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Biomedical subjects

Michael S Bronze

Publications and source records attributed to Michael S Bronze.

At least 19 recordsLinked to original sources
PubMed2005

Infectious Aortitis.

Infection of the aorta usually results from septic embolization to the vasa vasorum, hematogenous seeding of an existing aneurysm, or extension from a contiguous site of infection. The diagnosis should be considered in patients, often men over the age of 50 years with atherosclerosis, who present with fever, abdominal pain, palpable abdominal mass, and leukocytosis, with or without positive blood cultures. In the pre-antibiotic area, infectious aortitis was largely a complication of infective endocarditis, and was usually caused by group A streptococci, Streptococcus pneumoniae, or Haemophilus influenzae. Now a diverse array of bacteria and fungi has been associated, most commonly Salmonella species, which comprise nearly one third of the abdominal aortic infections and Staphylococcus aureus. Computed tomography is the most useful imaging modality. Medical treatment alone carries a high mortality, whereas the mortality with surgery combined with antimicrobial treatment is lower. Empiric antibiotics effective against S. aureus and gram-negative rods, such as Salmonella, should be initiated in cases identified before microbiologic diagnosis. Surgical debridement and revascularization should be completed early because delay may lead to aneurysm rupture, which increases mortality. The intent of surgery is to 1) control hemorrhage, if the aneurysm has ruptured; 2) confirm the diagnosis; 3) control sepsis; and 4) reconstruct the arterial vasculature. The patient should remain on parenteral or oral antibiotics for at least 6 weeks, perhaps longer, to assure full eradication of the pathogen and prevent recurrent infection. Close medical follow-up is indicated and includes serial blood cultures and computed tomography scans.

Journal Article↗
PubMed2004

Current therapy and the development of therapeutic options for the treatment of diseases due to bacterial agents of potential biowarfare and bioterrorism.

An important part of biodefense is the optimization of current therapy and the development of new therapeutic options for the treatment of the diseases most likely encountered in the form of biological weapons. Guidelines for the prevention and treatment of anthrax, plague, tularemia and botulinum toxin intoxication are reviewed. The strategies in development for the prevention of anthrax focus primarily on active and passive immunization against protective antigen, because of its central role as a toxin delivery module. Novel vaccine strategies for plague, tularemia and botulism are also reviewed.

Animals↗
PubMed2004

Overview and management of obesity in adults.

Teaching Points. The prevalence of overweight or overtly obese adults in the United States is growing and associated with significant morbidity and mortality. Office evaluation of the overweight or obese adult includes a thorough history and physical examination complemented by several laboratory tests that evaluate for co-morbid conditions. Treatment of the overweight or obese adult requires a step-wise approach beginning with lifestyle modification followed by pharmacologic or surgical interventions in selected patients. Treatment decisions should take into consideration body mass index, waist circumference and the presence of comorbidities or obesity-associated risk factors.

Adult↗
PubMed2003

Prevention and treatment of bacterial diseases caused by bacterial bioterrorism threat agents.

There is general consensus that the bacterial agents or products most likely to be used as weapons of mass destruction are Bacillus anthracis, Yersinia pestis, Francisella tularensis and the neurotoxin of Clostridium botulinum. Modern supportive and antimicrobial therapy for inhalational anthrax is associated with a 45% mortality rate, reinforcing the need for better adjunctive therapy and prevention strategies. Pneumonic plague is highly contagious, difficult to recognize and is frequently fatal. Therefore, the development of vaccines against this agent is crucial. Although tularemia is associated with low mortality, the highly infectious nature of aerosolized F. tularensis poses a substantive threat that is best met by vaccine development. Safer antitoxins and a vaccine are required to meet the threat of the use of botulinum toxin as a weapon of mass destruction. In this article, the current status of research in these areas is reviewed.

Adjuvants, Immunologic↗
PubMed2003

Preventive and therapeutic approaches to viral agents of bioterrorism.

Certain viruses, such as those that cause smallpox and hemorrhagic fevers, have been identified as possible bioterrorism agents by the Centers for Disease Control and Prevention. They have been designated as potential threats because large quantities can be propagated in cell culture, they are transmissible as aerosols and, for the most part, there are only limited vaccine and pharmaceutical strategies for either prevention or treatment of established infection. An additional concern is the potential to genetically modify these agents to enhance virulence or promote resistance to vaccines or identified antivirals. Although the major impact of these agents is human illness, the release of zoonotic agents, such as the Nipah virus, would have consequences for both humans and animals because infected and noninfected animals might need to be sacrificed to control the spread of infection. Continued research is necessary to develop effective strategies to limit the impact of these biological threats.

Animals↗
PubMed2003

Therapeutic options for diseases due to potential viral agents of bioterrorism.

The etiologic agents of smallpox and viral hemorrhagic fever have emerged as potential agents of bioterrorism due to their virulence, potential for human to human dissemination and limited strategies for treatment and prevention. Cidofovir has shown significant promise in animal models, and limited case reports in humans are encouraging. Ribavirin is the treatment of choice for certain hemorrhagic fever viral infections, but has no current application to Ebola and Marburg infections. Current vaccine strategies for smallpox are effective, but carry significant risk for complications. Licensed vaccines for hemorrhagic fever viruses are limited to yellow fever, but animal studies are promising. Genomic analysis of the viral pathogen and the animal model response to infection may provide valuable information enabling the development of novel treatment and prevention strategies. Current knowledge of these strategies is reviewed.

Antiviral Agents↗
PubMed2002

Terrorism from a public health perspective.

The use of biological and chemical weapons as agents of warfare and terrorism has occurred sporadically, but recent events demonstrate the increasing risk and possibility that terrorist groups with grievances against the government or groups may employ them. Historically, most evaluations of the potential risk for biological weaponry have focused on the military, but the recent release of anthrax in the United States demonstrates that civilian populations are also at risk. More likely than not, most bioterrorism events will be of a small scale; however, agents such as Bacillus anthracis and Yersinia pestis could leave hundreds of thousands dead or incapacitated. The impact of the attack will depend on a number of variables, including the agent used, method of dispersal, and the responsiveness of the public health system. With any large-scale event, the public health infrastructure will be called upon to deal with mass casualties and the "worried well."

Bioterrorism↗
PubMed2002

Bacterial pathogens as biological weapons and agents of bioterrorism.

Bacterial pathogens have been identified as agents that have been, or could be, used as weapons of biological warfare and/or biological terrorism. These agents are relatively easily obtained, prepared, and dispersed, either as weapons of mass destruction or for more limited terrorist attacks. Although phylogenetically diverse, these agents all have the potential for aerosol dissemination. Physicians in the United States and most of the developed world have never encountered most of these agents and the diseases they produce. Public health programs must be prepared, and individual primary care providers must be able to recognize, diagnose, treat, and prevent infection with these agents.

Anthrax↗