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PubMed2000

Treatment of Clostridium difficile-associated diarrhea and colitis.

Treatment of C. difficile diarrhea with metronidazole or vancomycin is highly effective at relieving symptoms. The high rate of diarrhea recurrence is concerning, but fortunately most patients respond to a second course of treatment. The problem of vancomycin resistance in hospital organisms has markedly reduced usage of this agent as a first-line treatment for C. difficile diarrhea, leaving metronidazole as the mainstay of treatment in the United States where teicoplanin and fusidic acid are not marketed. It is likely that any new antimicrobial agent used to treat C. difficile will be similarly plagued by a high rate of recurrence, presumably incurred as a result of disruption of normal bowel flora. There is a need for improved treatment and prevention of this increasingly frequent and debilitating nosocomial infection. Treatments that utilize passive antibodies, immunization, nontoxigenic C. difficile, or other forms of biotherapy may hold the key to improved treatment and prevention of C. difficile disease in the future. In the meantime, it behooves all practitioners to use antimicrobials judiciously in order to prevent as many cases of C. difficile diarrhea as possible.

Abdomen, Acute↗
PubMedDate not supplied

Disposal options for infectious medical waste generated during home-based dental care.

The number of dentists providing mobile care is increasing. One of the challenges the mobile dentist faces is proper handling and disposal of infectious medical waste generated during patient care. Mobile dentists must concern themselves with meeting Federal, state, and local regulations. Federal agencies that have jurisdiction over this issue are the Environmental Protection Agency (EPA) and the Occupational Safety and Health Administration (OSHA). EPA guidelines are summarized and clarified with respect to pre-transportation and transportation issues. Compliance with OSHA standards are addressed through presentation of a sample protocol for handling infectious medical waste. It is beyond the scope of this paper to discuss in detail the policies of each municipality, and practitioners are advised to consult with state and local authorities regarding proper handling and transportation of this material. Using the information presented in this paper, the mobile dentist can approach this complex issue in an organized manner.

Aged↗
PubMed2006

Training for terrorism-related conditions in hospitals: United States, 2003-04.

OBJECTIVE: This study estimates baseline data to determine which hospital characteristics are associated with providing terrorism preparedness training to clinical staff. METHODS: Information from a Bioterrorism and Mass Casualty Supplement to the 2003 and 2004 National Hospital Ambulatory Medical Care Surveys was used to provide national estimates of variations in terrorism preparedness training by eight hospital characteristics. Of 874 hospitals in scope, 739 (84.6 percent) responded. Estimates are presented with 95 percent confidence intervals. RESULTS: Hospitals with Joint Commission accreditation were more likely to provide terrorism preparedness training to all types of clinical staff (staff physicians, residents, nurse practitioners, physician assistants, and laboratory staff). Teaching hospitals, medical school affiliation, bed capacity, and urban location were also associated with training staff physicians, residents, nurse practitioners, and physician assistants. Hospitals with residency programs were associated with training only staff physicians and residents. There was more parity across hospital characteristics in training nurses and laboratory staff than for physicians, residents, nurse practitioners, and physician assistants. Joint Commission accreditation was the most consistent factor associated with providing training for all nine exposures studied (smallpox, anthrax, chemical and radiological exposures, botulism, plague, tularemia, viral encephalitis, and hemorrhagic fever).

Adult↗
PubMed2006

Vinegar: medicinal uses and antiglycemic effect.

Vinegar folklore is as colorful as it is practical. Legend states that a courtier in Babylonia (c. 5000 BC) "discovered" wine, formed from unattended grape juice, leading to the eventual discovery of vinegar and its use as a food preservative. Hippocrates (c. 420 BC) used vinegar medicinally to manage wounds. Hannibal of Carthage (c. 200 BC), the great military leader and strategist, used vinegar to dissolve boulders that blocked his army's path. Cleopatra (c. 50 BC) dissolved precious pearls in vinegar and offered her love potion to Anthony. Sung Tse, the 10th century creator of forensic medicine, advocated hand washing with sulfur and vinegar to avoid infection during autopsies. Based on the writings of US medical practitioners dating to the late 18th century, many ailments, from dropsy to poison ivy, croup, and stomachache, were treated with vinegar, and, before the production and marketing of hypoglycemic agents, vinegar "teas" were commonly consumed by diabetics to help manage their chronic aliment. This review examines the scientific evidence for medicinal uses of vinegar, focusing particularly on the recent investigations supporting vinegar's role as an antiglycemic agent. Epidemiologic studies and clinical trials were identified by a MEDLINE title/abstract search with the following search terms: vinegar, glucose; vinegar, cancer; or vinegar, infection. All relevant randomized or case-control trials were included in this review.

