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PubMed1992

Characterization of morphologic changes and lymphocyte subset distribution in lymph nodes from cats with naturally acquired feline immunodeficiency virus infection.

Lymph nodes were collected at biopsy or necropsy from 18 cats with naturally acquired symptomatic feline immunodeficiency virus (FIV) infection and from 18 seronegative cats. Thirty-five of the cats were domestic shorthairs and one was a Persian cross. The cats ranged from 7 months to 16 years of age and were mainly obtained from California veterinary practitioners, a California cattery, and a Veterinary Teaching Hospital. Based on clinical signs present at tissue collection, ten FIV-infected cats fell into the acquired immunodeficiency syndrome (AIDS)-related complex (ARC) clinical stage and eight in the terminal (AIDS) stage of FIV disease. All cats were FeLV negative by antigen ELISA. Histologic sections of lymph nodes from each cat were examined blindly and were categorized as hyperplastic, involuting, mixed hyperplastic and involuting, depleted, or normal based upon subjective evaluation of follicles and paracortex. The relative abundance of plasma cells was evaluated in methyl green pyronin (MGP) and hematoxylin and eosin-stained sections. Similar numbers of FIV-seropositive and -seronegative cats fell into each lymph node category. The only difference evident between FIV-infected cats and control cats was in the degree of plasmacytosis present; moderate to marked plasmacytosis was present in 13/18 FIV-infected cats but in only 3/18 control cats.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2001

[Repeat antibiotic prescriptions following treatment with sulfonamide or pivmecillinam. A survey of prescriptions among women aged 15-50 years in the county of Nordjylland].

INTRODUCTION: A sulphonamide is the antibiotic of first choice for the treatment of uncomplicated urinary tract infections in Denmark. However, this recommendation has been challenged. MATERIAL AND METHODS: The study comprised 9,224 women, aged 15 to 50 years, who were residents in the County of North Jutland, Denmark. During 1997-1998 they had handed in a prescription from a general practitioner for either sulphonamide or pivmecillinam, but no other prescriptions for antibiotics during the preceding six months. Any antibiotic prescription handed in within the ensuing 31-day period was recorded, with the exception of macrolides. The proportion of women with a repeat prescription was a proxy for therapeutic failure. RESULTS: Eight thousand two hundred and sixty-nine women (89.6%) had handed in a prescription for a sulphonamide and 955 (10.4%) a prescription for pivmecillinam. A total of 1,490 women (16.2%) handed in a repeat prescription, i.e. 16.0% (95% confidence limits [CI] 15.2-16.8%) of women treated with sulphonamide and 17.8% (95% CI 15.4-20.4%) of women treated with pivmecillinam. The relative risk of a repeat prescription was 1.11 (95% CI 0.95-1.31) for women with a primary prescription for pivmecillinam, as compared to women with a sulphonamide prescription. Women who had handed in a sulphonamide prescription for less than three defined daily doses had an increased risk of a repeat prescription. DISCUSSION: The proportion of women with a repeat prescription did not differ much between women treated with sulphonamide and those treated with pivmecillinam. Controlled clinical trials should be performed before revision of current Danish recommendations are considered.

Adolescent↗
PubMed2002

Human papillomaviruses. Applications, caveats and prevention.

Unlike cervical cytology, human papillomavirus (HPV) testing provides an objective assessment of neoplasia risk. The major advantages of this technology are the potential for "reflex testing" (when used with liquid-based cytology); efficient exclusion of HPV-negative women, who can be triaged to yearly follow-up; and identification of HPV-positive women, who require colposcopic triage. However, practitioners should be aware that highly sensitive HPV tests will also identify many women with little or no immediate risk of significant neoplasia, may impose a psychosocial burden on the patient and may be used or interpreted inappropriately by both practitioners and patients. However, these caveats are similar to those inherent in any screening program involving a sexually transmitted disease, and the disadvantages of HPV testing will be minimized by attention to patient concerns and a keen awareness of the limitations of this technology. Ultimately, control of cervical cancer and its precursors rests with active prevention via vaccination programs targeting HPV. If successful, such programs could radically alter the number of women requiring triage for preinvasive disease and initiate a progressive decline in cervical cancer incidence.

Colposcopy↗
PubMed1997

[Infection or epidemic? On the problem of mono-causal thinking in medicine. The contribution of Adolf Gottstein (1857-1941)].

