Search PubMed⌕ Search

Biomedical subjects

Zuber D Mulla

Publications and source records attributed to Zuber D Mulla.

At least 19 recordsLinked to original sources
PubMed2006

Therapies for necrotising fasciitis.

Necrotising fasciitis is a rare but life-threatening infectious disease emergency. Delays in diagnosis and treatment are common, and mortality rates often exceed 30%. Successful management of this disease requires high clinical suspicion and aggressive action. The mainstays of therapy include early and wide surgical debridement, antibiotics and supportive care, with prompt surgical intervention. Adjunctive modalities, such as protein synthesis inhibitors, hyperbaric oxygen and intravenous immunoglobulin, may have a role, but their effectiveness remains unproven. New rapid diagnostic tools are emerging that promise to revolutionize early detection of necrotising fasciitis. Research into the molecular microbiology, especially regarding group A streptococcus, are providing novel insights into the pathogenesis of necrotising soft tissue infections and identifying future targets for rationally designed interventions.

Animals↗
PubMed2005

Iron deficiency and Helicobacter pylori infection in the United States.

Using data from the current National Health and Nutrition Examination Survey (1999-2000), the authors assessed whether Helicobacter pylori infection is associated with iron deficiency and iron-deficiency anemia (IDA) in the United States. Iron deficiency was defined as at least two abnormal results out of three biomarkers of iron stores. IDA was defined as a low hemoglobin level in the presence of iron deficiency. H. pylori infection was measured by serology. Complex survey estimators were used in the analysis. For 7,462 survey participants aged >or=3 years, H. pylori infection was associated with decreased serum ferritin levels (percent change = -13.9%, 95% confidence interval (CI): -19.5, -8.0) but not with levels of free erythrocyte protoporphyrin, transferrin saturation, or hemoglobin (percent change = 1.5%, -2.8%, and -1.1%, respectively). Multinomial logistic regression analyses indicated that H. pylori infection was associated with the prevalence of IDA (prevalence odds ratio (POR) = 2.6, 95% CI: 1.5, 4.6) and, to a lesser degree, other types of anemia (POR = 1.3, 95% CI: 1.0, 1.7). H. pylori infection was associated with a 40% increase in the prevalence of iron deficiency (POR = 1.4, 95% CI: 0.9, 2.0) after controlling for relevant covariates. In the United States, H. pylori infection was associated with iron deficiency/IDA regardless of the presence or absence of peptic ulcer disease.

Adolescent↗
PubMed2005

Invasive group A streptococcal disease: race, hypotension, and immunogenetics.

OBJECTIVE: To determine if there was an association between race and the incidence of hypotension among patients hospitalized for invasive group A streptococcal disease (IGASD). DESIGN: Data were obtained from a retrospective cohort study of IGASD patients. The subjects were hospitalized throughout Florida for IGASD between 1996 and 2000 (N=151). The exposure variable for the current study was race (African Americans, Caucasians). The binary outcome was the presence of hypotension within 48 hours of hospital admission. A sensitivity analysis was performed to determine if a particular human leukocyte antigen (HLA) class II haplotype (DRB1*1501/DQB1*0602) confounded the association between race and the risk of hypotension. IGASD patients possessing this haplotype are less likely to experience hypotension with multiple organ failure. RESULTS: We found that Caucasians had three times the odds of developing hypotension than African Americans (adjusted odds ratio=3.02, 95% confidence interval: 1.10-8.29, P=.03). The sensitivity analysis revealed that the HLA class II haplotype DRB1*1501/DQB1*0602 was most likely not a confounder. CONCLUSIONS: Caucasians were significantly more likely than African Americans to develop the adverse outcome of hypotension within 48 hours of being hospitalized for IGASD. This excess risk is most likely not due to a particular host genetic factor, the HLA class II haplotype DRB1*1501/DQB1*0602.

Black or African American↗
PubMed2004

Hospitalization for nontraumatic disorders of the eye and ocular adnexa: analysis of the Florida agency for health care administration data set.

OBJECTIVE: To study the demographic features and patterns of hospital admission in Florida for nontraumatic disorders of the eye and ocular adnexa. METHODS: The public data set from the Florida Agency for Health Care Administration for 2001 was used to identify persons hospitalized for 24 hours or longer for nontraumatic disorders of the eye and ocular adnexa by using International Classification of Diseases, Ninth Revision, Clinical Modification codes. RESULTS: In 2001, there were 2137 hospital admissions for nontraumatic disorders of the eye and ocular adnexa, most of which were for infections or neuro-ophthalmologic disorders. The median length of stay was 3.0 days (mean +/- SD, 3.4 +/- 3.8 days). On average, 1 patient was admitted per month to 180 Florida hospitals. Eighty-three patients (3.9% of eye admissions) were hospitalized for 10 days or longer and accounted for 18.1% of total hospital-patient days. Prolonged hospital stay was positively associated with hospital transfer (P <.001) and facial cellulitis (P =.04). A trend for positive association with Medicaid coverage was also observed (P =.07). CONCLUSIONS: Nontraumatic eye care composes a small proportion of all inpatient care (< 0.1%) in Florida. Few of these patients require prolonged hospitalization but use a large proportion of inpatient care on the basis of the percentage of gross charges. An opportunity exists to improve hospital efficiency and improve eye care by targeting the patients at highest risk for prolonged hospital stay.

