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Biomedical subjects

D Kaye

Publications and source records attributed to D Kaye.

244 records · Page 14Linked to original sources
PubMedDate not supplied

Pneumonia caused by gram-negative bacilli: an overview.

Colonization of the oropharynx by Pseudomonas aeruginosa and enteric gram-negative bacilli in acutely ill or debilitated patients, alcoholics, diabetics, and persons with chronic bronchitis may lead to pneumonia. Although gram staining of sputum may provide immediate etiologic clues, the diagnosis is proven only by isolation of the pathogen from blood or pleural fluid or by various invasive techniques since expectorated specimens from highly susceptible patients are often contaminated with aerobic gram-negative bacilli colonizing the oropharynx. However, restricting the definition of cases to those involving empyema or bacteremia results in an underestimation of incidence. Combination therapy with a beta-lactam antibiotic plus an aminoglycoside is commonly recommended for gram-negative bacillary pneumonia because (1) the patients involved are usually debilitated and immunocompromised; (2) mortality is high; and (3) the spectrum of antibacterial activity is increased, emergence of resistance may be retarded, and synergistic activity may result. For example, a third-generation cephem antibiotic plus an aminoglycoside can be used for initial treatment of community-acquired gram-negative bacillary pneumonia, and piperacillin or azlocillin plus amikacin can be used for initial treatment of nosocomial infection in which P. aeruginosa or some other antibiotic-resistant gram-negative bacillus is more likely to be involved.

Acinetobacter Infections↗
PubMedDate not supplied

Infectious diseases fellowship training: another viewpoint.

According to some observers, an oversupply of physicians in general, and of infectious disease (ID) specialists in particular, already exists; if not, oversupply may be imminent. More stringent licensing requirements, mandatory accreditation for specialty programs, and legislation restricting Medicare expenditure on direct education may help to keep the numbers of specialists down. However, once saturation is reached, it will persist longer in ID than in other, older subspecialties. In the future, many ID specialists may spend much of their time evaluating conditions that have no obvious relation to an infectious disease. Rather than an unfortunate waste, however, ID training will be advantageous in these circumstances because of the excellent background acquired in evaluating histories and performing thorough physical examinations and the emphasis placed on cost-effective use of antimicrobial agents. Physicians well trained in ID are likely to be cost conscious in the use of the laboratory as well as parsimonious in the use of drugs. A further lowering of costs probably results from contributions of these physicians to hospital formulary committees and infection control programs. Thus, residents in internal medicine who wish ID training should be given the opportunity; they will be better internists for the experience.

Education, Medical, Graduate↗
PubMedDate not supplied

Central nervous system monoamine neurotransmitter turnover in primary and obesity-related human hypertension.

Recent experiments in laboratory animals have challenged the conventional view that the dominant effect of CNS noradrenergic neurons in cardiovascular control is sympathetic nervous inhibition and blood pressure reduction, describing instead sympathetic activation. We have tested whether such a stimulant effect on sympathetic outflow is also evident in human hypertension. CNS norepinephrine turnover was estimated from the combined overflow of norepinephrine, MHPG and DHPG into the internal jugular veins. Cerebral blood flow scans allowed differentiation between cortical and subcortical jugular venous drainage. In patients with pure autonomic failure, jugular overflow of norepinephrine and metabolites was not reduced, indicating brain neurons and not cerebrovascular sympathetics was the source. In healthy men, CNS norepinephrine turnover and muscle sympathetic nerve activity were directly related (p < 0.02). Administration of the ganglion blocker, trimethaphan, caused a compensatory five-fold increase in jugular overflow of MHPG. Conversely, intravenous clonidine reduced CNS norepinephrine turnover by approximately 50%, this possibly representing a mechanism of drug action. In cardiac failure patients, sympathetic nervous activation was associated with a trebling of CNS norepinephrine turnover (p < 0.01). In untreated patients with essential hypertension, the sympathetic activation present was associated with 250% higher CNS norepinephrine turnover (p < 0.01), but in subcortical brain regions only. A close and direct relation exists between brain norepinephrine turnover and human sympathetic nervous activity. CNS release of norepinephrine, presumably in the forebrain where noradrenergic neurons are sympathoexcitatory and pressor, mediates increased sympathetic nerve firing in patients with essential hypertension.