Robert Koch (1843-1910) had by the end of the 1870 invented a definite and reproducible method of determine bacteria. During the first decades after the origin of bacteriology he and his disciples developed in practice a strictly monocausal theory: where there is a specific germ, only the specific disease occurs. The importance of Adolf Gottstein (1857-1941) must be viewed against this background. As a general practitioner Gottstein noticed that there are considerable differences between the single specific infection and its massive spread as an epidemic. As one of the first clinical epidemiologists he learnt how to verify his experience and presumptions by systematical, quantitative analyses. His epidemiologically founded publications were a key factor in the process of abandoning the monocausal theory of illness of the early period of the Koch era and giving way to a multicausal view. The dynamic aetiology of Gottstein was a major contribution to the development of social hygiene and public health care.

Causality↗
PubMed2006

Raising awareness of pressure ulcer prevention and treatment.

PURPOSE: To provide the practitioner with updated information about pressure ulcers and their management. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in better understanding the scientific principles governing pressure ulcer development and treatment. OBJECTIVES: After reading this article and taking this test, the participant should be able to: 1. Discuss the etiology and assessment of pressure ulcers. 2. Describe treatment options for pressure ulcers.

Bandages↗
PubMed2006

Disinfection of needleless catheter connectors and access ports with alcohol may not prevent microbial entry: the promise of a novel antiseptic-barrier cap.

BACKGROUND: Needleless valve connectors for vascular catheters are widely used throughout the United States because they reduce the risk of biohazardous injuries from needlesticks and exposure to bloodborne pathogens, such as human immunodeficiency virus and hepatitis C virus. Patients with long-term central venous catheters are at significant risk of acquiring catheter-related bloodstream infections caused by microbes that gain access through the connection between the administration set and the catheter or an injection port. Most healthcare practitioners wipe the membranous septum of the needleless connector or the injection port with 70% alcohol before accessing it. We report a simulation study of the efficacy of conventional alcohol disinfection before access, compared with that of a novel antiseptic-barrier cap that, when threaded onto a needleless luer-activated valved connector, allows a chlorhexidine-impregnated sponge to come into continuous contact with the membranous surface; after removal of the cap, there is no need to disinfect the surface with alcohol before accessing it. METHODS: One hundred five commercial, needleless luer-activated valved connectors, each accessible by a blunt male-connector luer-lock attachment, were purchased from 3 manufacturers and were tested. The membranous septum of each test device was first heavily contaminated with approximately 10(5) colony-forming units of Enterococcus faecalis and then was allowed to dry for 24 hours. Fifteen of the contaminated devices were not disinfected (positive controls), 30 were conventionally disinfected with a commercial 70% alcohol pledget, and 60 had the antiseptic cap threaded onto the connector and then removed after 10 minutes. The test connectors were then accessed with a sterile syringe containing nutrient broth media, which was injected, captured on the downstream side of the intraluminal fluid pathway, and cultured quantitatively. RESULTS: All 15 control connectors (100%) showed massive transmission of microorganisms across the membranous septum (4,500-10,000 colony-forming units). Of the 30 connectors accessed after conventional disinfection with 70% alcohol, 20 (67%) showed transmission of microorganisms (442-25,000 colony-forming units). In contrast, of the 60 connectors cultured after application of the novel antiseptic cap, only 1 (1.6%) showed any transmission of microorganisms (P < .001). CONCLUSIONS: The findings of this study show that, if the membranous septum of a needleless luer-activated connector is heavily contaminated, conventional disinfection with 70% alcohol does not reliably prevent entry of microorganisms. In contrast, the antiseptic-barrier cap provided a high level of protection, even in the presence of very heavy contamination. This novel technology deserves to be studied in a clinical trial.

Bacteriological Techniques↗
PubMed2000

The 1997-1998 epidemic of classical swine fever in the Netherlands.

In 1997, the pig husbandry in the Netherlands was struck by a severe epidemic of classical swine fever (CSF). During this epidemic 429 CSF-infected herds were depopulated and approximately 1300 herds were slaughtered pre-emptively. In addition millions of pigs of herds not CSF-infected were killed for welfare reasons (over crowding or overweight). In this paper, we describe the course of the epidemic and the measures that were taken to control it. The first outbreak was detected on 4 February 1997 in the pig dense south-eastern part of the Netherlands. We estimate that CSF virus (CSFV) had already been present in the country by that time for 5-7 weeks and that the virus had been introduced into approximately 39 herds before the eradication campaign started. This campaign consisted of stamping-out infected herds, movement restrictions and efforts to diagnose infected herds as soon as possible. However, despite these measures the rate at which new outbreaks were detected continued to rise. The epidemic faded out only upon the implementation of additional measures such as rapid pre-emptive slaughter of herds in contact with or located near infected herds, increased hygienic measures, biweekly screening of all herds by veterinary practitioners, and reduction of the transportation movements for welfare reasons. The last infected herd was depopulated on 6 March 1998.

