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At least 847 records · Page 47Linked to original sources
PubMed1997

Pathogenesis, diagnosis, and management of trichomoniasis in cattle.

Trichomoniasis is a disease of the pregnancy, but apparently not of either the cow or the bull, except in the case of postcoital pyometra. Its self-limiting nature in the cow and chronic nature in the bull mean that a positive diagnosis for the herd can more easily be obtained from bulls than from cows. Incubation of preputial scrapings or washings (or pyometritic fluid, if available) in a selective growth medium such as the InPouch system is the diagnostic method of choice. The diagnosis is based on identification of the morphology and characteristic rolling motility of the trichomonad. "High tech" molecular approaches may eventually offer greater diagnostic sensitivity than can culture methods, but currently they are no more accurate. In addition, serologic screening of the female herd (but interestingly, not the bulls) may become possible and may allow the practitioner to at least determine whether exposure has occurred in an unvaccinated herd. Control in an infected herd involves no pharmacologic treatment but rather culling of infected bulls, retention of younger, culture-negative bulls, and segregation of the female herd by reproductive status.

Animals↗
PubMed2003

Overview of pediatric liver transplantation.

Liver transplantation is a successful and useful therapy for children with chronic or end-stage liver disease and those with a variety of extrahepatic metabolic diseases that can be corrected by liver replacement. Major developments in medical management, donor availability and procurement, operative techniques, and post-operative management all contributed to the dramatic improvement in outcome and growth of liver transplantation from its inception in 1963 [1,7,21]. The excellent long-term outcomes that have been achieved are the product of the coordinated efforts of liver transplant surgeons, specialists in pediatric hepatology and other medical areas, nurses, local practitioners, and the patients and their families. Future advances in transplant immunobiology, organ availability and infection control are likely to lead to still greater improvements in short and long-term outcome [34].

Child↗
PubMed1991

Infected physicians: what are the ethical and legal standards?

The law addressing the area of physicians infected by blood-borne diseases is very new and sometimes vague. It remains important, though, to ask how patients can be protected from real risks without excluding competent and safe practitioners.

Centers for Disease Control and Prevention, U.S.↗
PubMedDate not supplied

Infection control procedures in intraoral radiology: a survey of Michigan dental offices.

A questionnaire was mailed to members of the Michigan Dental Association to determine the extent and adequacy of infection control procedures utilized during intraoral radiography. These measures were then compared with the infection control guidelines recommended by the American Dental Association for exposing and processing radiographs. During exposure procedures, it was found that an overwhelming majority of practitioners wore disposable gloves and placed saliva-contaminated film packets in a receptacle after removing them from the mouth. Very few clinicians complied with the ADA recommendations for wrapping surfaces in the X-ray operatory, but many used disinfectants to decontaminate surfaces touched by the operator. Most respondents washed or removed their gloves before leaving the operatory to process films, thereby stopping the spread of saliva. ADA recommendations for infection control during processing were generally not followed although alternate methods were frequently used. It is emphasized that infection control regimens be employed for all patients, and not only for those who are thought to be infectious. Auxiliaries should be educated in these protocols because they expose radiographs in many dental offices.

Communicable Disease Control↗
PubMed2003

Immunonutrition: problematic or problem solving?

The addition of immune-modulating nutrients to enteral formulas has been examined in clinical trials and meta-analyses. Enhancing immunity through diet is generally done by adding n-3 fatty acids, arginine, and nucleotides to an otherwise nutritionally complete formula. Despite flaws in many studies, a consistent trend to reduced infectious complications has been seen with immunonutrition, especially in patients undergoing surgery for upper gastrointestinal cancer or trauma. In critical care populations, however, the results have been mixed. In this review, we analyze these studies and focus on select clinical points that may explain the variation. One common flaw has been a failure to deliver an adequate nutrition volume. Few patients, especially in the earliest studies, received even close to goal feeding. A minimum quantity of immunonutrition may be required for effective reduction in infections. When feeding volumes are low, immunonutrition is usually not better than an isonitrogenous control. In more recent studies, practitioners have been increasingly aggressive with enteral feeding, and this has been reflected in improved outcomes from immunonutrition. Early delivery of immunonutrition (preoperatively in surgical patients with cancer) might be particularly beneficial. Another consideration is illness severity: we discuss evidence that the use of immunonutrition in moderate illness is more likely to be helpful, whereas severe sepsis is probably beyond the reach of any nutritional intervention, and mild illness is more likely to improve irrespective of feeding. If future trials can consider these vital points, level 1 recommendations in favor of immunonutrition might be justified, although presently such evidence is lacking for most clinical indications.

