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Biomedical subjects

D A Talan

Publications and source records attributed to D A Talan.

46 records · Page 3Linked to original sources
PubMed1989

Staphylococcus intermedius in canine gingiva and canine-inflicted human wound infections: laboratory characterization of a newly recognized zoonotic pathogen.

Staphylococcal gingival flora was characterized in cultures from 135 dogs. Staphylococcus intermedius was isolated in 39% of the cultures, S. aureus was isolated in 10%, and both were isolated in 2.0%. S. aureus was isolated more often from dogs of working breeds with weights of greater than 40 lb (ca. 18 kg) and with outdoor habitats than was S. intermedius, which was associated with dogs of nonworking breeds with weights of less than 40 lb and indoor habitats. S. intermedius was distinguished from S. aureus by the following characteristics: coagulation of rabbit plasma at 4 h (26 versus 100%, respectively), hemolysis of sheep blood at 24 h (30 versus 79%, respectively), and mannitol fermentation at 24 h (4 versus 93%, respectively). A clear separation of the two species was apparent only with the acetoin (modified Voges-Proskauer) reaction (100% of the S. aureus isolates versus 0% of the S. intermedius isolates) and beta-galactosidase activity on the API Staph-Ident strip (0% of the S. aureus isolates and 100% of the S. intermedius isolates). Susceptibilities of S. intermedius and S. aureus were 72 and 7%, respectively, to penicillin G, and 100% of both species to oxacillin. Fourteen previously collected strains of coagulase-positive staphylococci from infected canine-inflicted human wounds were reanalyzed; 3 of 14 (21%) isolates were S. intermedius. We conclude that S. intermedius is a common canine gingival flora and is responsible for some canine-inflicted human wound infections, thus representing a newly recognized zoonotic pathogen.

Animals↗
PubMed1989

Frequency of Staphylococcus intermedius as human nasopharyngeal flora.

Staphylococcus intermedius, a veterinary flora and pathogen, has recently been isolated from humans with infected dog bite wounds. The frequency of S. intermedius as a human nasopharyngeal flora was determined by culturing samples from 144 veterinary college staff members. This bacterium was isolated from only one individual (0.7%). It appears that S. intermedius is a true zoonotic opportunistic pathogen.

Adolescent↗
PubMed1989

Advances in cutdown techniques.

Emergency Department physicians must be expert in rapidly obtaining adequate intravenous access. Cutdown techniques are an essential part of this endeavor. We have described the step-by-step techniques of placement of a variety of upper- and lower-extremity cutdowns in the Emergency Department.

Bloodletting↗
PubMed1988

Cephalic vein cutdown at the wrist: comparison to the standard saphenous vein ankle cutdown.

We first developed a technique for cutdown of the cephalic vein at the wrist. We then conducted a prospective cross-over cadaver study comparing the ability of medical students to perform this technique with that of the standard saphenous vein cutdown at the ankle. All students had a previous course in anatomy but had never performed a cutdown. Before testing, the students were given written material and a ten-minute lecture describing both approaches. Seventeen students performed 34 cutdowns; nine students attempted the cephalic cutdown followed by the saphenous cutdown; the remaining eight used the reverse order. The mean time (+/- SD) to isolation of the cephalic vein was 85 +/- 70 seconds; for the saphenous vein, mean time was 70 +/- 89 seconds (P = NS). There was one failure (inability to isolate the vein within five minutes) in 17 attempts at the cephalic vein and two failures in 17 attempts at the saphenous (P = NS). There were no complications (nerve, artery, or tendon injury) with either technique. The mean external vein diameter (+/- SD) of the cephalic vein and the saphenous vein were 3.2 +/- 1.0 mm and 3.6 +/- 0.7 mm, respectively (P = NS). We conclude that relatively inexperienced providers can learn to perform the cephalic vein cutdown at the wrist on fresh cadavers with similar speed and success as that for the saphenous vein cutdown at the ankle. Cutdown at this site may provide a useful alternative to the saphenous cutdown in certain clinical situations.

Humans↗
PubMed1982

Twenty-four hour continuous ECG recordings in long-distance runners.