Animals↗
PubMed2000

Tuberculosis: the latest.

Tuberculosis (TB) is a complex disease with a long history of human infection. This article provides an overview of TB and discusses ramifications for anesthesia practitioners. Specific individuals and groups are at an increased risk of developing TB. The acid-fast bacilli that causes TB is transmitted via the airborne route. The anesthesia provider must adapt his/her approach to the patient with TB so that protection is afforded that practitioner, colleagues, and the patient. Future patients are also shielded from potential exposure to acid-fast bacilli. To minimize the risk of transmission of acid-fast organisms, the anesthesia practitioner must consider TB as a possible diagnosis when performing a preanesthetic evaluation. Standard precautions for bloodborne pathogens must be followed. In addition, appropriate respiratory precautions must be taken. Proper cleansing, decontaminating, sterilizing, or disposal of equipment must occur. Screening of anesthesia providers for the possibility of infection with TB is to be conducted at intervals recommended by the Occupational Safety and Health Administration. Each anesthetist has a responsibility to practice safely. In today's anesthesia practice, safety includes vigilance against TB.

Humans↗
PubMed1998

Improving sexually transmitted disease management in the private sector: the Jamaica experience.

OBJECTIVES: To improve the quality of sexually transmitted disease (STD) case management in Jamaica by providing comprehensive continuing medical education to private practitioners who manage 60% of all STDs on the island. METHODS: Six half-day STD seminars were presented at 3-4-month intervals and repeated in three separate geographic locations. All Jamaican practitioners received invitations. The subjects were as follows: urethritis, genital ulcer disease, HIV infection, vaginal discharge syndrome, STDs in children and adolescents, and a review seminar. The program effectiveness was evaluated with a written, self-reported pre-test and a telephone post-test that measured changes in clinical management. RESULTS: Six hundred and twenty eight practitioners attended at least one seminar. Comparing pre- versus post-test scores, there were practitioner improvement trends in all four of the general STD management categories: counseling/education (69.8-73.3%; P > 0.05); diagnostics/screening (57.2-71.0%; P= 0.042); treatment (68.3-74.5%; P> 0.05); and knowledge (66.4-83.2%; P= 0.002). Obtaining syphilis serologies during pregnancy rose from 38.3 to 83.8% (P= 0.001), and providing effective treatment for gonorrhea rose from 57.8 to 81.1 % (P= 0.002), but correct responses on treatment for mucopurulent cervicitis at the post-test was a low 32.4%. CONCLUSION: The introduction of continuing medical education for improved STD care targeting private physicians in Jamaica was successful based on high attendance rates and self-reported STD management practices. However, efforts should continue to address the weaknesses found in STD management and counseling and to reach the providers who did not participate. In the global effort to reduce HIV transmission by improving STD care services, continuing education programs that target the private sector can be successful and should be included as a standard activity to improve care and provide a public/private link to STD/HIV control.

Adolescent↗
PubMed2002

Selection of antimicrobial agents in periodontal therapy.

BACKGROUND: The recognition over the past 3 decades of microbial specificity in periodontitis has afforded dental practitioners the ability to prevent and treat the disease with a variety of antimicrobial drugs. These include systemic antibiotics, topical antibiotics and topical antiseptics. RESULTS: Systemic antibiotic therapy can be essential in eliminating pathogenic bacteria that invade gingival tissue and in helping control periodontal pathogens residing in various domains of the mouth from where they may translocate to periodontal sites. Frequently used periodontal combination antibiotic therapies are metronidazole-amoxicillin (250-375 mg of each 3 x daily for 8 days) and metronidazole-ciprofloxacin (500 mg of each 2 x daily for 8 days). Microbiological analysis helps determine the optimal antibiotic therapy and effectiveness of treatment. Topical antibiotics that are commercially available as controlled release devices suffer from several potential problems, including insufficient spectrum of antimicrobial activity in some periodontal polymicrobial infections, risks of producing an antibiotic resistant microbiota, and high acquisition costs. Topical antiseptics of relevance in periodontal treatment include 10% povidone-iodine placed subgingivally by a syringe for 5 min, and 0.1% sodium hypochlorite solution applied subgingivally by patients using an irrigation device. CLINICAL IMPLICATIONS: The present paper recommends periodontal treatment that includes a battery of professionally and patient-administered antimicrobial agents (properly prescribed systemic antibiotics, povidone-iodine and sodium hypochlorite subgingival irrigants, and chlorhexidine mouthrinse). Available chemotherapeutics can provide effective, safe, practical and affordable means of controlling subgingival colonization of periodontal pathogens and various types of periodontal disease.