Databases, Factual↗
PubMed2004

Clinical pathway care improves outcomes among patients hospitalized for community-acquired pneumonia.

PURPOSE: To examine the impact of a unique evidence-based clinical pathway on six outcomes of care in patients hospitalized for community-acquired pneumonia (CAP). METHODS: A retrospective cohort study of CAP patients discharged between January 1999 and December 2001, from 31 Adventist Health System institutions nationwide. A total of 22,196 records were available for multivariate analyses. Odds ratios (OR) for the outcomes were calculated and stratified by a unique severity score. The severity score ranged from 1 to 5, where 5 indicated the most severe condition. RESULTS: Pathway patients were significantly less likely to die in-hospital compared with non-pathway patients in four of the five severity strata (OR in severity level 1=0.37; 95% confidence interval [CI], 0.20-0.70). In all severity strata, pathway patients were approximately twice as likely as non-pathway patients to receive blood cultures and appropriate antibiotic therapy. Among patients who were classified as severity level 1, pathway patients experienced an 80% reduction in the odds of respiratory failure requiring mechanical ventilation (OR=0.20; 95% CI, 0.12-0.33). CONCLUSIONS: Patients who were placed on pneumonia clinical pathway care were much more likely than non-pathway patients to have favorable outcomes of care.

Adolescent↗
PubMed2004

Treatment options in the management of necrotising fasciitis caused by Group A Streptococcus.

Invasive Group A Streptococcus (GAS) disease is a serious condition that has multiple manifestations. A particularly severe form of invasive GAS disease is necrotising fasciitis (NF). The case-fatality rate of GAS NF is approximately 20%. Penicillin remains the antibiotic of choice when treating invasive GAS infections. Epidemiological studies have shown that clindamycin is effective in the treatment of deep infections that are caused by GAS. Clinicians should consider adding clindamycin to the beta-lactam antibiotic regimen when NF or myositis is present. Intravenous immunoglobulin appears to be a promising adjunctive therapy in the management of GAS NF. Consultations with surgeons and infectious disease specialists are imperative.

Anti-Bacterial Agents↗
PubMed2003

Invasive group A streptococcal infections in Florida.

BACKGROUND: Several previous studies of invasive Group A streptococcal (GAS) disease have been hindered by small sample sizes (< or = 100 patients) and limited generalizability. METHODS: We conducted a population-based study of invasive GAS disease. The objectives of the study were to describe the clinical features of individuals who were hospitalized for invasive GAS disease and to identify risk factors for hospital mortality. The cases were 257 patients who were hospitalized throughout Florida during a 4-year period and reported to the Florida Department of Health. Logistic regression was used to calculate adjusted odds ratios (OR) for mortality and 95% confidence intervals (CI). RESULTS: The overall mortality was 18% (41 of 228). Admission into an intensive care unit was a strong predictor of mortality (OR, 20.41; 95% CI, 6.41-64.96). Treatment with clindamycin reduced mortality in patients who had necrotizing fasciitis (OR, 0.11; 95% CI, 0.01-0.89) but not in patients who did not have necrotizing fasciitis (OR, 1.01; 95% CI, 0.31-3.33). CONCLUSION: Clindamycin reduces mortality in patients with invasive GAS disease who have necrotizing fasciitis.

Anti-Bacterial Agents↗
PubMed2002

Invasive group A streptococcal disease and intensive care unit admissions.

OBJECTIVE: To determine the clinical epidemiology of invasive group A streptococcal disease (IGASD) and identify predictors of admissions into an intensive care unit (ICU). DESIGN: A cross-sectional study. SETTING: Retrospective review of data. PATIENTS: A total of 204 patients hospitalized throughout the state of Florida, United States, between August 1996 and August 2000 for IGASD. INTERVENTION: None. MEASUREMENTS AND RESULTS: Prevalence odds ratios for ICU admissions were calculated for several demographic and clinical variables. The prevalence of ICU admissions was lower among patients 69 years of age or older compared to younger patients (odds ratio=0.43, 90% confidence interval: 0.23-0.83). The odds ratio associated with the presence of necrotizing fasciitis was 6.98 (90% confidence interval: 3.13-15.58). CONCLUSION: In this analysis of patients hospitalized for IGASD, the presence of necrotizing fasciitis was the strongest factor associated with admissions into an ICU.

Aged↗
PubMedDate not supplied

The reliability of clinical methods in ophthalmology.

The reliability of clinical methods is often taken for granted. There is considerable evidence, however, that variability of clinical measurements, interpretations, and judgements are greater than commonly thought. Inconsistency of clinical methods has profound and widespread implications in clinical practice. The inferential capacity of measurements depends on accuracy and reproducibility. Appropriate medical decisions cannot be reached without accurate and reliable data. This review will examine the conceptual relationship of reliability, accuracy, and validity. The role of observer reliability in ophthalmic test measurements and interpretations will be addressed in the context of three case reports.

Adult↗