Twenty-four hour ambulatory ECG recordings were performed on 20 male long-distance runners, aged 19 to 28 years, during normal activities other than running. Average, maximum, and minimum waking heart rates, respectively, ranged from 58 to 108 (mean +/- SD, 73 +/- 15), 90 to 164 (120 +/- 19), and 34 to 53 (43 +/- 5) beats/min. Longest waking sinus pauses ranged from 1.35 to 2.55 (1.7 +/- 0.3) seconds. Average, maximum, and minimum sleeping heart rates, respectively, ranged from 38 to 58 (47 +/- 6), 69 to 114 (83 +/- 14), and 31 to 43 (36 +/- 3) beats/min. Longest sleeping sinus pauses ranged from 1.60 to 2.81 (2.0 +/- 0.3) seconds. All 20 runners had atrial premature beats, but only one (5 percent) had more than 100/24 hours. Fourteen runners (70 percent) had ventricular premature beats, but only two (10 percent) had more than 50/24 hours, and none had ventricular couplets or ventricular tachycardia. Eight runners (40 percent) had one or more episodes of type 1 second-degree atrioventricular (A-V) block. Compared with untrained males of similar age, the runners had slower heart rates (by approximately 10 beats/min), longer sinus pauses, and a higher prevalence of A-V block. Runners and untrained males did not differ with respect to prevalence of ventricular premature beats, R on T phenomenon, ventricular couplets, or ventricular tachycardia.

Adult↗
PubMedDate not supplied

Comparison of ciprofloxacin (7 days) and trimethoprim-sulfamethoxazole (14 days) for acute uncomplicated pyelonephritis pyelonephritis in women: a randomized trial.

CONTEXT: The optimal antimicrobial regimen and treatment duration for acute uncomplicated pyelonephritis are unknown. OBJECTIVE: To compare the efficacy and safety of a 7-day ciprofloxacin regimen and a 14-day trimethoprim-sulfamethoxazole regimen for the treatment of acute pyelonephritis in women. DESIGN: Randomized, double-blind comparative trial conducted from October 1994 through January 1997. SETTING: Twenty-five outpatient centers in the United States. PATIENTS: Of 378 enrolled premenopausal women aged at least 18 years with clinical diagnosis of acute uncomplicated pyelonephritis, 255 were included in the analysis. Other individuals were excluded for no baseline causative organism, inadequate receipt of study drug, loss to follow-up, no appropriate cultures, and other reasons. INTERVENTIONS: Patients were randomized to oral ciprofloxacin, 500 mg twice per day for 7 days (with or without an initial 400-mg intravenous dose) followed by placebo for 7 days (n = 128 included in analysis) vs trimethoprim-sulfamethoxazole, 160/800 mg twice per day for 14 days (with or without intravenous ceftriaxone, 1 g) (n = 127 included in the analysis). MAIN OUTCOME MEASURE: Continued bacteriologic and clinical cure, such that alternative antimicrobial drugs were not required, among evaluable patients through the 4- to 11-day posttherapy visit, compared by treatment group. RESULTS: At 4 to 11 days posttherapy, bacteriologic cure rates were 99% (112 of 113) for the ciprofloxacin regimen and 89% (90 of 101) for the trimethoprim-sulfamethoxazole regimen (95% confidence interval [CI] for difference, 0.04-0.16; P = .004). Clinical cure rates were 96% (109 of 113) for the ciprofloxacin regimen and 83% (92 of 111) for the trimethoprim-sulfamethoxazole regimen (95% CI, 0.06-0.22; P = .002). Escherichia coli, which caused more than 90% of infections, was more frequently resistant to trimethoprim-sulfamethoxazole (18%) than to ciprofloxacin (0%; P<.001). Among trimethoprim-sulfamethoxazole-treated patients, drug resistance was associated with greater bacteriologic and clinical failure rates (P<.001 for both). Drug-related adverse events occurred in 24% of 191 ciprofloxacin-treated patients and in 33% of 187 trimethoprim-sulfamethoxazole-treated patients, respectively (95% CI, -0.001 to 0.2). CONCLUSIONS: In our study of outpatient treatment of acute uncomplicated pyelonephritis in women, a 7-day ciprofloxacin regimen was associated with greater bacteriologic and clinical cure rates than a 14-day trimethoprim-sulfamethoxazole regimen, especially in patients infected with trimethoprim-sulfamethoxazole-resistant strains.

