RESUMO
A wealth of information on chronic fatigue syndrome (CFS) and fibromyalgia is available on the World Wide Web for health care providers and patients. These illnesses have overlapping features, and their etiologies remain unknown. Multiple Web sites were reviewed, and selected sites providing useful information were identified. Sites were classified according to their content and target audience and were judged according to suggested standards of Internet publishing. Fifty-eight sites were classified into groups as follows: comprehensive and research Web sites for CFS and fibromyalgia, meetings, clinical trials, literature search services, bibliographies, journal, and CFS and fibromyalgia Web sites for the patient.
Assuntos
Diretórios como Assunto , Síndrome de Fadiga Crônica , Fibromialgia , InternetRESUMO
Establishing a clinical diagnosis of infection in residents of long-term-care facilities (LTCFs) is difficult. As a result, deciding when to initiate antibiotics can be particularly challenging. This article describes the establishment of minimum criteria for the initiation of antibiotics in residents of LTCFs. Experts in this area were invited to participate in a consensus conference. Using a modified delphi approach, a questionnaire and selected relevant articles were sent to participants who were asked to rank individual signs and symptoms with respect to their relative importance. Using the results of the weighting by participants, a modification of the nominal group process was used to achieve consensus. Criteria for initiating antibiotics for skin and soft-tissue infections, respiratory infections, urinary infections, and fever where the focus of infection is unknown were developed.
Assuntos
Antibacterianos/uso terapêutico , Doenças Transmissíveis/tratamento farmacológico , Uso de Medicamentos/normas , Instituições Residenciais/normas , Idoso , Centers for Disease Control and Prevention, U.S. , Resistência Microbiana a Medicamentos , Febre/tratamento farmacológico , Hospitais de Doenças Crônicas/normas , Hospitais de Veteranos/normas , Humanos , Casas de Saúde/normas , Guias de Prática Clínica como Assunto , Infecções Respiratórias/tratamento farmacológico , Dermatopatias Infecciosas/tratamento farmacológico , Estados Unidos , Infecções Urinárias/tratamento farmacológicoRESUMO
Although patients with chronic fatigue syndrome (CFS) typically present subjective complaints of cognitive and psychological difficulties, studies to date have provided mixed objective support for the existence of specific cognitive deficits. The present study was designed to examine differences in performance between individuals diagnosed with CFS and matched controls with respect to sustained attention, processing efficiency, learning, and memory. Subjects included 17 patients meeting Centers for Disease Control research criteria for CFS and 17 control subjects. Subjects were administered six measures assessing attention, memory, and word-finding ability and two measures assessing psychological distress. For the most part, the two groups did not differ on measures of neurocognitive functioning. Significant group differences were found on a single measure of attention and incidental memory. However, CFS patients differed markedly from controls with respect to reported psychological distress. The results support previous findings of notable levels of psychological distress among CFS patients. They also suggest the need for alternative research paradigms to assess the cognitive abilities of CFS patients.
Assuntos
Transtornos Cognitivos/diagnóstico , Transtorno Depressivo/etiologia , Síndrome de Fadiga Crônica/psicologia , Testes Neuropsicológicos , Adulto , Transtornos Cognitivos/etiologia , Transtorno Depressivo/diagnóstico , Feminino , Humanos , MasculinoAssuntos
Antivirais/uso terapêutico , Vacinas contra Influenza , Influenza Humana/prevenção & controle , Humanos , Vírus da Influenza A , Vacinas contra Influenza/administração & dosagem , Vacinas contra Influenza/efeitos adversos , Vacinas contra Influenza/imunologia , Influenza Humana/epidemiologia , Influenza Humana/fisiopatologia , Influenza Humana/terapia , Estados Unidos/epidemiologia , VacinaçãoRESUMO
We describe a 22-year-old woman who developed fever, shaking chills, and leukocytosis after insertion of a terconazole (80 mg) vaginal suppository for mild vaginal candidiasis. The patient became afebrile and asymptomatic 24 hours after hospital admission without antibiotic therapy. More experience with terconazole is needed before it can be considered as safe as other imidazole derivatives that have been available for more than 15 years.
Assuntos
Antifúngicos/efeitos adversos , Febre/induzido quimicamente , Leucocitose/induzido quimicamente , Triazóis/efeitos adversos , Administração Intravaginal , Adulto , Candidíase/tratamento farmacológico , Feminino , Humanos , SupositóriosRESUMO
Four cases of Salmonella prosthetic valve endocarditis have been reported previously in the English medical literature (Fraser et al. 1967; Yamamoto et al., 1974; Shanson et al., 1977; Bassa et al., 1989). This report describes a fifth case in a 62-year-old woman who developed tricuspid valve endocarditis after an episode of Salmonella gastroenteritis, and reviews prior cases of Salmonella prosthetic valve endocarditis.
Assuntos
Bioprótese , Endocardite Bacteriana/etiologia , Próteses Valvulares Cardíacas , Infecções por Salmonella/etiologia , Feminino , Gastroenterite/complicações , Humanos , Pessoa de Meia-Idade , Salmonella/isolamento & purificação , Valva TricúspideRESUMO
Tsukamurella paurometabolum is a weakly acid-fast, pleomorphic gram-positive bacterium found in soil. Human infection due to this organism has rarely been described, and there are no published accounts of bacteremia. Three cases of bacteremia due to T. paurometabolum and related to long-term use of a central venous catheter in patients with cancer who were receiving chemotherapy are described.