Acetic Acid↗
PubMed1995

[Microbiological diagnosis in the clinical laboratory].

In general, microbiological diagnostic procedures in the practitioner's office are limited to direct detection of group A streptococci in throat swabs in patients with pharyngitis and to semiquantitative urine culture with Uricult or Urotube test kits in patients in whom urinary tract infection is suspected. Negative direct tests with throat swabs should be confirmed by culture in the clinical microbiology laboratory, as several test kits have only moderate sensitivity in detecting group-A beta-hemolytic streptococci and do not detect other groups of beta-hemolytic streptococci. The results of semiquantitative urine cultures should always be interpreted together with clinical data. Quality control procedures are necessary for the accurate performance of these tests, and an external quality assessment program will probably be introduced in the near future.

Bacteriological Techniques↗
PubMed2002

[How do Hungarian family physicians think about Helicobacter pylori? Results of national survey].

UNLABELLED: INTRODUCTION, AIMS: In spring of 2000 a national survey was conducted on the diagnostic and therapeutic attitudes of Hungarian family practitioners concerning Helicobacter pylori. RESULTS: Based on responses, endoscopy, urea breath test and serology are easily available to 98, 42 and 48% of family practitioners respectively. Only 45% of responders performs Helicobacter pylori testing him/herself, while 82% prescribes eradication therapy without a gastroenterologist. In the second part of the questionnaire responders had to decide in 15 routine clinical cases, whether to perform Helicobacter pylori testing, and if so, whether to be satisfied with noninvasive testing or also to perform an endoscopy. Responses comply with international and Hungarian national recommendations, reflecting at the same time the uncertainties inherent in medical literature. Five responses of Hungarian family practitioners differed from the recommendations of literature. Two questions were related to screening Helicobacter pylori: in a complaint-free patient family practitioners are not inspired to perform a screening either in the case of familiarity of gastric cancer or in that of duodenal ulcer known from the individual case history. Helicobacter pylori testing is often superfluously suggested to young patients suffering from gastro-esophageal reflux disease. An empirical approach is revealed by the fact, that in cases of Helicobacter pylori positive duodenal ulcer, when eradication eliminates complaints, 41% of family practitioners would not test result of eradication. At the same time it is considered a mistake, that in case of young patients with a Helicobacter pylori positive gastric ulcer, being free of complaints after eradication, 66% of physicians refrains from endoscopic control. CONCLUSIONS: The possibilities, education, diagnostic and therapeutic skills as to diseases due to Helicobacter pylori of Hungarian family practitioners seems to be appropriate. In education emphasis should be primarily placed on screening and post-eradication tasks. Guidelines should be offered to family practitioners concerning controversary issues (gastro-esophageal reflux disease, dyspepsia, administration of non-steroid anti-inflammatory drugs).

Adult↗
PubMedDate not supplied

[Diabetes mellitus: causes for hospitalization, intrahospital complications and mortality].

OBJECTIVE: To determine hospitalization causes, complications and mortality in Mexican patients with diabetes mellitus (DM). METHODS: Between July and December 2001, we reviewed all admissions to the Department of Internal Medicine. Patients with a diagnosis of DM were included. A structured questionnaire was applied with the assessment of the following variables: sociodemographic; clinical history; variables associated with DM (complications associated with DM, treatment and diet, control of the disease by general practitioner or specialist); admissions (causes, length of stay, complications, glycemia at onset of admission and causes of death). RESULTS: One hundred forty-seven patients were hospitalized, 57% were women with a mean age of 58 years and disease duration of 165 months; 43% knew their glycemia value upon admission and 67% were seen in the outpatient clinic 30 days previous to admission. At onset of hospitalization 61% were hyperglycemic, 5% had hypoglycemia and 22% had normal glycemic values. The causes of hospitalization were cardiovascular diseases (37%), complications associated with DM (20%), and infections (18%). The mean length of hospital stay was 10 days. There were 16 (11%) deaths specifically due to cardiovascular disease. CONCLUSIONS: Frequent causes of hospitalizations, intrahospital complications and deaths were similar to previous studies in other countries.

Diabetes Complications↗
PubMed2002

Urinary tract infections in adult general practice patients.

