Biomedical subjects
Publications and source records attributed to M Radetsky.
John Keats was trained as an apothecary, the general practitioner of the day. Precocious in his sensibilities and fluent in his imagery, he also was the model of the romantic poet. That he was a physician and a poet makes his early death from tuberculosis poignant and revealing. This history traces his life and death against the backdrop of medicine at the turn of the 19th century.
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Early discharge of suitable newborns is rapidly becoming a hospital standard. One concern is that truncated hospital observation of the infant during the first days of life, even with home visits or early clinical appointments, would allow early signs of a serious infection to go unnoticed, which could lead to a missed chance for early therapy and could imperil the child's favorable recovery. An analysis of available data for early onset neonatal bacterial sepsis and neonatal herpes virus infection shows that this new practice should not unduly place newborns at risk of treatable infections, however, so long as conventional risk factors are appreciated and reasonable, nationally sanctioned discharge criteria are followed.
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In the United States, Epstein-Barr virus is acquired primarily in late adolescence. Acute infectious mononucleosis and other syndromes, complications, and atypical infections associated with EBV are described, as are the differential diagnosis, management, and treatment.
Infectious disease emergencies are those in which delays in diagnosis or treatment may lead to untoward harm. Recent developments in the field offer few new therapies, but rather emphasize familiar infections in new guises or clarify approaches to troublesome entities. An enduring concern for the legal risks implicit in the care of infected children has recently received new attention.
The prompt diagnosis and therapy of bacterial meningitis remain enduring clinical challenges, for no physician would knowingly delay appropriate therapy. However, whether a delay in the initiation of antimicrobials in fact causes a worse outcome is a separate and tangential question. In clinical medicine a treatment decision involves a bedside estimate of the risk and potential severity of illness balanced against the benefits and adverse effects of therapy. For severe infections, the inexorable damage of untreated disease is presumed, and antimicrobials properly are given without hesitation. In contrast the methodical weighing of evidence regarding the issue of causation is for the purpose of characterizing biologic phenomena. Although legal and medical implications may be contained in such an analysis, its relevance to any particular clinical case is only retrospective. To judge responsibly the strength of a causative link, all available scientific evidence must be analyzed by established criteria. Such as analysis suggests that any connection between a delay in the treatment of bacterial meningitis and outcome depends on the presenting clinical pattern. If the presentation is that of a nonspecific illness with general symptoms, then a short delay of < 3 to 5 days does not appear to alter the risk of sequelae or death. In the case of fulminant meningitis a delay in initiating therapy seems unconnected to outcome. Finally for patients with a history of clinically overt meningitis, an inappropriate delay in commencing therapy incrementally increases the risk of permanent injury.
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There is no ideal laboratory procedure or culture medium in current use for susceptibility testing of pathogenic yeasts. Six candidate growth media (RPMI 1640 with L-glutamine, yeast nitrogen base, Casamino Acids medium, Mueller-Hinton broth, Sabouraud dextrose broth, and minimum essential medium-Eagle salts) were screened by spectrophotometric absorbance for nucleic acid and protein. From these, two media were selected: a chemically defined growth medium (RPMI 1640 with L-glutamine) and a chemically complex medium (Casamino Acids). MICs of four antifungal agents (5-fluorocytosine, miconazole, ketoconazole, and amphotericin B) for 84 clinical isolates of various Candida species were then determined with both media in agar dilution and microtiter broth dilution systems. The resultant MICs were correlated with clinical outcome for those isolates obtained from patients treated with single antifungal agents, and susceptibility cut points were calculated. Derived MIC cut points for susceptibility were validated in a murine model of systemic candidiasis. RPMI 1640 with L-glutamine was found to have the lowest absorbance values for both nucleic acid and protein, while Casamino Acids medium was highest in both categories. We found that RPMI 1640 with L-glutamine was superior to Casamino Acids medium in the yield of MICs which correlated with actual clinical and animal outcome data. While there were no significant differences in MICs when RPMI 1640 medium was used, the microtiter broth dilution technique was superior to agar dilution in efficiency and ease of performance. We conclude that a microtiter broth system containing RPMI 1640 medium with L-glutamine is a simple, precise, and economical technique for susceptibility testing of pathogenic Candida species. We also suggest that the validation of susceptibility cut points with patient and animal outcome data make this microtiter broth system a preferential method for yeast susceptibility testing.
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Fever in infants (age less than 24 months) is a medical urgency because of the possibility that a severe bacterial infection may be present. A clinical approach to this recurring dilemma is provided to help the practitioner avoid the twin dangers of either missing a serious infection or embarking on an over-exuberant diagnostic work-up.
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The overall scheme for evaluating a new diagnostic test is presented in Fig. 2. The office-based practitioner has encountered a new diagnostic test (A). The purpose of the new test seems to be one that would be useful in an office practice, for the suspected disease is seen frequently enough to justify stocking an office test (B), and the benefits of the test, if true, would augment the delivery of patient care (C). From the manufacturer, appropriate literature references are obtained which compare the new test with either the current office test or an accepted standard; the article is from a peer review journal (D). This article is then examined more carefully (E). The conclusions contained in the Abstract, if true, would lead the practitioner to change his current office procedure. The Methods section of the article is now examined for evidence that an independent clinical standard of comparison was used; a patient population was described similar to that in the office practice; a wide spectrum of disease presentations was evaluated; a sensible definition of "normal" was utilized; the study was "blinded" to avoid bias; and a detailed description of the test techniques was provided. In the Results section, one notes the precision and inter-observer variability of the test, and an appropriate statistical analysis is verified. Finally, the Discussion is skimmed to find out whether the authors have commented on the utility of the test in an office setting.(ABSTRACT TRUNCATED AT 250 WORDS)