Animals↗
PubMedDate not supplied

Risk factors, nature and severity of domestic violence among women attending antenatal clinic in Mulago Hospital, Kampala, Uganda.

OBJECTIVES: To determine the prevalence, types, severity and risk factors for domestic violence among women attending antenatal clinic. DESIGN: Cross sectional study. SETTING: The antenatal clinic, Mulago Hospital, the national referral hospital, Kampala, Uganda. SUBJECTS: Pregnant women (n = 379) attending the antenatal clinic, on their index visit. METHODS: Interviewer-administered pre-coded questionnaires about history of domestic violence during the index pregnancy (prevalence, nature, severity, and associated factors from socio-demographic history, reproductive history, childhood history and domicile); during the previous one year prior to the interview, or beyond the previous year. MAIN OUTCOME MEASURES: History of domestic violence and its severity, type, risk factors and associated factors in the index pregnancy or prior to it. RESULTS: Over 57% of the subjects reported moderate-to-severe abuse due to domestic violence. Abuse in childhood and witnessing abuse in childhood were significantly associated with domestic violence in index pregnancy (p = 0.000). Staying with co-wife, adolescent pregnancy and the first pregnancy were significantly associated with domestic violence. CONCLUSIONS: Domestic violence is common in pregnancy at Mulago; is moderate to severe and physical abuse is often associated with both sexual and psychological abuse.

Adolescent↗
PubMedDate not supplied

In vitro inhibition of growth of neisseria gonorrhoeae by genital microorganisms.

The ability of microorganisms present in titers of over 10(5)/ml in the vaginal or cervical secretions to inhibit growth of N. gonorrhoeae in vitro was tested. Study of a strain of N. gonorrhoeae against 77 microorganisms demonstrated that most strans of S. epidermidis, S. aureus and the one "Gaffkya anaerobia" interfered with the growth of the N. gonorrhoeae. A minority of strains of S. viridans, Neisseria, Candida and Bifidobacterium demonstrated interference. No strains of enterococcus, diptheroids, aerobic Lactobacillus, Peptostreptococcus, Peptococcus, anaerobic Lactobacillus or Veillonella demonstrated interference.

Bacteria↗
PubMedDate not supplied

The use and preliminary results of the Troutman surgical keratometer in cataract and corneal surgery.

The Troutman microsurgical keratometer has been shown to be useful in monitoring intraoperative procedures, and it has been demonstrated in the case of cataract and keratoplasty to have a significant influence on the control of operatively induced astigmatism. It is applicable to any surgical procedure which has the potential of altering permanently and unpredictably the corneal curvatures. Intraoperative keratometry has clearly demonstrated some inadequacies of our current cataract and keratoplasty techniques. It is now being used to guide our efforts toward a more rational control of the vexing problem of astigmatism.

Astigmatism↗
PubMedDate not supplied

Preliminary experience with inhaled nitric oxide for acute pulmonary hypertension after heart transplantation.

BACKGROUND: Substantial interest has developed in the physiologic and therapeutic role of nitric oxide in the last few years. In patients with pulmonary hypertension it appears to be a useful selective pulmonary vasodilator; however, many issues of both staff and patient safety remained unanswered. METHODS: This study examines further safety issues and also presents preliminary clinical experience in patients after orthotopic heart transplantation with pulmonary hypertension and right-sided ventricular failure. RESULTS: Atmospheric levels of nitric oxide and nitrogen dioxide are 100 times less than occupational health standards. When nitric oxide is used at 70 parts per million in the presence of a fraction of inspired oxygen greater than 0.60, nitrogen dioxide levels in the circuit exceed the published short-term exposure limit of the American Conference of Government Industrial Hygienist of 5 parts per million. CONCLUSION: Staff safety appears confirmed, but despite encouraging clinical results, further longer term safety and efficacy studies are indicated.

Administration, Inhalation↗