Urinary tract infections (UTIs) are symptomatic infections of the urinary tract, mainly caused by the bacterium Escherichia coli. One in two women suffers from a UTI at least once in her life. The young and sexually active are particulaly affected, but it is also seen in elderly, postmenopausal women. The likelihood of recurrence is high. Diagnosis is made with regard to typical complaints and the presence of leucocytes and nitrites in the urine. A culture is unnecessary in most cases. Uncomplicated UTI should be distinguished from complicated UTI, which has a risk of severe illness. The treatment of choice--short-term therapy with trimethoprim or nitrofurantoin--is successful in over 80% of the cases. Co-trimoxazol fluoroquinolones or cephalsporins are not considered first-choice drugs. There are indications that general practitioners' (GPs') management of UTI is not always optimal, specifically concerning diagnostic tests, the application of second-choice antibiotics, and the length of prescribed treatment courses. Many points relevant to GPs requirefurther research, such as epidemiology and resistance of urinary pathogens in the community and natural history of UTI, as well as optimal management in elderly or complicated patients and men.

Adult↗
PubMed2002

Babesiosis and heartwater: threats without boundaries.

Suppose one of your clients from southern Florida starts talking about cattle egrets while you are vaccinating her cat. It seems she found a nearly dead egret near the cattle pen a few days ago, picked it up, and noticed a number of what looked like small ticks on the legs. Or, suppose you are called out to a small dairy in central Texas to look at some cows that are feverish and anemic. The first animal you examine has a few brown ticks attached just under the tail. Finally, perhaps you are looking at a lame tortoise for a reptile fancier, a new client, and find a large, colorful tick on a hind leg, well up under the shell. Ring any bells? Egrets are great hosts for the immature stages of Amblyomma ticks and have been captured and marked in the eastern Caribbean, then recaptured in the Florida Keys. Those cattle ticks in Texas might be acaricide-resistant Boophilus ticks that originated in Mexico. The Amblyomma tick on the tortoise could well have "hitch-hiked" all the way from South Africa. By now you remember that both Amblyomma and Boophilus ticks are efficient vectors of two tickborne diseases in this hemisphere, heartwater (in the case of Amblyomma) and babesiosis (transmitted by Boophilus ticks). Both of these diseases are exotic to the United States, and because our livestock are considered to be totally susceptible, an introduced infection could result in high initial death losses (approximately 70%); thus, both the ticks and the diseases pose immediate threats to the health and economic security of United States animal industries. Most importantly, you, whether as a small animal or large animal practitioner, are the first line of defense against such exotic diseases and their vectors.

Animal Diseases↗
PubMed2004

[Vaccination of general practitioners].

The vaccination of general practitioners represents significant problems for two reasons: they can be a reservoir of infectious diseases for the patients they are in contact with and their attitudes towards vaccination can influence their preventative acts and consequently the vaccination coverage of the population. The anti-influenza vaccination of the care providers is associated with a decrease of mortality amongst patients. Hepatitis B is one of the most frequent professional occupational infectious diseases and vaccination is necessary for all the professionals at risk. Concerning the whooping-cough we can observe at the present time an increase in the number of cases. The "Conseil Supérieur d'Hygiène" advises to propose vaccination of the people in contact with infants and people who have not HAD vaccination supplements in childhood. The rubella vaccination for unprotected women is also recommended for the care providers, to avoid the risk of infection and the possible implications for the foetus. The existing data in Belgium on the vaccination coverage of general practitioners is poor, but leads us to believe there is an insufficient vaccination coverage against these diseases. A study will shortly be undertaken to analyze the vaccination status of the Belgian French-speaking doctors and to further analyse their reasoning for any possible non-vaccination.

Carrier State↗
PubMed2005

HIV and the breast.

HIV infection and antiretroviral therapy may alter the spectrum and frequency of diseases that affect the breast. The differential diagnosis of conditions of the breast that a practitioner may encounter in HIV-infected persons includes infection, morphologic alterations, and malignancy. Atypical infections may involve the breast as CD4+ T-cell counts wane. More commonly, HIV-infected persons present with gynecomastia, which may be caused by a variety of conditions, including exposure to HAART. True gynecomastia, resulting from proliferation of male breast ducts and periductal stroma, might be differentiated from lipomastia--a manifestation of lipodystrophy, characterized by the deposition of adipose tissue in the breast. In the era of HAART, HIV-infected patients with malignancy--particularly those who have robust CD4+ T-cell counts and well-controlled HIV viral loads--should be treated similarly to their HIV-negative counterparts.

Anti-HIV Agents↗
PubMed2002

Evolution of WHO policies for tuberculosis control, 1948-2001.