Adjuvants, Immunologic↗
PubMed2005

A case-control study of acute respiratory tract infection in general practice patients in The Netherlands.

BACKGROUND: Acute respiratory tract infections (ARTIs) are responsible for considerable morbidity in the community, but little is known about the presence of respiratory pathogens in asymptomatic individuals. We hypothesized that asymptomatic persons could have a subclinical infection and thus act as a source of transmission. METHODS: During the period of 2000-2003, all patients with ARTI who visited their sentinel general practitioner had their data reported to estimate the incidence of ARTI in Dutch general practices. A random selection of these patients (case patients) and an equal number of asymptomatic persons visiting for other complaints (control subjects) were included in a case-control study. Nose and throat swabs of participants were tested for a broad range of pathogens. RESULTS: The overall incidence of ARTI was 545 cases per 10,000 person-years, suggesting that, in the Dutch population, an estimated 900,000 persons annually consult their general practitioner for respiratory complaints. Rhinovirus was most common in case patients (24%), followed by influenza virus type A (11%) and coronavirus (7%). Viruses were detected in 58% of the case patients, beta -hemolytic streptococci group A were detected in 11%, and mixed infections were detected in 3%. Pathogens were detected in approximately 30% of control subjects, particularly in the youngest age groups. CONCLUSION: This study confirms that most ARTIs are viral and supports the reserved policy of prescribing antibiotics. In both case and control subjects, rhinovirus was the most common pathogen. Of bacterial infections, only group A beta-hemolytic streptococci were more common in case patients than in control subjects. Furthermore, we demonstrated that asymptomatic persons might be a neglected source of transmission.

Acute Disease↗
PubMed1996

Sterilisation. Past confusions and current recommendations.

Since 1990 more than 15 reference texts and guidelines from various bodies and organisations have been produced to assist or direct medical practitioners in their understanding of sterilisation and/or disinfection issues. Approximately 90% of these monographs is a rewrite of standard thoughts and approximately 10% represent new thoughts, often in contradiction to opinions published previously. As a result, much confusion exists. The most recent offering is that from the National Health and Medical Research Council titled Infection Control in the Health Care Setting. The stated aim of this publication is to 'establish a nationally accepted minimum standard for infection control'. Although an excellent document in many ways, it too adds to the confusion. This article reviews this document and places its recommendations into perspective with other authoritative works. A summary of what is now appropriate for general practitioners to do in their own clinical settings is also provided.

Australia↗
PubMed2005

Response to antibiotics of women with symptoms of urinary tract infection but negative dipstick urine test results: double blind randomised controlled trial.

OBJECTIVE: To assess the effectiveness of antibiotic treatment of women with symptoms of urinary tract infection but negative urine dipstick testing. DESIGN: Prospective, double blind, randomised, placebo controlled trial. SETTING: Primary care, among a randomly selected group of general practitioners in Christchurch, New Zealand. PARTICIPANTS: 59 women aged 16-50 years presenting with a history of dysuria and frequency in whom a dipstick test of midstream urine was negative for both nitrites and leucocytes. Participants with complicated urinary tract infection were excluded. INTERVENTION: Trimethoprim 300 mg daily for three days or placebo. MAIN OUTCOME MEASURES: Self reported diary of symptoms for seven days, recording the presence or absence of individual symptoms each day, followed by a structured telephone questionnaire after seven days. The main clinical outcome was resolution of dysuria at three and seven days and median time to resolution. Secondary outcomes were resolution of other symptoms. RESULTS: The median time for resolution of dysuria was three days for trimethoprim compared with five days for placebo (P = 0.002). At day 3, five (24%) of patients in the treatment group had ongoing dysuria compared with 20 (74%) in the placebo group (P = 0.005). This difference persisted until day 7: two patients (10%) in the treatment group v 11 (41%) in the placebo group; P = 0.02). The number needed to treat was 4. The median duration of constitutional symptoms (feverishness, shivers) was reduced by four days. CONCLUSIONS: Although a negative dipstick test for leucocytes and nitrites accurately predicted absence of infection when standard microbiological definitions were used (negative predictive value 92%), it did not predict response to antibiotic treatment. Three days' treatment with trimethoprim significantly reduced dysuria in women whose urine dipstick test was negative. These results support the practice of empirical antibiotic use guided by symptoms. Balancing the competing interests of symptom relief and the minimisation of antibiotic use remains a dilemma-further research is needed to determine clinical predictors of response to antibiotics.

