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PubMed2002

Chronic symptoms are common in patients with neuroborreliosis -- a questionnaire follow-up study.

OBJECTIVES: The existence of chronic neuroborreliosis is controversial. The aim of our study was to investigate the existence and kind of persistent symptoms in patients previously treated because of neurological symptoms as a result of neuroborreliosis. MATERIALS AND METHODS: A total of 106 patients with neuroborreliosis, according to established criteria, and a control group of 123 patients with Borrelia induced erythema migrans diagnosed in a general practitioner office were studied. A questionnaire was sent to patients and controls concerning their health situation. Time from onset of neurological symptoms to the questionnaire send out was 32 months (mean) for the patients with neuroborreliosis and 33 months (mean) for the controls. RESULTS: Fifty per cent of the individuals in the patient group compared with 16% of the individuals in the control group showed persistent complaints after their Borrelia infection (P < 0.0001). The most significant differences between the groups were the presence of neuropsychiatric symptoms such as headache, attention problems, memory difficulties and depression. Paresthesia, pain and persistent facial palsy was also significantly more common in patients treated because of neuroborreliosis. CONCLUSION: Our study shows that persisting neurological symptoms are common after a neuroborreliosis infection. The pathological mechanisms that lay behind the development of chronic symptoms, however, are still uncertain.

Adult↗
PubMed2001

Australia's notifiable diseases status, 1999: annual report of the National Notifiable Diseases Surveillance System.

In 1999 there were 88,229 [corrected] notifications of communicable diseases in Australia reported to the National Notifiable Diseases Surveillance System (NNDSS). The number of notifications in 1999 was an increase of 3 per cent on notifications in 1998 (85,227) and the second largest reporting year since the NNDSS commenced in 1991. Notifications in 1999 consisted of 29,977 bloodborne infections (34% of total), 22,255 gastrointestinal infections (25%), 21,704 sexually transmitted infections (25%), 5,986 vector borne infections (7%),5,228 vaccine preventable infections (6%), 1,967 (2%) other bacterial infections (legionella, meningococcal, leprosy and tuberculosis), 1,012 zoonotic infections (1%) and 3 quarantinable infections (0.003%). Notifications of bloodborne viral diseases particularly hepatitis B and hepatitis C and some sexually transmitted infections such as gonorrhoea and chlamydia continue to increase in Australia. Steep declines in vaccine preventable diseases such as Haemophilus influenzae type b, measles, mumps and rubella continued in 1999. This report also summarises data on communicable diseases from other surveillance systems including the Laboratory Virology and Serology Surveillance Scheme (LabVISE) and sentinel general practitioner schemes. In addition this report comments on other important developments in communicable disease control in Australia in 1999.

Australia↗
PubMed1998

Randomized controlled trial of omeprazole or endoscopy in patients with persistent dyspepsia: a cost-effectiveness analysis.

BACKGROUND: Cost-effectiveness analysis, Helicobacter pylori research and the development of proton pump inhibitors are having an increasing impact on the management of dyspepsia. However, clinical trials have not always included both H. pylori diagnosis and proton pump inhibitors in their protocols. METHODS: Patients who were referred for upper gastrointestinal endoscopy by their general practitioner were randomized to either prompt endoscopy followed by directed medical treatment (conventional group, n=38), or to empirical treatment with omeprazole and, in the case of symptom relapse, serological screening for H. pylori infection followed by eradication therapy in seropositive patients (empirical group, n=42). The study lasted for up to 1 year. RESULTS: In the empirical group, only 13 patients (31%) underwent endoscopy. The average number of days for which the patients kept records of their dyspeptic symptoms was 266 (95% CI: 226-307) in the empirical group, of which 166 (95% CI: 128-204) were symptom-free. In the conventional group, 159 (95% CI: 119-198) out of 255 days (95% CI: 209-302) were recorded as symptom-free. The average medical cost in the empirical group was $284 (95% CI: 218-350) and in the conventional group $491 (95% CI: 383-600). In the empirical group, two malignancies were found, whereas in the conventional group one malignancy was found. CONCLUSIONS: The empirical drug treatment strategy in patients with persistent dyspeptic symptoms resulted in 69% fewer diagnostic endoscopies with lower medical costs and equal effectiveness in the first year, compared to prompt endoscopy followed by directed medical treatment.