We examine the evolution of WHO managerial policies for tuberculosis control during 1948-2001 to provide a new framework that will accelerate control expansion in the near future. In the first period (1948-63), a vertical approach to tuberculosis control was the policy adopted by WHO and the international community. However, although this approach was successful in more-developed countries, it largely failed in resource-poor settings. As a result, involvement of general health services was soon deemed essential. During 1989-98, a new framework for effective tuberculosis control was created and a new five-element strategy was branded with the name of DOTS. This period was characterised by the recognition of tuberculosis control as a public-health priority, the intensification of tuberculosis control efforts worldwide, and the return of tuberculosis to the political agenda of governments. However, although nominal adoption of DOTS increased rapidly due to massive promotion by WHO and partners, expansion to provide full access was too slow and only 23% of all infectious cases in 1999 were managed under DOTS. A truly multisectoral approach based on advocacy and social mobilisation, community involvement, and engagement of private-for-profit practitioners is becoming the way forward for tuberculosis control. HIV-associated tuberculosis and multidrug-resistant tuberculosis must be tackled as priority issues. We conclude that, based on the lessons of the past, the future of tuberculosis control should be focused on a pragmatic approach combining a specialised, well-defined management system with a fully integrated service delivery. A multisectoral approach that builds on global and national partnerships is the key to future tuberculosis control.

AIDS-Related Opportunistic Infections↗
PubMed2003

Health effects of indoor fungal bioaerosol exposure.

Occupational and environmental health professionals are confronted with issues concerning the health effects of indoor fungal bioaerosol exposure. This article reviews current data on the health effects of indoor mold exposure and provides practical suggestions for occupational and environmental health practitioners regarding how best to manage these exposures based on published human studies. We conducted MEDLINE searches and reviewed all English language studies on indoor mold exposure (visible survey or objective sampling) and human health effects published from 1966 to November 2002. The main findings of the studies are analyzed in conjunction with plausible association of health effects and fungal exposure. Five case control studies, 17 cross-sectional surveys, and 7 case reports met the selection criteria. Current evidence suggests that excessive moisture promotes mold growth and is associated with an increased prevalence of symptoms due to irritation, allergy, and infection. However, specific human toxicity due to inhaled fungal toxins has not been scientifically established. Methods for measuring indoor bioaerosol exposure and health assessment are not well standardized, making interpretation of existing data difficult. Additional studies are needed to document human exposure-disease and dose-response relationships.

Adult↗
PubMedDate not supplied

Risk management.

The purpose of this article is to provide the orthodontic practitioner with a basic understanding of the concept of "Risk Management" so that he/she might be able to minimize the possibility of being sued. There are a number of factors regarding risk management which will also help the prudent practitioner reduce the likelihood of losing a lawsuit should it occur. Many dentists have spent hundreds of hours learning new skills to enhance their service to their patients. My suggestion is that we must also try to increase our risk management skills and our understanding of legal matters if we are to survive the 1990's.

Dental Records↗
PubMed1991

Drug-usage evaluation: a system for the prospective evaluation of antibiotic utilization in minimum inhibitory concentration documented infections.

Large hospitals appear to have advantages in using specialized clinical practitioners to provide prospective reviews on drug therapy. Using the PRMC pharmacy service as a model, a prospective DUE program can be duplicated in small hospitals with four or five fulltime pharmacists. The minimal requirements are a microbiology laboratory, administrative support, and a pharmacy service committed to providing prospective patient oriented care.

Anti-Bacterial Agents↗
PubMed2003

Babesia odocoilei infection in elk.

Two male North American elk from a commercial herd were evaluated because of a sudden onset of lethargy, anorexia, and voiding of red urine. These 2 elk were kept in the same pen as 4 other male elk that had died during the preceding 2 months. Laboratory analyses revealed anemia and intraerythrocytic parasites, later confirmed as Babesia odocoilei (a protozoal hemoparasite of cervids). Of the 240 elk remaining in the herd, 59 were screened for B odocoilei by microscopic evaluation of blood smears, protozoal culture of blood, and immunofluorescent antibody testing of serum. Of those 59 elk, 34 (58%) were infected with B odocoilei. Babesia odocoilei infection in elk can be fatal and should be considered in cases of sudden death or acute hemolytic anemia. Familiarity with the disease in elk is essential for practitioners because of the increasing popularity of commercial elk farming.

Animals↗
PubMed2001

Dental unit waterlines: review and product evaluation.

