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Biomedical subjects

C S Bryan

Publications and source records attributed to C S Bryan.

At least 91 records · Page 5Linked to original sources
PubMed1991

Management of the HIV-infected patient: a comprehensive approach. The SCMA AIDS Task Force.

Management of the early stages of HIV infection has become relatively straightforward. Therapy with AZT (Retrovir) should be instituted when the CD4 count is consistently between 400 and 500 per cmm, and prophylaxis against Pneumocystis carinii pneumonia should be instituted when the CD4 count falls below 200 per cmm. Although numerous complications punctuate the later course of HIV infection, those requiring emergency intervention are relatively few in number and usually recognizable. On the horizon are new approaches expected to further enhance the duration and quality of life for HIV-infected patients. Caring for HIV-infected patients can be a rewarding clinical experience, and the barriers to providing such care are by no means insurmountable.

HIV Infections↗
PubMed1991

Fort Host.

Explore the source record for details and available documents.

Humans↗
PubMed1990

Perioperative antibiotic prophylaxis for herniorrhaphy and breast surgery.

We assessed the efficacy of perioperative antibiotic prophylaxis for surgery in a randomized, double-blind trial of 1218 patients undergoing herniorrhaphy or surgery involving the breast, including excision of a breast mass, mastectomy, reduction mammoplasty, and axillary-node dissection. The prophylactic regimen was a single dose of cefonicid (1 g intravenously) administered approximately half an hour before surgery. The patients were followed up for four to six weeks after surgery. Blinding was maintained until the last patient completed the follow-up and all diagnoses of infection had been made. The patients who received prophylaxis had 48 percent fewer probable or definite infections than those who did not (Mantel-Haenszel risk ratio, 0.52; 95 percent confidence interval, 0.32 to 0.84; P = 0.01). For patients undergoing a procedure involving the breast, infection occurred in 6.6 percent of the cefonicid recipients (20 of 303) and 12.2 percent of the placebo recipients (37 of 303); for those undergoing herniorrhaphy, infection occurred in 2.3 percent of the cefonicid recipients (7 of 301) and 4.2 percent of the placebo recipients (13 of 311). There were comparable reductions in the numbers of definite wound infections (Mantel-Haenszel risk ratio, 0.49), wounds that drained pus (risk ratio, 0.43), Staphylococcus aureus wound isolates (risk ratio, 0.49), and urinary tract infections (risk ratio, 0.40). There were also comparable reductions in the need for postoperative antibiotic therapy, non-routine visits to a physician for problems involving wound healing, incision and drainage procedures, and readmission because of problems with wound healing. We conclude that perioperative antibiotic prophylaxis with cefonicid is useful for herniorrhaphy and certain types of breast surgery.

Bacterial Infections↗
PubMed1990

Is there divine justice in AIDS? Why now, and not before?

Retroviruses emerged before Homo sapiens in the course of vertebrate evolution. The first human retrovirus was isolated in 1979; the human immunodeficiency virus (HIV-1) assumed epidemic importance in 1981. That such a novel threat to the survival of our species struck only when we had in place, for the first time, the science necessary to fight back seems remarkably coincidental. Cause-and-effect explanations include (1) human activities unique to the late 20th century and (2) a merciful, slow-to-anger God willing to "hold back" until the right time (chairos). By either possibility, AIDS might signify our failure to manage properly the world's ecosystems, the limitations of scientific progress, and/or deficiencies in our collective worldview.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Clinical implications of positive blood cultures.

Positive blood cultures can be classified according to their veracity (true-positive or false-positive culture), clinical severity (inconsequential or life threatening), place of origin (community acquired or nosocomial), source (primary or secondary), duration (transient, intermittent, or continuous), pattern of occurrence (single episode, persistent, or recurrent), or intensity (high or low grade). In general, however, positive blood cultures identify a patient population at high risk of death. In my studies, patients with positive blood cultures were 12 times more likely to die during hospitalization than patients without positive blood cultures. Many bacteremias and fungemias occur in complicated clinical settings, and it appears that only about one-half of the deaths among affected patients are due directly to infection. Hence, it is appropriate to speak of "crude mortality" and "attributable mortality." Among hospitalized patients, recent trends include rising incidences of Staphylococcus aureus and coagulase-negative staphylococcal and enterococcal bacteremias and a dramatic increase in the incidence of fungemias. The diagnostic and therapeutic implications of blood cultures positive for specific microorganisms continue to evolve and are the subject of a large and growing medical literature.

False Positive Reactions↗
PubMed1989

Strategies to improve antibiotic use.

The desideratum of "appropriate" antibiotic therapy include efficacy, safety, and low cost. Strategies for achieving these goals include education, control of the hospital formulary, written justification forms and automatic stop orders, ongoing utilization review, restriction, required consultation, control of laboratory susceptibility testing, and limitation of contact time between physicians and pharmaceutical representatives. Because traditional education methods have had limited impact on "appropriate" antibiotic use, the potential of the newer strategies must be explored. Most published studies emanate from teaching hospitals, leaving the applicability of the findings to community hospitals largely unsettled. At each hospital, it should be determined which combination of strategies will strike the best balance between effectiveness and palatability. Computer technology continues to hold promise as a way to provide instantaneous, nonthreatening feedback to prescribing physicians.

Anti-Bacterial Agents↗