly associated with lower genital tract carcinoma; therefore, its detection and eradication are important. All patients with evidence of human papillomavirus infection should undergo colposcopy and, depending on the extent of infection and the type of histology, should receive definitive treatment.

Female↗
PubMed1990

Marital adjustment among housestaff and new attorneys.

Previous reports have suggested that physicians' marriages may be adversely affected by the stresses of the profession. Some social scientists, however, question the view that demanding careers are the primary cause of poor marital adjustment and suggest instead that such careers may actually invigorate a marriage. This study, involving 116 housestaff physicians, 106 new attorneys, and the spouses of both groups, identified the factors that significantly affected their marital adjustments. No difference in marital adjustments was found between housestaff and attorneys or between the two spouse groups. In general, the spouses had higher marital adjustment scores than did the professionals, and the women professionals had higher scores than did the men professionals. The two most important factors associated with adjustment were the perceived level of emotional support received from one's spouse for one's career and the level of such support given to one's spouse for his or her career. The results suggest that housestaff and new attorneys are as satisfied with their marriages as are the other populations in which the same marital inventory has been used.

Adaptation, Psychological↗
PubMed1990

Diagnosis of group A beta-hemolytic Streptococcus using clinical scoring criteria, Directigen 1-2-3 group A streptococcal test, and culture.

Cultures for group A beta-hemolytic Streptococcus were performed on 806 patients presenting with a sore throat to five urgent care centers. The accuracies of a clinical scoring system and of a liposomal in-office direct test for Streptococcus were compared with culture results. The Directigen 1-2-3 group A streptococcal test had a sensitivity of 67%, a specificity of 85%, a positive predictive value of 61%, and a negative predictive value of 89% compared with culture. The scoring system had a sensitivity of 26%, a specificity of 94%, a positive predictive value of 58%, and a negative predictive value of 79%. Using a combination of the direct test results and the clinical score did not improve the accuracy significantly over the use of either alone. The rates of delayed treatment, unnecessary treatment, and increased costs were compared using different combinations of the clinical scoring system, the in-office streptococcal test, and culture. Neither the Directigen 1-2-3 group A streptococcal test nor the clinical score can replace culture in the diagnosis of group A beta-hemolytic streptococcal pharyngitis.

Adolescent↗
PubMed1989

Comparison of the Directigen 1-2-3 Group A Strep Test with culture for detection of group A beta-hemolytic streptococci.

The Directigen 1-2-3 Group A Strep Test (DGAST; BBL Microbiology Systems, Cockeysville, Md.) was compared with conventional culture procedures on Trypticase soy agar with 5% sheep blood (BBL) and Selective Streptococcal Agar (ssA; BBL) for detection of group A beta-hemolytic streptococci (GABHS) for 1,006 patients complaining of sore throat. The DGAST was performed at five acute-care clinics according to the instructions of the manufacturer; interpretation of the cultures was done at the central microbiology laboratory. Of 924 patients with complete data, 243 (26.3%) were positive for GABHS on culture when both sheep blood agar and ssA were used. Of the patients with positive cultures, 159 were detected by the DGAST, yielding a sensitivity of 65.4%, a specificity of 84.7%, a positive predictive value of 60.5%, and a negative predictive value of 87.3%. The greater the number of colonies on culture, the greater the sensitivity of the DGAST, and the more intense the positive reaction on the DGAST, the higher the positive predictive value of the test. For the identification of GABHS, sheep blood agar was superior to ssA by 12.9% at 24 h and by 3.4% at 48 h of incubation.

Acute Disease↗
PubMed1989

The association between dietary intake and reported history of Candida vulvovaginitis.

The association between dietary intake and the history of Candida vulvovaginitis was evaluated in 166 women who had a history of Candida vulvovaginitis in the past 5 years (cases) and in 207 women without such a history (total population), as well as in 74 women with five or more episodes in the past 5 years and 125 women with no history of Candida vulvovaginitis. Women were interviewed about their demographic data, past medical and sexual history, and their history of vaginal or pelvic infections. An extensive dietary history was taken to determine each woman's usual adult dietary intake. Results indicate associations between total caloric intake, carbohydrates, and fiber and a history of Candida vulvovaginitis. The results were not altered by controlling for age, body mass index, smoking, use of oral contraceptives, and sexual activity variables. These results suggest several dietary constituents may influence susceptibility to Candida vulvovaginitis infections. A follow-up prospective study, using culture confirmation of Candida infection, is needed.

Adult↗
PubMed1989

Differentiation of Gardnerella vaginalis, Candida albicans, and Trichomonas vaginalis infections of the vagina.

This study evaluated the positive predictive values of factors associated with Gardnerella vaginalis, Candida albicans, and Trichomonas vaginalis for diagnosing vaginitis in a community-based population. One hundred ninety-six women with and without vaginal complaints were evaluated for historical factors, physical examination findings, and office laboratory results that were potentially associated with each of the three vaginal organisms. Extensive microbiological tests were performed to detect pathogenic organisms in the vagina and cervix. Gardnerella vaginalis was associated with findings of clue cells, gray or creamy vaginal discharge, amine ordor on application of potassium hydroxide solution to the discharge, pH greater than 5, and a history of more than six sexual partners. Candida albicans was associated with the presence of pseudohyphae or budding yeast on microscopic examination and the lack of clue cells. Current use of oral contraceptives and the recent use of antibiotics were not predictive of a Candida albicans infection. Trichomonas vaginalis was more common in patients presenting with symptoms, but otherwise was not predicted by the factors tested.

Adolescent↗
PubMed1988

Prevalence of Chlamydia trachomatis and Mycoplasma pneumoniae in children with and without pharyngitis.

The prevalence of Chlamydia trachomatis, Mycoplasma pneumoniae, group A beta-hemolytic streptococcus, and other treatable organisms was studied in children with and without pharyngitis. Children aged 2 to 12 years were evaluated between November 1985 and April 1986 in three family practice offices in the Salt Lake City area. Chlamydia trachomatis was not detected in the pharynx of any of the children studied. Mycoplasma pneumoniae was cultured from 5 percent of the 242 children studied, group A beta-hemolytic streptococcus from 30 percent, non-group A beta-hemolytic streptococcus from 5 percent, Hemophilus influenzae from 4 percent, and Staphylococcus aureus from 14 percent. The symptoms reported were not statistically associated with any organism isolated, and clinical signs of pharyngitis were associated only with the presence of group A beta-hemolytic streptococcus. Based on these results, management of pharyngitis in children should continue to be based on the detection and treatment of group A beta-hemolytic streptococcus.

Child↗
PubMed1988

Postpartum hemorrhage.

Postpartum hemorrhage is usually unexpected, and blood loss can be massive. Excessive bleeding after delivery may result from uterine atony, disruption of the genital tract, placental abnormalities, coagulation disorders and miscellaneous obstetric complications. Prompt treatment is imperative. Treatment options include oxytocics, prostaglandins, uterine exploration, uterine packing and, occasionally, surgery.

Ergonovine↗
PubMed1988

Gestational diabetes mellitus.

Gestational diabetes is an asymptomatic disease of pregnant women, which results in significant morbidity and mortality. However, prompt diagnosis and treatment of this disorder have been found to be effective in decreasing complications. The increased risk for eventual diabetes in the patient and obesity or glucose intolerance in her off-spring suggests that long-term weight control and medical follow-up for both are important.

Female↗