Assuntos
Infecções por Actinomycetales/microbiologia , Actinomycetales/isolamento & purificação , Bacteriemia/microbiologia , Cateterismo Venoso Central , Neoplasias/complicações , Infecções por Actinomycetales/etiologia , Adolescente , Idoso , Bacteriemia/etiologia , Neoplasias da Mama/complicações , Neoplasias da Mama/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológico , Neoplasias Pélvicas/complicações , Neoplasias Pélvicas/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Sarcoma de Ewing/complicações , Sarcoma de Ewing/tratamento farmacológicoRESUMO
The average age of patients with endocarditis is increasing. It is becoming a disease of the elderly, especially related to use of prosthetic heart valves and IV lines or catheters associated with bacteremias. Recognition is the major problem in the elderly patient since many features of the disorder are often attributed to aging. The diagnosis should be considered in the elderly patient with fever or other unexplained findings. Blood cultures are indicated to prevent misdiagnosis.
Assuntos
Envelhecimento , Endocardite Bacteriana/diagnóstico , Idoso , Erros de Diagnóstico , Endocardite Bacteriana/etiologia , Endocardite Bacteriana/terapia , Humanos , Pessoa de Meia-Idade , PrognósticoRESUMO
We have reported previously (H. R. Kotilainen, J. P. Brinker, J. L. Avato, and N. M. Gantz, Arch. Intern. Med. 149:2749-2753, 1989) that the quality of nonsterile examination gloves available for clinical use may be extremely variable. In view of the concern over human immunodeficiency virus and hepatitis B virus transmission to health care workers, the continuing variability of gloves available for use, and the need for a simple and safe test, we have evaluated 2,500 vinyl (five brands) and 2,000 latex (four brands) gloves by the 300-ml and the newly proposed 1,000-ml water tests and for permeability to herpes simplex virus type 1 and poliovirus type 1, respectively. While all 300-ml watertight gloves were unlikely to leak herpes simplex virus type 1 (1.3% vinyl; 0.5% latex), poliovirus was recovered much more frequently (8.9% vinyl, 6.1% latex). In all gloves that passed the 1,000-ml test, herpes simplex virus type 1 was not recovered. Poliovirus was recovered infrequently (1.4% vinyl, 1.5% latex). Preliminary analyses suggest that the 1,000-ml water test has significantly increased sensitivity over the 300-ml water test in the detection of small holes in both vinyl and latex gloves that may allow the passage of viral particles. Gloves that pass a 1,000-ml water challenge are unlikely to allow the passage of a small virus such as poliovirus. Given that human immunodeficiency virus, hepatitis B virus and herpes simplex virus type 1 are larger particles than poliovirus, gloves that pass the 1,000-ml water test theoretically could provide better protection.
Assuntos
Luvas Cirúrgicas/normas , Látex , Polivinil , Vírus , Vírus da Hepatite B , Humanos , Permeabilidade , Poliovirus , Garantia da Qualidade dos Cuidados de Saúde , Sensibilidade e Especificidade , SimplexvirusRESUMO
In general, ciprofloxacin is well tolerated. The most common adverse effects are nausea, vomiting, diarrhea, dizziness, nervousness, and rash. Reversible leukopenia can be associated with the use of oral ciprofloxacin, as shown by our case. Leukopenia should be watched for as the use of this drug increases.
Assuntos
Ciprofloxacina/efeitos adversos , Leucopenia/induzido quimicamente , Endocardite Bacteriana , Feminino , Próteses Valvulares Cardíacas , Humanos , Pessoa de Meia-Idade , Infecções por Salmonella , Sepse , Valva TricúspideRESUMO
In December 1987, we investigated an increased number of cases of herpetic whitlow in medical intensive care unit nurses who routinely gloved for secretion contact. One particular brand of vinyl examination glove had been used in the medical intensive care unit. Restriction endonuclease mapping established the similarity of employee isolates with one patient isolate of herpes simplex virus type I. When initial viral assay demonstrated 2.5% to 10% penetration of herpes simplex virus type I across unused gloves, an evaluation of glove quality was undertaken. In a 300-mL watertightness test, seven brands of vinyl gloves failed 4% to 28% (average, 11.1%; 132/1200), while seven brands of latex gloves failed 0% to 2.6% (average, 1.4%; 24/1750). The brand of vinyl glove that had been in use in the medical intensive care unit failed 28% of the time. Watertight gloves were then tested for permeability to herpes simplex virus type I. None of the latex gloves failed (n = 1726), while only 10 of the vinyl gloves failed (n = 1068, 0.95%). Extreme variability in glove quality was observed. However, gloves made from intact vinyl may provide similar protectiveness as those made from intact latex. As the demand for gloves increases, emphasis should be placed on the production of plentiful, better quality latex and vinyl gloves.
Assuntos
Mão de Obra em Saúde , Roupa de Proteção/normas , Surtos de Doenças , Contaminação de Equipamentos , Falha de Equipamento , Herpesviridae/isolamento & purificação , Infecções por Herpesviridae/epidemiologia , Infecções por Herpesviridae/transmissão , Humanos , Unidades de Terapia Intensiva , Látex , Teste de Materiais , Microscopia Eletrônica , Polivinil , Controle de QualidadeRESUMO
A woman with diabetes mellitus and coronary artery disease developed pneumonia and bacteremia from Branhamella catarrhalis. This is only the fifth reported case of pneumonia with bacteremia due to this organism, which was previously considered normal upper airway flora.