Adult↗
PubMed2006

Percutaneous versus surgical tracheostomy: A randomized controlled study with long-term follow-up.

OBJECTIVE: To compare the safety, availability, and long-term sequelae of percutaneous vs. surgical tracheostomy. DESIGN: Prospective, randomized, controlled study. SETTING: Combined medical/surgical intensive care unit in a tertiary referral hospital. PATIENTS: Two hundred critically ill mechanically ventilated patients who required tracheostomy. INTERVENTIONS: Tracheostomy by either percutaneous tracheostomy or surgical tracheostomy performed in the intensive care unit. MEASUREMENTS AND MAIN RESULTS: The primary outcome measure was the aggregate incidence of predefined moderate or severe complications. The secondary outcome measures were the incidence of each of the components of the primary outcome. Long-term follow-up included clinical assessment, flow volume loops, and bronchoscopy. Both groups were well matched for age, gender, admission Acute Physiology and Chronic Health Evaluation II score, period of endotracheal intubation, reason for intubation, and admission diagnosis. There was no statistical difference between groups for the primary outcome. Bleeding requiring surgical intervention occurred in three percutaneous tracheostomy patients and in no surgical tracheostomy patient (p = .2). Postoperative infection (p = .044) and cosmetic sequelae (p = .08) were more common in surgical tracheostomy patients. There was a shorter delay from randomization to percutaneous tracheostomy vs. surgical tracheostomy (p = .006). Long-term follow-up revealed no complications in either group. CONCLUSIONS: Both percutaneous tracheostomies and surgical tracheostomies can be safely performed at the bedside by experienced, skilled practitioners.

Aged↗
PubMed2005

Diabetes and female sexual dysfunction: moving beyond "benign neglect".

Female sexual response is a complex, nonlinear progression from desire to arousal and orgasm. Diabetes may affect all these, but it particularly affects arousal with decreased genital sensation and lubrication. Vaginal dryness and infections may lead to dyspareunia. Predictors of sexual dysfunction in women include depression. Neither age, duration of diabetes, glycemic control, nor complications predict sexual dysfunction in women as they do in men. Objective measures of decreased genital sensation or lubrication do not correlate with a subjective sense of female sexual arousal disorder. Low androgens and possibly estrogens may be etiologic, as may numerous medications used by patients with diabetes. Practitioners should recognize the high prevalence of female sexual dysfunction (up to 50%) and potential increase, in tandem with that of diabetes. In the absence of definitive treatment evidence, psychological counseling, improvised vaginal lubricants, and low doses of estrogens or androgens have been used to relieve the personal distress of female sexual dysfunction.

Arousal↗
PubMed2002

Biosecurity for reproductive diseases.

Application of rational principles of risk management in designing an effective biosecurity plan for reproductive diseases can be an important part of a profitable operation. Knowledge of the disease status of the particular herd, the effective strategies for disease exclusion including test performance and reservoirs is necessary. Vaccination can be an effective part of a biosecurity program by increasing herd immunity and decreasing the impact of an outbreak, but by itself will not prevent infections and losses. A more comprehensive approach to disease control is needed. Development and implementation of a biosecurity program is an individualized effort undertaken for a particular operation. Knowledge of the disease status of the herd for each agent of concern and prioritization of the diseases most important in the herd is necessary. The biosecurity plan is then specific for the herd and the particular agent(s) of concern. Practitioners can apply knowledge of the epidemiology and ecology of disease agents to identify and implement logical control points for the individual herd. Many control strategies may be effective for more than one disease. A comprehensive look at the operation is necessary to make sure that the cost of the biosecurity plan does not exceed the return in prevented disease and increased production over the planning period.

Abortion, Veterinary↗
PubMed1994

Body temperature changes before minor illness in infants.

