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Biomedical subjects

J S Keystone

Publications and source records attributed to J S Keystone.

At least 37 records · Page 2Linked to original sources
PubMed1996

Cyclosporiasis: a new cause of diarrhea.

Cyclospora cayetanensis, a coccidian parasite, is a new cause of prolonged diarrhea. It has been most recently associated with ingestion of contaminated fruit. Although infection with C. cayetanensis is considered rare, the exact prevalence in Canada is unknown. Transmission is thought to occur through contaminated food and water. The incubation period varies from days to weeks. Patients present with nausea, vomiting, anorexia, bloating, abdominal cramping, increased gas and watery diarrhea. The illness may last up to 6 weeks and may respond to treatment with trimethoprim-sulfamethoxazole. C. cayetanensis is differentiated from other coccidians by its sporulation characteristics and its autofluorescence. To obtain a positive result of a laboratory test for the organism, a modified Ziehl-Neelsen acid-fast stain is recommended. Proper laboratory handling of specimens is facilitated by inclusion of clinical information on requisition forms.

Animals↗
PubMed1996

Knowledge and attitudes of hospital-based physicians and trainees about HIV infection in the United States, Canada, India, and Thailand.

OBJECTIVE: To examine the attitudes and knowledge of health care professionals regarding human immunodeficiency virus (HIV) infection in countries with a varying prevalence of HIV infection to assist in the development of acquired immunodeficiency syndrome (AIDS) educational programs. DESIGN: Anonymous questionnaire with four sections: demographics, attitudes, knowledge, and an open-ended question investigating feelings about the potential impact that HIV infection may have on respondents' practices. PARTICIPANTS: Final-year medical students, house staff, and attending physicians at teaching hospitals in India, Thailand, Canada, and the United States. RESULTS: From January to October 1992, 819 health care professionals completed the questionnaire: 340 from India, 196 from Canada, 155 from the United States, and 128 from Thailand. The percentage of respondents who had previous contact with patients with HIV/AIDS varied from 30% to 98%; it was lowest in India, followed by Thailand and then Canada, and highest in the United States. Percentages of respondents uncomfortable performing a physical examination on a patient with HIV/AIDS were 24%, 25%, 9%, and 4%, respectively. Mean HIV/AIDS knowledge scores were 83%, 84%, 92%, and 93%, respectively. Most respondents correctly identified modes of transmission of HIV infection. Only 67% of Indian health care professionals understood the concept of a false-negative screening serologic test, compared with 98% of Canadian health care professionals. In Canada and the United States, only 78% and 76%, respectively, understood the concept of a false-positive screening serologic test. Awareness of an asymptomatic stage of HIV infection ranged from 32% in India to 74% in Canada. Despite their concerns of becoming infected, health care professionals in countries with a lower prevalence of HIV infection reported a strong ethical duty to care for these patients. CONCLUSIONS: Level of comfort in caring for HIV-infected patients and HIV/AIDS knowledge scores varied directly with the amount of previous contact with these patients. Disturbing numbers of health care professionals from all four countries did not understand the potential problems of the enzyme-linked immunosorbent assay serologic test and a significant percentage were unaware of the asymptomatic stage of HIV infection. There is a universal need for increased education of health care professionals about HIV infection and AIDS.

Attitude of Health Personnel↗
PubMed1996

Failure of combined chloroquine and high-dose primaquine therapy for Plasmodium vivax malaria acquired in Guyana, South America.

The presence of chloroquine-resistant Plasmodium vivax malaria in the New World has been suspected but not confirmed. We report the cases of three patients who acquired vivax malaria in Guyana, South America, and for whom standard chloroquine therapy (25 mg/kg) failed despite therapeutic blood levels. The optimal treatment of chloroquine-resistant P. vivax malaria is unknown, but recent studies suggest that a combination of chloroquine (25 mg/kg) and high-dose primaquine (2.5 mg/kg over 48 hours) is effective therapy. Two of our patients had recurrences of P. vivax malaria 6-8 weeks after receiving directly observed therapy with this combination. These cases confirm the presence of chloroquine-resistant P. vivax in Guyana and emphasize the need for better treatment regimens for chloroquine-resistant and primaquine-resistant P. vivax malaria.

Adult↗
PubMed1996

Short report: severe hiccups secondary to doxycycline-induced esophagitis during treatment of malaria.

A 51-year-old man who was treated with quinine and doxycycline for Plasmodium falciparum malaria acquired in West Africa developed hiccups soon after his first dose of antimalarial therapy. Endoscopic examination performed when his hiccups became intractable showed an esophageal erosion and ulcer most likely due to doxycycline. The patient's symptoms resolved on treatment with omeprazole and sucralfate.

Anti-Bacterial Agents↗
PubMed1995

Concurrent falciparum malaria and Salmonella bacteremia in travelers: report of two cases.