Administration, Topical↗
PubMedDate not supplied

Ethical issues of treating patients with AIDS in a rehabilitation setting.

Human Immunodeficiency Virus (HIV) is frightening and fatal. The great fear of acquiring HIV magnifies ethical issues concerning patients and health care workers. Practitioners in the field of rehabilitation medicine will become increasingly aware of these issues, because at least 50% of patients with HIV-related illnesses develop neurological disorders. Many will need physical, emotional, social, psychological or vocational restoration. This article explores some of the ethical issues related to Acquired Immune Deficiency Syndrome (AIDS) rehabilitation, including confidentiality, risk of exposure to infected patients or infected health care workers, treatment of patients and the rights of patients and health care workers.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Changes in dentists' attitudes and practice in paediatric dentistry.

AIM: The purpose of the study was to determine if there had been any changes in the clinical practice and attitudes to the care of children by general dental practitioners over a ten year period from 1986 to 1996, following the introduction of a system of capitation payments in the United Kingdom. METHODS: A questionnaire was mailed to 1,290 general dental practitioners practicing in Yorkshire (UK) in an identical way to a previous survey ten years before. Practitioners were asked questions concerning their practice of dental caries prevention, behaviour management, restoration of primary teeth and pulp therapy. Responses were compared with the results of the 1986 survey. RESULTS: Of the total of 687 replies (53.2% response) 61% practiced, or said they practiced, diet evaluation and gave dietary advice. Oral hygiene instruction was reported by 87% and 57% used fissure sealants. The routine use of amalgam, previously 80%, had declined to 35% in favour of glass ionomer cements (57%). There had been a significant improvement in the use of pulp therapy for primary teeth at 35% compared with previous 3%. The use of rubber dam also increased, but only from 0% before to 9% in the present study. The usage of stainless steel crowns had changed from 2% over ten years to 8% and strip crowns from 1% to 5%. CONCLUSION: The use of paediatric dental techniques by general dental practitioners had generally increased, particularly in preventive measures and pulp treatment. Restorative techniques had marginally changed, but a dramatic shift away from amalgam had occurred. There was still a very low usage of stainless steel crowns and rubber dam was also not used to the extent that it should be.

Adolescent↗
PubMed1991

Prophylactic intranasal alpha 2 interferon and viral exacerbations of chronic respiratory disease.

BACKGROUND As respiratory virus infections often lead to exacerbations of chronic bronchitis and asthma an effective antiviral drug may be helpful in such patients. Alpha 2 interferon has been shown to give protection against rhinovirus infections in field studies. METHODS Patients with chronic respiratory disease exposed to close contacts with symptoms of upper respiratory tract infection were randomly allocated to receive nasal sprays of recombinant alpha 2 interferon (3 x 10(6) IU) or placebo twice daily for five days. Of the 123 patients recruited into the study, 69 took 117 courses of medication; 11 courses were excluded from analysis. RESULTS No important side effects were recorded and the incidence of possible adverse effects was similar in the two groups. Interferon treatment did not reduce the number or severity of symptomatic episodes; 11 of 48 patients given interferon and 16 of 58 given placebo developed lower respiratory symptoms. There were no differences in mean symptom scores (51 interferon and 52 placebo), number of symptomatic days (3.3 interferon and 5.0 placebo), peak flow values, number of general practitioner consultations, or use of antibiotics. CONCLUSION Alpha 2 interferon 3 x 10(6) IU taken twice daily for five days does not protect patients with chronic respiratory disease from exacerbations after they have been in contact with an upper respiratory tract infection.

Administration, Intranasal↗
PubMed1997

TB and dentistry.

Tuberculosis (TB) has reemerged as a major public health problem. Although dental care providers are considered to be at low risk of exposure to patients with active TB, they should be familiar with the recent recommendations for preventing transmission of tuberculosis in health care settings. Dental practitioners should be able to recognize and evaluate signs and symptoms of active TB in their patient population and initiate appropriate medical referrals for any patient in whom active TB is suspected. Furthermore, education of the dentist and the office staff about the transmission, signs and symptoms of the disease, and methods of protection is one of the most effective components on an overall TB control program.

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

[Analysis of 83 bronchospasm episodes seen at urgent care during one spring night].