This study aimed to examine the overnight temperature pattern of babies during the prodromal phase of minor illnesses. The overnight rectal temperature pattern of 123 babies was recorded weekly from about 6 to at least 16 weeks old, while parents maintained detailed records of signs of illness. By analysis of patterns of signs and visits to the general practitioner, 86 periods of minor illness were identified, mostly upper respiratory tract infections, though it was not usually possible to identify the infection by conventional virology. Data were analysed separately for babies who had developed an adult-like night time temperature pattern and those who had not. In both groups, obvious signs of illness were preceded by a disturbance of night time temperature pattern. Temperature was significantly raised over control weeks, though few babies were clinically febrile. The greatest temperature disturbances were seen in the three days before illness, though some disturbances were seen up to seven days before. A similar disturbance of temperature was seen the night after diphtheria, pertussis, and tetanus immunisation, and individual responses to natural infection and immunisation were well correlated, suggesting that the temperature change is more a function of the host response than the infecting agent.

Body Temperature↗
PubMed1998

Women with HSV and HPV: a strategy to increase self-esteem.

This study tested the impact of the use of a self-help module on knowledge of disease and the cognitive perceptual variables of self-esteem, self-concept, satisfaction with intimate relationships and body image in young adult women with herpes simplex virus (HSV) or human papillomavirus (HPV) infections. In this prospective, experimental study, 40 HSV-positive and 58 HPV-positive women were randomly assigned to the intervention or routine counseling groups. Analysis of covariance was used to test for treatment differences. The HSV intervention groups had greater satisfaction with intimate relationships after the intervention and a greater increase in self-esteem, but no effect of the intervention was found for the HPV groups. Pre- and posttest mean change scores were compared for the separate groups using t-test analysis. Although scores on the knowledge of disease tests were high for the subjects, they reported engaging in risky sexual behaviors. The findings indicate that the use of a self-help module to assist HSV-infected women with the psychological impact of this disease may be an effective strategy to enhance adjustment, but knowledge did not deter risk-taking behavior.

Adaptation, Psychological↗
PubMedDate not supplied

[Gloves: some unknowns].

The diffusion of transmissible diseases such as the Acquired Immunodeficiency Syndrome, well known as AIDS, has induced in the population a great sensibility to the problem of disease transmission. Dentists and patients, because of peculiar features of oral environment and dental procedures, are very exposed to these risks. For this reason every technique which reduces the risk of cross-infections patient to patient and patient to dentist to patient are absolutely necessary. From this point of view the use of gloves is very important to protect dental operator and patients. The aim of this study is: a) to stress the importance of mechanical barriers, like gloves, in dentistry in order to sensitize dental practitioners to the use of gloves; b) to underline that the quality of dental gloves in Italy is lower than in other countries which have a quality standard.

Cross Infection↗
PubMed2005

American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: controlling tuberculosis in the United States.

During 1993-2003, incidence of tuberculosis (TB) in the United States decreased 44% and is now occurring at a historic low level (14,874 cases in 2003). The Advisory Council for the Elimination of Tuberculosis has called for a renewed commitment to eliminating TB in the United States, and the Institute of Medicine has published a detailed plan for achieving that goal. In this statement, the American Thoracic Society (ATS), Centers for Disease Control and Prevention (CDC), and the Infectious Diseases Society of America (IDSA) propose recommendations to improve the control and prevention of TB in the United States and to progress toward its elimination. This statement is one in a series issued periodically by the sponsoring organizations to guide the diagnosis, treatment, control, and prevention of TB. This statement supersedes the previous statement by ATS and CDC, which was also supported by IDSA and the American Academy of Pediatrics (AAP). This statement was drafted, after an evidence-based review of the subject, by a panel of representatives of the three sponsoring organizations. AAP, the National Tuberculosis Controllers Association, and the Canadian Thoracic Society were also represented on the panel. This statement integrates recent scientific advances with current epidemiologic data, other recent guidelines from this series, and other sources into a coherent and practical approach to the control of TB in the United States. Although drafted to apply to TB-control activities in the United States, this statement might be of use in other countries in which persons with TB generally have access to medical and public health services and resources necessary to make a precise diagnosis of the disease; achieve curative medical treatment; and otherwise provide substantial science-based protection of the population against TB. This statement is aimed at all persons who advocate, plan, and work at controlling and preventing TB in the United States, including persons who formulate public health policy and make decisions about allocation of resources for disease control and health maintenance and directors and staff members of state, county, and local public health agencies throughout the United States charged with control of TB. The audience also includes the full range of medical practitioners, organizations, and institutions involved in the health care of persons in the United States who are at risk for TB.