Dental practitioners must be knowledgeable regarding microbial contamination and biofilm formation in dental unit waterlines. Education should stress the need for improvement in the quality of water delivered to patients during treatment. Manufacturers must also play an important role by providing training and education regarding the proper use and maintenance of their systems. Dental facilities, both public and private, need reliable methods to prevent the development of biofilms within DUWs. These methods must be economical and require minimal effort to use on the part of the dental staff. In order for the system to work efficiently, the effluent water that is produced must be compatible with dental materials and be potentially free from toxic or carcinogenic materials. There are numerous models of water filtration units and chemical flushes available to the dental practitioner. However, the Food and Drug Administration have not approved all products currently on the market. Our evaluation of Zerosil, a new waterline-cleaning product, indicates that it is very easy to use and is extremely effective in killing the commonly found microorganisms in dental unit waterlines, as well as eliminating existing biofilms. It is also economical and requires minimum staff time to keep the waterlines clean. Following the initial treatments during week one, the water emanating from the DUWs was free from any viable microorganisms. This effect was present the entire three weeks in which the waterlines were treated. The elimination of viable microorganisms continued into a fourth study week, even though no further treatment of the DUWs was performed. Although the manufacturer recommends weekly treatment of DUWs following the initial treatment regimen, this result indicates that the product has a longer lasting effect than previously thought. Finally, the product can be delivered through any of the commercially available reservoir/bottle water delivery systems. From our study, Zerosil appears to meet the demanding requirements of keeping dental unit waterlines clean. Based on the research that has been done thus far, no universal treatment protocol can be recommended. A combination of approaches may offer the best available assurance of high-quality dental treatment water. Independent water reservoir systems, when used with a periodic chemical treatment protocol, have demonstrated safety and efficacy. Until we reach a point when a recommendation based on thorough evaluations can be made, dental offices should follow current ADA, OSAP, and CDC guidelines: flush waterlines for two to three minutes at the beginning of each day and for 20 to 30 seconds between each patient, and anti-retraction valves should be installed to prevent oral fluids from being drawn into dental waterlines. It is expected that in the near future, the dental practitioner will have a choice of proven systems and products to deal with this issue. Until that time, one should carefully evaluate any product or system being considered to prevent the formation of biofilms in DUWs.

Biofilms↗
PubMed1998

The changing patterns of antimicrobial susceptibility of urinary pathogens in Trinidad.

OBJECTIVE: The prevalence of antimicrobial resistance in urinary pathogens is increasing worldwide. Accurate bacteriologic records of culture results may provide guidance on empirical therapy before sensitivity patterns are available. We report the changing antibiograms of pathogens associated with urinary tract infections (UTI) over a 4-year period at a newly commissioned hospital complex diagnostic laboratory in Trinidad. METHODS: From January 1992 to December 1995, kept records of antibiograms of all urinary pathogens isolated were examined. Samples were derived from hospital sources (wards and out-patient clinics) and general practice sources (health centers and general practitioners). Quantitative bacteriologic cultures were performed according to standard laboratory procedures, and identification of isolates were based on Gram reaction, morphology and biochemical characteristics. Significant bacteriuria was defined as the presence of greater than 100,000 organisms per mL of a midstream urine specimen or more than 3000 bacteria per mL in a catheter specimen of a single specie. Antimicrobial sensitivities were done using the following antibiotics: norfloxacin, ampicillin, tetracycline, nitrofurantoin, gentamicin, co-trimoxazole (sulfamethoxazole-trimethoprim), trimethoprim, nalidixic acid, cephalexin and augmentin (amoxicillin-clavulanic acid). Control organism was E coli NCTC 10,418 strain. RESULTS: The total number of specimens for the 4-year period in hospital was 14,181 with an isolation rate of 17%, and a general practice isolation rate of 67% from a total of 5,088 specimens. E coli was the most frequent isolate in both hospital (40%) and general practice (30%). There was an increase isolation of P aeruginosa from community practice reflecting an increase in home care catheterised male patients. Resistance to tetracycline was most significant in hospital (99%) and general practice (81%). Similar trend was observed for trimethoprim in hospital, and co-trimoxazole in both practices. Resistance to ampicillin, augmentin and cephalexin was relatively stable over the 4-year period. CONCLUSION: We conclude that laboratories should encourage accurate bacteriologic record keeping of urinary isolates and their antibiograms to serve as guidance in empirical treatment in UTI. Also, urine microscopy may reduce the number of specimens sent for culture which are not cost-effective.

Anti-Bacterial Agents↗