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Biomedical subjects

R Wurtz

Publications and source records attributed to R Wurtz.

At least 19 recordsLinked to original sources
PubMed2001

Do new surgeons have higher surgical-site infection rates?

We compared class I surgical-site infection (SSI) rates for new and experienced surgeons. Data showed that new surgeons in two surgical subspecialties associated with higher baseline SSI rates had rates higher than their experienced colleagues. They took longer in the operating room (OR), but did not operate on sicker patients. As the surgeons gained more experience (as measured by cumulative cases), their OR times and SSI rates decreased toward their colleagues'. New surgeons who perform infection-prone surgery may have higher SSI rates than more experienced colleagues until they gain experience. A new surgeon's SSI rate could be one factor considered in assessing competence.

Clinical Competence↗
PubMed2000

From Animal to Man: Tinea Barbae.

Dermatophytic fungi cause human infection worldwide. One clinical syndrome--tinea barbae, which closely resembles tinea capitis--is a trichophytosis involving the beard and mustache areas of the face. The fungal agents responsible for tinea barbae (Trichophyton verrucosum and Trichophyton mentagrophytes) are contracted through occupational exposure to animals infected with zoophilic dermatophytes. Tinea barbae may be confused with other facial infections, especially those caused by Staphylococcus aureus or other facial dermatophytes (usually anthrophilic). In an afebrile patient without leucocytosis, a distinctive facial lesion, called a kerion, can be the essential diagnostic finding. Diagnosis requires suspicion based on appropriate exposure. Definitive diagnosis requires a combination of clinical examination, direct microscopic examination using potassium hydroxide, and culture confirmation. Topical treatment is not effective. Oral therapy with an antifungal (eg, terbinafine) or an azole is recommended. This article reviews these factors, as well as germane epidemiologic and prevention measures.

Journal Article↗
PubMed2000

Adipose redistribution in human immunodeficiency virus-seropositive patients: association with CD4 response.

We have noted that human immunodeficiency virus (HIV)-seropositive patients who develop adipose redistribution (AR) while receiving combination antiretroviral therapy (ART) also tend to have a better response to ART, as indicated by the relative change in CD4 percent compared to those who don't develop AR on therapy. Whether the possible benefits of the improved CD4 response outweigh the metabolic and cosmetic problems associated with lipodystrophy is not known.

Adult↗
PubMed2000

La Crosse encephalitis presenting like herpes simplex encephalitis in an immunocompromised adult.

The diagnosis of the precise cause of viral encephalitis can be difficult, hampered by the nonspecific presentation, the number of etiologic viruses, and limited culture and serologic diagnostic methods. Because herpes simplex encephalitis (HSE) can be neurologically devastating and is treatable, timely diagnosis is important. We report an immunocompromised adult with encephalitis clinically consistent with HSE who had serology consistent with recent La Crosse encephalitis (LAC).

Adult↗
PubMed1999

The cost of tuberculosis: utilization and estimated charges for the diagnosis and treatment of tuberculosis in a public health system.

SETTING: An urban tuberculosis (TB) control program. OBJECTIVE: The use of medical services was analyzed from diagnosis through completion of treatment for TB patients in a public health system in order to estimate charges and service utilization. DESIGN: The in- and out-patient medical records, including long term care and jail health service records, were retrospectively reviewed for the first 100 patients diagnosed with TB in 1993 at a public hospital. Because the hospital did not have a cost-accounting system, charges were estimated based on a variety of sources. RESULTS: Complete records were available for 92 patients; one outlier was excluded. The resulting 91 patients represented 11% of newly diagnosed patients in Chicago in 1993. Overall, almost 99% of the charges reflected in-patient (acute and long term care) utilization. Total charges of $3,154,583 represent the charges to complete therapy for only 46 patients, or $68,578 per completed case. CONCLUSIONS: This study attempts to overcome the limitations of aggregate data sets by looking at individual patients followed longitudinally through a complex public health system. Expensive in-patient care may be partially, but not completely, replaced by directly observed therapy. The findings may be used to predict resource utilization for diagnosis and treatment programs.

Adult↗
PubMed1998

Psychiatric diseases presenting as infectious diseases.

Although many psychiatric diseases have somatic manifestations, some focus on fears or delusions of infection. When a patient with a psychiatric basis for an apparent infection presents to an infectious disease physician, the physician may find the problem confusing, amusing, and ultimately frustrating until the psychiatric basis for disease is recognized. Some of these psychiatric disorders can be treated and controlled with medication and psychotherapy, although patients may resist psychiatric referral. This article reviews examples of psychiatric disorders in patients who present to the infectious disease physician, including factitious infection, malingering, obsessive compulsive disorder, phobias, veneroneuroses, somatization disorders, and delusional infection. The role that physicians play in amplifying these disorders is reviewed. Strategies for referral to psychiatric services are also discussed. Patients with a psychiatric disease are seen in infectious disease practices more commonly than physicians realize.