Adolescent↗
PubMedDate not supplied

Wound swabbing technique.

Many nurses perform clinical procedures that are based on ritual, without understanding the rationale behind them (Parker, 1999). Health policy in the UK emphasises the need for evidence-based care and requires practitioners to ensure that clinical practice is founded on scientifically-derived findings rather than intuition and ritual.

Colony Count, Microbial↗
PubMed2005

Outbreak of mesotherapy-associated skin reactions--District of Columbia area, January-February 2005.

Mesotherapy is a treatment involving local subcutaneous injections of minute quantities of various substances (e.g., vitamins or plant extracts) for cosmetic purposes (e.g., fat and wrinkle reduction or body contouring) or relief of musculoskeletal pain. In February 2005, the Virginia Department of Health and CDC were notified of a cluster of skin reactions unresponsive to antimicrobial therapy among patients who had been administered mesotherapy by an unlicensed practitioner in the District of Columbia (DC) area. This report 1) summarizes the subsequent investigation by CDC and state and local health departments in Virginia, Maryland, and DC, which identified prolonged skin reactions in 14 patients, and 2) provides recommendations for practices related to mesotherapy. Patients should accept medical therapy only from licensed practitioners and should not permit injection of substances that have not been approved by the Food and Drug Administration (FDA). Licensed practitioners should follow safe-injection practices when practicing mesotherapy and patients should observe that safe-injection practices are followed.

Adult↗
PubMed1994

Management of otitis externa.

Otitis externa represents one of the most common reasons that pets are presented for veterinary attention. They are also some of the more frustrating entities practitioners are called on to deal with. Successful management depends on an understanding of the primary, predisposing, and perpetuating factors involved in the pathogenesis of otitis externa. Emphasis is then placed on establishing a diagnosis through physical examination, cytologic examination, culture and sensitivity testing, radiographs and biopsies. The general goals of management are to resolve, remove, or control primary factors, clean and dry the ear, reduce inflammation and resolve secondary infections. These goals are achieved through various cleaning techniques, topical, and systemic therapies. Therapeutic alternatives are given for otitis involving bacteria, Malassezia, otodectes, demodex, allergies, ceruminous disorders, the idiopathic inflammatory/hyperplastic otitis externa of cocker spaniels, "Swimmer's Ear", contact/irritant reactions, overtreatment, and concurrent otitis media.

Animals↗
PubMed1999

Long-lasting improvement in general practitioners' prescribing of antibiotics by means of medical audit.

OBJECTIVE: To evaluate the usefulness of medical audit of GPs' antibiotic prescription habits. DESIGN: Medical audit according to the APO method. Registration of antibiotic prescriptions for respiratory tract infections during a 3 year period. Intervention with courses, visits to the laboratory, and distribution of recommendations concerning diagnosis and treatment of respiratory infections. SETTING: 24 Danish GPs in cooperation with Audit Project Odense (APO) and Department of Clinical Microbiology, Odense University Hospital. 207 GPs acted as controls. MAIN OUTCOME MEASURES: Changes in the number of antibiotic prescriptions and in the penicillin/broad-spectrum antibiotic ratio. RESULTS: The proportion of antibiotic prescriptions was reduced during the investigation period, but a similar reduction was found in the control groups. Only for acute sinusitis was a lasting decrease not found in the control groups recorded. The penicillin/broad-spectrum antibiotic ratio increased in the intervention group (1.33 in 1992, 1.94 in 1993 and 2.70 in 1995). This increase was significantly higher than in the control groups. The change was seen for acute sinusitis, bronchitis, and pneumonia, but not for acute otitis media or acute tonsillitis. The changes induced from 1992 to 1993 were maintained or increased from 1993 to 1995 although the educational measures had stopped. CONCLUSION: Medical audit according to the APO method is a useful tool for inducing and maintaining desirable changes in GPs' prescription habits.