Fever in travelers or immigrants from the tropics is an increasingly common problem facing physicians in urban centers of North America. Malaria and typhoid fever are endemic in developing countries and affect millions of people annually. An association between falciparum malaria and salmonella bacteremia has been noted for many years, although the underlying mechanisms have not been fully elucidated. We report on two travelers with falciparum malaria and concomitant salmonella bacteremia and review the possible mechanisms that may explain this association.

Adult↗
PubMed1995

Clofazimine induced cardiotoxicity--a case report.

A 66-year-old Indian male who had been treated for recurrent erythema nodosum leprosum with 300 mg of clofazimine per day for 11 months presented to hospital with a 4 week history of severe gastrointestinal upset. Soon after admission he developed several short runs of ventricular tachycardia with a morphology suggestive of torsade de pointe. The patient had a slightly low magnesium level which was corrected within 2 days; however, his rhythm disturbance persisted for 5 days despite management with intravenous lidocaine. His gastrointestinal symptoms abated 2 weeks after clofazimine was discontinued. Subsequent investigations showed that the patient had a keratopathy and myelin-type figures in his polymorphonuclear white cells similar to that seen with the cardiotoxic drugs chloroquine and amiodarone. It is postulated that clofazimine alone or in conjunction with electrolyte disturbance was responsible for the patient's cardiac arrythmia.

Aged↗
PubMed1994

Transmission of health information on leprosy from children to their families in an urban centre.

A health education study utilizing a homework assignment was carried out in a private secondary school in Bangalore, South India, to determine whether health information about leprosy would be transferred from children to their families. After a pre-test questionnaire on knowledge and attitude about leprosy was administered to 3 Standard VII classes and their family members, a different comprehensive health education session was given to each class: (i) leprosy plus a homework assignment; (ii) leprosy alone; and (iii) tuberculosis alone. A post-test questionnaire was administered to all participants 1 month later. Of the 118 children and 229 family members who entered the study, almost 80% of the participants completed it. The children in the leprosy-educated groups showed significant improvement in knowledge compared with controls, but no change in their attitude towards leprosy. Although post-test responses of household members showed modest improvement in knowledge about leprosy, attitudes remained the same or worsened. The homework assignment did not appear to improve the transmission of health information to household members. This study showed that the knowledge level of family members in South India could be improved modestly by educating their children about leprosy. However, attitudes towards leprosy were unaffected or worsened.

Adolescent↗
PubMed1994

Kimura's disease: an unusual cause of head and neck masses.

This article presents a case report of a patient who presented with Kimura's disease. Kimura's disease is an unusual condition with predilection to involve the head and neck. Since Kimura's disease often imitates a neoplastic or inflammatory process of the head and neck it behooves the otolaryngologist-head and neck surgeon to be able to recognize this entity.

Adult↗
PubMed1993

Creeping eruption. A review of clinical presentation and management of 60 cases presenting to a tropical disease unit.

BACKGROUND AND DESIGN: Cutaneous larva migrans is an infection with a larval nematode, most frequently by dog or cat hookworms. It has a characteristic presentation that is easily recognizable. We reviewed the charts of 60 patients with cutaneous larva migrans who presented to the Tropical Disease Unit, Toronto (Ontario) Hospital, during a 6-year period. RESULTS: Ninety-five percent of the patients were Canadians who had recently returned from the tropics or subtropics, notably the Caribbean. Almost all patients had a linear or serpiginous, very pruritic larval track. Topical thiabendazole was efficacious in 52 (98%) of 53 patients treated. Albendazole cured six (88%) of seven patients treated. Because of adverse effects, oral thiabendazole and liquid nitrogen were not utilized. CONCLUSION: We conclude that topical thiabendazole and oral albendazole are very effective and safe modalities for the treatment of cutaneous larva migrans.

Adolescent↗
PubMed1993

Trematode infections. Opisthorchiasis, clonorchiasis, fascioliasis, and paragonimiasis.

The parasitic diseases of the liver and lung are caused by trematodes or flukes--Opisthorchis viverrini, O. felineus, Fasciola hepatica, and Paragonimus westermani. Humans get infected by eating the second intermediate host of the fluke, for example, fish, crab, or water plant. The disease runs a chronic course. The diagnosis is made by the recover of eggs in stools or sputum, or by serodiagnosis. Praziquantel is the drug of choice except in falcioliaisis.

Adult↗
PubMed1993

Short course ciprofloxacin therapy for enteric fever.

A short course of ciprofloxacin, 750 mgm b.i.d. for 7 days was found to be effective in the treatment of enteric fever in 21 hospitalized patients with S.typhi (18) and S.paratyphi A(3). Median time for fever response was 3 days. All isolates were susceptible to ciprofloxacin (MIC 0.0078-0.062 mcgm/ml). The mean serum peak and trough levels were 5.4 and 1.6 mcgm/ml respectively. Stool cultures were free of Salmonellae on follow up (11-24 weeks). Two developed recurrence of paratyphoid fever, 17 days and 4 months after therapy.

Adult↗