Adult↗
PubMed1997

Mycobacterium tuberculosis DNA Not Detected by Polymerase Chain Reaction In Air Samples From Hospital Rooms of Tuberculosis Patients.

Background: As the incidence of tuberculosis (TB) increased in the United States, the risk of occupational and nosocomial TB also increased. Airborne Mycobacterium tuberculosis (MTB) is difficult to measure directly. Quantifying MTB DNA by polymerase chain reaction in air samples obtained from isolation rooms of patients with TB would provide a measure of the number of airborne organisms produced by a patient and the efficacy of ventilation, and might predict when an individual patient is no longer infectious. Methods and Results: The air was sampled through cellulose ester filters from the isolation room of a patient with newly diagnosed pulmonary TB, from a patient on therapy for 14 days, and from adjacent offices, and an attempt was made to detect MTB DNA; however, MTB DNA was detected only on positive control filters. Conclusions: Mycobacterium tuberculosis was not detected by polymerase chain reaction in air samples from the rooms of two patients with pulmonary TB. This may have been due to the large number of room air changes with resultant rapid clearance of airborne droplet nuclei or to the limited air volume sampled. A sensitive molecular assay of airborne MTB could be used to monitor the efficacy of infection control measures by sampling a sufficient volume of isolation room air and could aid in determining when an individual patient was no longer infectious.

Journal Article↗
PubMed1997

Antimicrobial dosing in obese patients.

Although the dose of some drugs is commonly adjusted for weight, weight-related dosage adjustments are rarely made for most antimicrobials. We reviewed the English-language literature on antimicrobial pharmacokinetics and dosing in obesity. Although there are many potential pharmacokinetic consequences of obesity, the actual effect on the pharmacokinetics and clinical efficacy of most antimicrobials is unknown. Since approximately 30% of adipose is water, an empirical approach is use of the Devine formula to calculate ideal body weight (IBW), to which is added a dosing weight correction factor (DWCF) of 0.3 times the difference between actual body weight (ABW) and IBW (IBW + 0.3 x [ABW-IBW]) to arrive at a weight on which to base dosage of hydrophilic antibiotics. No studies confirm this approach for beta-lactam drugs. Clinical studies suggest a DWCF of approximately 0.40 for aminoglycosides and 0.45 for quinolones. Final dosage adjustments for antimicrobials with a narrow toxic-therapeutic window should be based on serum concentrations.

Animals↗
PubMed1996

Positive tuberculin skin test reactions among house staff at a public hospital in the era of resurgent tuberculosis.

BACKGROUND: The number and significance of tuberculin skin test reactions were compared with self-reported baseline values among house staff working in a public hospital. High-risk medical specialties, locations, and infection control practices were examined. METHODS: House staff interviews, tuberculin skin test applications, review of employee health service records, and environmental monitoring of high-risk areas were performed. RESULTS: Among house staff self-reported as having negative tuberculin skin test status, 46.2% (95% CI 27.0% to 65.4%) of internal medicine house staff, compared with 4.8% (95% CI 4.3% to 13.9%) of house staff from other areas (p < 0.005), had positive results on a repeat tuberculin skin testing before graduation. These differences were not entirely explained by the use of surgical masks, year of training, or previous vaccination with bacille Calmette-Guérin. Most skin test reactions (69%) occurred among house staff who had not been vaccinated with bacille Calmette-Guérin. Increased skin reactivity probably represented excess conversions from unprotected exposure. Tuberculosis transmission was facilitated by delays in diagnosis, inadequate isolation facilities, and suboptimal ventilation. House staff did not comply with recommended tuberculosis surveillance because of time constraints, fear, and misunderstandings about tuberculin skin test interpretations in light of previous bacille Calmette-Guérin vaccination. CONCLUSIONS: House staff in high-exposure settings with suboptimal environmental controls are at increased risk for tuberculosis infection. Participation in surveillance programs can be increased by enlisting the participation and advocacy of respected medical colleagues, screening house staff differentially according to exposure and job classifications, and more accurately interpreting subsequent test results from baseline two-step testing.

BCG Vaccine↗
PubMed1996

Specimen contamination in mycobacteriology laboratory detected by pseudo-outbreak of multidrug-resistant tuberculosis: analysis by routine epidemiology and confirmation by molecular technique.

A cluster of multidrug-resistant tuberculosis sputum isolates led to the detection of specimen contamination in a hospital mycobacteriology laboratory. Thirteen specimens were smear negative but culture positive from one specimen only; 12 appeared to be contaminated. Each of these specimens was processed in the same batch as one or more smear- and culture-positive isolates. Molecular analysis confirmed the traditional epidemiologic, laboratory, and clinical methods of evaluating presumed mycobacterial contamination.

Bacteriological Techniques↗