Anti-Bacterial Agents↗
PubMed2003

Antibiotic prescribing patterns of French GPs for upper respiratory tract infections: impact of fusafungine on rates of prescription of systemic antibiotics.

INTRODUCTION: Despite attempts to limit their use, systemic antibiotics are extensively prescribed for respiratory infections in France. This survey analyzed data from the Thales database, which contains information from 1010 representative French general practitioners (GPs). The objective was to assess French GP prescribing patterns in upper respiratory tract infections (URTIs) including the rate of prescription of systemic antibiotics and anti-inflammatory drugs in the presence or absence of prescribing fusafungine (Locabiotal) an antibiotic with anti-inflammatory activity indicated for local use in URTIs. Drug costs to the French National Sickness Fund were also assessed. METHODS: This was a retrospective, longitudinal, case-control analysis. Prescribing patterns and costs were compared between patients who did and patients who did not receive fusafungine for a URTI (rhinopharyngitis, tonsillitis, or an influenza-like condition). The fusafungine group consisted of all patients in the database who were prescribed fusafungine at least once between 1 December 1999 and 30 November 2000. The control group was made up of randomly selected patients, matched for age and sex with the study group, who received at least one drug prescription (but not fusafungine) for a URTI during the same period. Patients were selected at the time of their first prescription, and their records for 1 year were analyzed. RESULTS: Each group contained 22 164 patients. For URTIs overall, systemic antibiotics were widely prescribed (at a rate of 54.6% and 67.8% in the fusafungine and control groups, respectively; p < 0.01). The rate of prescription of systemic antibiotics, NSAIDs and corticosteroids per prescription and per episode was significantly lower in the fusafungine group than in the control group. The mean cost per prescription for the French National Sickness Fund was significantly lower for the three URTIs overall when fusafungine was prescribed (9.21 euros [euro] vs euro9.67; p < 0.01). The mean cost to the National Sickness Fund per prescription of systemic antibiotics, NSAIDs, and corticosteroids was also significantly lower in the fusafungine group compared with the control group. The cost of nasal preparations was higher in the fusafungine group because Locabiotal is classified as a nasal preparation. The cost per prescription to the National Sickness Fund was increased by the presence of systemic antibiotics, NSAIDs, or corticosteroids among the prescribed drugs and decreased with the prescription of fusafungine. CONCLUSION: When fusafungine was prescribed for URTIs, fewer systemic antibiotics were prescribed, an important result in the current context of concern about emerging antibiotic resistance. The use of fusafungine was associated with a lower mean cost per prescription to the French National Sickness Fund.

Adolescent↗
PubMed2001

Influenza diagnosis and treatment: a view from clinical practice.