BACKGROUND: The new treatments for the bronchial inflammation in asthma, have contributed to decrease the mortality rate. However, there is still a group of population with no diagnosis fo asthma, who requires urgent medical attention in situations such as air pollution or risen pollen levels. On 2nd June 2000, 83 subjects with an acute crisis of asthma, came to the Emergency Room in our Hospital in just 6 hours, coinciding with the highest annual pollen measurement and a strong storm. METHODS AND RESULTS: Personal data from those 83 patients, medical behaviour at the Casualty and post-attention recommendations were considered for analysis. 21 % never had previous diagnosis of asthma and 93 % followed no regular medical control. 61.45 % did no treatment. A chest radiography was taken in 53.76 % of the patients. Salbutamol was administrated in most of them (92.18 %) and parentally administration of steroids in 23.47 %. 21 % were referred to an specialist. CONCLUSIONS: A significant rate of asthmatics is under-diagnosed, under-controlled and under-treated. Public Health authorities should consider the creation of new Allergy Units, a fluid communication between general practitioners and specialists, and the monitorization of pollen recounts with special plans of emergency situations to contribute to solve this problem.

Adrenal Cortex Hormones↗
PubMed1987

The impact of AIDS on the general practitioner of dentistry.

The AIDS epidemic has caused widespread concern in the community and there has been a corresponding impact on dentistry. Dentists have seen themselves as vulnerable due to frequent exposure to blood and to the salivary pool, which may possibly be infective, either inherently or by reason of blood contamination. The fear of AIDS, affecting the community and the dental profession, has been strongly emotional because of the recorded mortality rates. It is necessary to recognize that screening techniques, however carefully carried out and interpreted, cannot identify all the potential carriers of AIDS. A similar, but much greater risk applies to carriers of hepatitis B virus, since a dentist seeing 20 patients per day will encounter a hepatitis B carrier every 7 days, at the current developed-country levels of prevalence. Four out of five of these carriers will be unaware of their infectious status. It is essential therefore that dentists amend their infection control techniques and regard all contact with blood as potentially infective. The fears of dentists can be assuaged by the realization that well-accepted infection control methods applicable to hepatitis B, are also effective against AIDS. The paper reviews the major considerations to be taken into account in implementing an infection control regimen, and in identifying at-risk groups among patients.

Acquired Immunodeficiency Syndrome↗
PubMed2003

A survey of patterns of physician hygiene in ophthalmology clinic patient encounters.

PURPOSE: This study examined physician hygiene patterns in the eye clinic of a major medical center to assess compliance with recommended practice patterns to avoid nosocomial infection during patient encounters. METHODS: One hundred ophthalmology resident-patient encounters were observed anonymously by the authors. Examining physicians were evaluated in handwashing between patients, cleaning and disinfecting of tonometer tips after each use, and recapping of diagnostic drop bottles after each use. RESULTS: Physicians washed their hands 74% of the time between patient encounters. The surfaces of tonometer tips were disinfected with an alcohol pad 100% of the time. Diagnostic drop bottles were recapped 57% of the time after each use. CONCLUSIONS: There is ample clinical evidence in the ophthalmic literature that practitioners' hands and tonometer tips can be vectors for transmission of nosocomial infection and that vigorous handwashing and disinfection of instruments can decrease the rates of transmission. Sometimes, however, physicians neglect to follow these simple and effective steps. We suggest posting visual educational materials in examination rooms as a reminder to ophthalmology residents and clinic personnel to adhere to these precautions, benefiting doctors and patients.

Ambulatory Care Facilities↗
PubMed1997

General overview of PRRSV: a perspective from the United States.

Four years after the report of its discovery, porcine reproductive and respiratory syndrome virus (PRRSV) continues to challenge swine producers, veterinary practitioners, and animal health researchers in the United States. The prevalence of infection is high--60% to 80% of herds is a reasonable estimate--but the clinical effects of infection vary widely among farms. In many herds, infection is unapparent and productivity seemingly unaffected. Some infected herds report occasional respiratory disease outbreaks in young pigs, or periodic outbreaks of reproductive disease, and a few herds experience severe, chronic disease problems, particularly in young pigs. In these herds, secondary infections with viral or bacterial pathogens, particularly Salmonella choleraesuis, Streptococcus suis, or Haemophilus parasuis typically occur concurrently with PRRSV infections. Understanding why some herds undergo devastating episodes of clinical disease and others show no apparent effects is central to solving the problem of clinical PRRS for swine producers. Understanding the ecology and epidemiology of PRRSV is the key to preventing and controlling PRRSV in the future. The objective of this article is to review recent developments in these areas.

Abortion, Veterinary↗