Adolescent↗
PubMedDate not supplied

A randomized double-blind controlled trial of roxithromycin and cefaclor in the treatment of acute lower respiratory tract infections in general practice.

A multicenter, randomized, double-blind, single-dummy placebo-controlled study is being undertaken by the Research Unit of the Royal New Zealand College of General Practitioners to compare the efficacy and tolerance of 150 mg twice daily roxithromycin with 250 mg three times daily cefaclor in the treatment of 250 general practice patients with acute lower respiratory tract infections (LRTIs). Interim analysis of 200 patients reveals no statistically significant differences in the study parameters. Of the patients on roxithromycin and cefaclor, 83% and 67%, respectively, had a moderate or severe illness. Based on efficacy criteria, 96% of roxithromycin recipients and 99% of cefaclor recipients had a satisfactory or improved response. On an intention-to-treat basis, this was reduced to 95% for both treatment groups. Sputum grading and semiquantitative culturing was performed according to NCCLS standards. The most common isolates in order were Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae. Efficacy for bacteriologically evaluable cases was 87.5% for roxithromycin and 57% for cefaclor. Four patients on roxithromycin (3.9%) and 11 patients on cefaclor (11.3%) withdrew because of side effects probably or possibly related to the study treatment. The study is ongoing.

Acute Disease↗
PubMed1988

Are general practitioners ready to prevent the spread of HIV?

General practitioners are excellently placed to assess a person's risk of being infected with the human immunodeficiency virus (HIV) and to give advice on reducing that risk. Their attitudes to the acquired immune deficiency syndrome (AIDS) and infection with HIV are, however, unknown. A questionnaire survey of 196 general practitioners in East Berkshire Health District was used to assess general practitioners' readiness to undertake opportunistic health education to prevent the spread of infection with HIV. Altogether 132 replied. Sixty four of them expressed little interest in health education about HIV, and one in six would not dissent from the notion that AIDS could be controlled only by criminalising homosexuality. Only 75 of them had initiated discussions about HIV with patients. Moreover, many underestimated the risks from heterosexual sex while exaggerating the risks from non-sexual contact. Advice from general practitioners if given extensively might reduce the spread of infection with HIV. How best this may be achieved needs to be considered urgently.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Managing cardiovascular risk in patients with HIV infection.

Highly active antiretroviral therapy (HAART) improves the survival of patients with HIV infection; however, several observational studies have described associations between HIV infection, HAART, and cardiovascular disease. Important limitations of these studies included a low incidence of cardiovascular events, short duration of HAART exposure, and retrospective design. Nevertheless, the weight of evidence from observational and surrogate end point studies suggests that the dyslipidemia and other metabolic changes that are common in patients with HIV infection and those using HAART may be associated with increased cardiovascular risk. The Infectious Disease Society of America/Adults AIDS Clinical Trials Group guidelines for the evaluation and management of dyslipidemia recommend target lipid levels and treatment of dyslipidemia in patients with HIV infection. Although practitioners should consider dyslipidemia and cardiovascular risk when making plans for initiating or altering HAART therapy, maintaining viremic control should be the overriding factor, because short-term absolute rates of cardiovascular disease are significantly lower than death rates from AIDS in inadequately suppressed patients. This article reviews the cardiovascular risks in patients receiving HAART and discusses the implementation of the new guidelines.