Influenza is a descriptive term for respiratory epidemic disease presenting with cough and fever. Influenza viruses are probably the most important of the pathogens that cause this condition. Clinical influenza occurs almost every winter in England and Wales and the outbreaks last 8-10 weeks. In recent years, influenza B virus outbreaks have occurred in January and February, whereas influenza H3N2 virus outbreaks have generally started long before Christmas. Influenza H3N2 virus outbreaks pressurize health service resources in winter more than influenza B viruses, that do not have the same impact in elderly people. Infections with influenza H1N1 viruses are also usually less severe in their impact than those with influenza H3N2 viruses, but, unlike influenza B viruses, influenza H1N1 viruses have a pandemic potential along with influenza H3N2 viruses. A diagnosis of respiratory infection in primary care is based on the presenting symptoms set within the context of the current pattern of consultations of patients with similar illness. Measurement of temperature, inspection of the throat and examination of the chest or ears add a little to the diagnostic process, but in general these procedures do not help in identifying the organism. However, if it is known that influenza viruses are circulating in the community, the probability of influenza as the cause is greatly increased, as was shown in clinical trials of neuraminidase antivirals. Maximum confusion occurs when respiratory syncytial virus (RSV) and influenza cocirculate. Although RSV infection can occur throughout the winter in young children, it assumes more of an epidemic character just before Christmas in children and possibly in adults just after. During seven of the last 20 winters, influenza has been prevalent around Christmas/New Year. In routine virological surveillance of influenza-like illness in the community during the winters of 1997, 1998 and 1999, ca. 30% of swab specimens yielded influenza viruses and 20% RSV. Given the limitations for routine surveillance, including variations in the interval between illness onset and specimen capture, the quality of swab, delays in transport, the growth properties of virus culture methods, etc., these figures probably underestimate the impact of both viruses in the community. The impact of influenza is considered against the background of total respiratory infections presenting to general practitioners over the last 10 years and some comparisons are made with the 1969 pandemic experience. Lessons relevant to pandemic planning are drawn. Current options for investigation and treatment are compared with those available in 1969. These include near-patient tests for assisting with diagnosis, widespread use of vaccination as a preventive in patients at increased risk, the availability of amantadine and the newer neuraminidase inhibitor antivirals and changes in the delivery of health care. Major advances in the understanding of influenza and improvements in investigation and treatment have taken place over the last 30 years. However, there are many obstacles before these can be translated into effective management of influenza sufferers and control of major epidemics.

Antiviral Agents↗
PubMed2000

Periodontal management of HIV-infected patients.

Recognition and diagnosis of the general oral manifestations and specific periodontal manifestations of HIV infection will continue to be a major responsibility of the dental practitioner. The dental team needs to understand the underlying principles of care for the necrotizing and inflammatory periodontal changes associated with HIV. In addition, the practitioner must take into consideration how the presence of opportunistic infections in the periodontium such as Candida as well as the patient's level of immunosuppression may affect conventional approaches to the common forms of periodontal diseases. By combining local and systemic therapy aimed at both preventing and treating oral lesions and periodontal diseases, combined with new systemic antiviral and vaccine therapies, dental and medical practitioners may together help reduce both the dental morbidity and the overall patient morbidity in the HIV infected patient.

AIDS-Related Opportunistic Infections↗
PubMed2001

Non-multiresistant and multiresistant methicillin-resistant Staphylococcus aureus in community-acquired infections.

OBJECTIVE: To survey Staphylococcus aureus strains isolated from patients presenting from the community, comparing clinical features and antibiotic sensitivity profiles between multiresistant and non-multiresistant methicillin-resistant and methicillin-sensitive isolates. DESIGN: Retrospective case series. PARTICIPANTS AND SETTING: Patients who presented to emergency or dermatology departments in hospitals served by the South Western Sydney Area Health Service between 1 May 1998 and 30 April 1999. All patients with methicillin-resistant S. aureus (MRSA) and the first 100 with methicillin-sensitive S. aureus were eligible. MAIN OUTCOME MEASURES: Patient demographic characteristics; risk factors; clinical presentation; treatment; outcome; and isolate antibiotic susceptibility. RESULTS: 139 patients were eligible, and 122 had clinical records available. Ten of these 122 (8%) had multiresistant MRSA, 26 (21%) non-multiresistant MRSA and 86 (70%) methicillin-sensitive S. aureus. Among patients with non-multiresistant MRSA, 29% (7/24) were born in New Zealand, Samoa or Tonga, a higher proportion than among those with multiresistant MRSA or methicillin-sensitive S. aureus (P= 0.03). Nearly half (44%) of non-multiresistant MRSA strains were community-acquired in patients with no risk factors. Two-thirds of patients with non-multiresistant MRSA (17/26) presented with cellulitis or abscess, and 58% (11/19 evaluable patients) required surgical treatment. CONCLUSIONS: Non-multiresistant MRSA strains are common, especially among people born in New Zealand, Samoa or Tonga, and are usually community acquired. Medical practitioners should routinely swab all staphylococcal lesions for culture and sensitivity.

Adult↗