Acute Disease↗
PubMedDate not supplied

Appropriateness of rabies postexposure prophylaxis treatment for animal exposures. Emergency ID Net Study Group.

CONTEXT: Rabies postexposure prophylaxis (RPEP) treatments and associated costs have increased in the United States. The extent to which RPEP use is consistent with guidelines is not well understood. OBJECTIVE: To characterize animal contacts and determine the frequency and factors associated with inappropriate RPEP use. DESIGN, SETTING, AND PATIENTS: Prospective case series study of patients presenting with an animal exposure-related complaint from July 1996 to September 1998 at 11 university-affiliated, urban emergency departments (the Emergency ID Net). MAIN OUTCOME MEASURES: Exposure type, circumstances, and RPEP use (appropriateness defined by local public health departments). RESULTS: Of 2030 exposures, 1635 (81%) were to dogs; 268 (13%) to cats; 88 (4%) to rodents/rabbits; 10 (0. 5%) to raccoons; 5 (0.2%) to bats; and 24 (1.2%) to other animals. Among those exposed, 136 (6.7%) received RPEP after dog (95), cat (21), raccoon (8), bat (4), or other animal (8) exposures. Use of RPEP varied by site (range, 0%-27.7% of exposures), with most frequent use reported at sites in the eastern United States. Management was considered appropriate in 1857 exposures (91.5%). Use of RPEP was considered inappropriate in 54 cases (40% of those in which it was given), owing to factors including animal availability for observation and exposure in a low-endemicity area. Rabies postexposure prophylaxis was considered inappropriately withheld from 119 cases (6.3% of those not receiving RPEP), often because a domestic animal was unavailable for observation or testing. CONCLUSION: These results suggest that use of RPEP is often inappropriate. Greater compliance with current guidelines would increase RPEP use. Physician education, improved coordination with public health officials, and clarification of RPEP guidelines could optimize use of this expensive resource. JAMA. 2000;284:1001-1007

Algorithms↗
PubMedDate not supplied

Role of empiric parenteral antibiotics prior to lumbar puncture in suspected bacterial meningitis: state of the art.

The performance of lumbar puncture (LP) in patients with suspected meningitis is often delayed if, for example, the clinical presentation suggests a need for prior computed tomographic (CT) scan or if patients are initially examined at settings with limited clinical facilities. The role of empiric parenteral antibiotic therapy prior to LP under these circumstances has not been critically analyzed. Review of the literature suggests that in cases of bacterial meningitis (1) the existing data are inadequate to assess the effect of a short delay of therapy on mortality and morbidity; (2) a short period of antibiotic therapy prior to LP does not change cerebrospinal fluid (CSF) white blood cell count, protein, or glucose; (3) the yield of CSF gram stain and culture may be somewhat reduced by a short period of antibiotic therapy, but these tests often remain positive; and (4) adjunctive tests, including blood cultures and CSF antigen tests, can often independently identify the bacterial meningopathogen. The available evidence suggests that if bacterial meningitis is suspected and LP must be delayed, intravenous antibiotics are warranted before CSF is obtained.

Anti-Bacterial Agents↗
PubMedDate not supplied

Emergency department management of pneumonia.

Many patients with pneumonia, especially those who are more severely ill, have their first medical contact in the emergency department. Pneumonia is usually diagnosed with appropriate signs and symptoms, although these can be lacking in the very young or the old. Gram stain and culture are seldom useful. The choice of appropriate antibiotic is usually determined by degree of illness and microbiological epidemiology. The most important decision made in the emergency department is whether to admit the patient with pneumonia to hospital; this decision can be aided by the use of clinical predictive rules. Initial treatment of pneumonia includes supportive care as needed (oxygen, intubation and bronchodilators) and an empirically chosen antibiotic. Appropriate choices include macrolides and azalides for low risk out-patients, and either a combination cephalosporin and macrolide or an extended spectrum fluoroquinolone in anticipation of drug-resistant Streptococcus pneumoniae for high risk out-patients and in-patients.

Ambulatory Care↗