Antiretroviral Therapy, Highly Active↗
PubMed2000

Clinical monitoring of HIV-1 infection in the ERA of antiretroviral resistance testing.

Viral replication of HIV-1 in the human body is a dynamic process. Incomplete suppression of replication during antiretroviral therapy ultimately selects for resistance that imparts an adaptive advantage to HIV-1. Therefore, the goal of antiretroviral therapy is complete suppression of viral replication. Viral suppression to below the lowest possible limits of detection has been associated with an optimal clinical response and delay of drug resistance. An ultrasensitive viral load assay with a very low threshold of detection remains our best laboratory tool to monitor the response to therapy. Patients may fail HAART for many reasons. Only when other potential causes of treatment failure are excluded should antiretroviral resistance testing be considered. Genotypic and phenotypic assays for assessing resistance are now available, and recent retrospective and prospective data support their use in clinical management as an adjunct to helping to choose among different antiretroviral drugs. Despite the growing enthusiasm for these tests, improvements in sensitivity, turnaround time, and quality control are still needed. A practitioner's decision about when to initiate or change therapy in an HIV-infected patient should depend primarily on viral load results, and not on antiretroviral resistance test results. Moreover, resistance testing is no substitute for a thorough clinical and drug history. As we approach the third decade of the HIV epidemic, we will learn how to use antiretroviral resistance tests in conjunction with (not in lieu of) proven clinical and laboratory tools.

Anti-HIV Agents↗
PubMed1998

Understanding physicians' intention to use a simple infection control measure: wearing gloves.

OBJECTIVE: The aim of this study was to identify the factors that explain the intention of physicians to wear gloves when contact with blood or body fluids was possible. METHODS: A survey was given to a representative sample of physicians (general practitioners, medical specialist, and surgeons of the Canadian province of Québec). A total of 720 physicians completed the self-administered questionnaire. The respondents' intention to wear gloves, psychosocial variables (attitude, perceived social norm, perceived behavioral control, perceived risk of infection, and habit of wearing gloves), and sociodemographic variables were assessed. RESULTS: A substantial proportion of physicians (80%) had strong intentions to wear gloves when contact with blood and body fluids was possible. Logistic regression indicated that the 3 most important factors explaining intention were perceived behavioral norm, attitudes, and perceived behavioral control. Perceived risk of infections, habit of wearing gloves, and being in a younger age category were additional factors related to intention. CONCLUSIONS: Interventions should reinforce the perception that the use of gloves is the norm among medical professionals. These programs also should emphasize the advantages of wearing gloves, counteract the perceived disadvantages of wearing them, and enhance the ability of physicians to circumvent the difficulties of wearing gloves when required.

Adult↗
PubMedDate not supplied

SARS: What We Have Learned So Far ...

This article addresses severe acute respiratory syndrome (SARS), which was first identified in November of 2002 and continued to spread till 2003. The article briefly covers the pathogenesis of SARS followed by a review of current epidemiological and empirical data on this new disease. Information on signs and symptoms of SARS as well as the current suggested treatment will be presented.

Algorithms↗
PubMed1999

Severe neutropenia as an adverse effect of methimazole in the treatment of hyperthyroidism.

Ms. K., a white, 47-year-old female with a history of hyperthyroidism had been treated with methimazole daily for a period of 9 years. She presented with a 2-day history of fever higher than 103 degrees F and cellulitis of the right arm after a scratch injury. White blood cell count (WBC) was noted at 0.4 x 10(3)/microL and neutrophils at 5.6%, indicating agranulocytosis. Methimazole was discontinued by the patient with the onset of symptoms. Appropriate intravenous antibiotic therapy and reverse isolation were provided in the acute-care setting, as well as administration of the granulocyte colony-stimulating factor (G-CSF) filgrastim. No recovery of the granulocyte count or improvement of clinical condition was noted until her sixth day of admission, at which time her WBC increased to 2.6 x 10(3)/microL. The administration of intravenous antifungals and antibiotics prevented overwhelming sepsis, while giving the G-CSF the opportunity to stimulate growth of granulocytes to finally fight the offending organisms and save this patient.

Antithyroid Agents↗