Where has Lyme disease gone? Levison, Matthew E; Kaye, Donald
Infectious Disease News,
01/2015, Letnik:
28, Številka:
1
Trade Publication Article
...the number may be considerably higher; the CDC estimates that the actual number of Lyme disease cases diagnosed annually may be as high as 300,000. Additional underreporting likely occurs in some ...highly endemic areas, like beach communities with transient summer residents, because diseases are reported by county of residence, rather than where the disease actually was acquired. Because of complications of delayed arthritis, peripheral neuropathy, cardiac manifestations and/or encephalomyelitis in untreated patients, Lyme disease is a larger problem than just the acute infection.
The purpose of this study was to explore the relationships among family quality of life (FQOL), parental self-blame, and religiosity in families of children with autism spectrum disorder (ASD). By ...doing so, this study aimed to identify aspects of family life that may contribute to FQOL, as well as inform service providers of how to best support families of children with ASD. The study utilized an online, self-report survey, which asked parents of a child with ASD to complete a number of questionnaires. The Beach Center FQOL Scale assessed participants' satisfaction with their FQOL, while the Religious Commitment Inventory - 10 assessed their religiosity. The ASD Parental Self-Blame Scale was developed for the purpose of this study, and measured feelings of self-blame. Participants also provided demographic information, including the length of time that had passed since their child's ASD diagnosis. In all, 114 parents completed the study. A significant negative correlation was found between scores on the measure of self-blame and scores on the FQOL scale. Specifically, parents who reported more feelings of self-blame for their child's diagnosis and difficulties associated with it generally demonstrated lower FQOL. Self-blame accounted for roughly 31% of the variance found in FQOL scores. Additionally, a significant negative correlation was found between self-blame scores and the length of time since the child's diagnosis of ASD. That is, parents whose child's diagnosis was more recent generally displayed more self-blame. No significant relationship was found between the measure of religiosity and FQOL. These findings demonstrate that parental self-blame may be an important factor for service providers to target in treatment, as it is possible that alleviating parental self-blame would increase FQOL. It is also important to note that in terms of the domains of FQOL, participants in this study displayed the least satisfaction within the Emotional Well-Being domain. This suggests that current emotional supports in place for families of children with ASD may need to be re-evaluated. Future research would need to use longitudinal designs to investigate the directionality of the relationship between self-blame and FQOL. Additionally, future research should explore possible mediating variables in the relationship between self-blame and FQOL, as well as investigate whether this relationship holds true for parents of children with other disabilities.
Anaerobic Pleuropulmonary Infection Levison, Matthew E
Infectious diseases in clinical practice (Baltimore, Md.),
2002-March/April, Letnik:
11, Številka:
3
Journal Article
Recenzirano
Obligate anaerobes are the predominant constituents of normal oropharyngeal flora and, produce pleuropulmonary infection in patients who are prone to aspirate. Obtaining material from these patients ...for culture from the site of infection that is uncontaminated, by normal flora is problematic. In-vitro cultivation of obligate anaerobes requires rigorous anaerobic techniques and susceptibility testing of obligate anaerobes is not standardized in many clinical microbiology laboratories. Few clinical trials of drugs have been done in patients with laboratory documented or putative anaerobic pulmonary infection. For these reasons the diagnosis and therapy of anaerobic pulmonary infection are frequently empirical and guided by published studies of in-vitro activity against collected clinical isolates. Several new drugs that have in-vitro activity against obligate anaerobes have recently become available for empirical treatment of pneumonia.
Pharmacodynamics of antibacterial agents relates the time course of drug concentration to its antimicrobial effects at the infection site. Antibacterial agents can be divided into three groups based ...on pharmacodynamic characteristics: agents that exhibit concentration-dependent bactericidal activity over a range of drug concentrations (e.g., aminoglycosides and fluoroquinolones); agents that exhibit time-dependent bactericidal activity that has little relationship to the magnitude of concentration, provided the concentrations are above a minimally effective level (e.g., beta-lactam antibiotics and vancomycin); and agents that exhibit a predominantly bacteriostatic effect. Knowledge of antimicrobial pharmacodynamics provides a rational basis for determining optimal regimens of dosage amounts and length of dosage intervals.
Nonpenicillin beta-lactams exhibit a variable spectrum of antimicrobial activity, have a wide range of clinical uses and a favorable safety profile. Cefepime's twice-daily dosage and increased ...activity against Enterobacteriaceae may offer some advantages over older cephalosporins. The carbapenems offer a broad antimicrobial spectrum, and meropenem has an improved safety profile compared with imipenem. Aztreonam is a useful alternative for patients with aerobic gram-negative infections who are allergic to penicillin. The emergence of resistant organisms, however, is an increasing problem with the frequent use of these antibiotics.
Infective Endocarditis Baddour, Larry M.; Wilson, Walter R.; Bayer, Arnold S. ...
Circulation (New York, N.Y.),
06/2005, Letnik:
111, Številka:
23
Journal Article
Recenzirano
Background— Despite advances in medical, surgical, and critical care interventions, infective endocarditis remains a disease that is associated with considerable morbidity and mortality. The ...continuing evolution of antimicrobial resistance among common pathogens that cause infective endocarditis creates additional therapeutic issues for physicians to manage in this potentially life-threatening illness. Methods and Results— This work represents the third iteration of an infective endocarditis “treatment” document developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. It updates recommendations for diagnosis, treatment, and management of complications of infective endocarditis. A multidisciplinary committee of experts drafted this document to assist physicians in the evolving care of patients with infective endocarditis in the new millennium. This executive summary addresses the major points detailed in the larger document that contains more extensive background information and pertinent references. For the first time, an evidence-based scoring system that is used by the American College of Cardiology and the American Heart Association was applied to treatment recommendations. Tables also have been included that provide input on the use of echocardiography during diagnosis and treatment of infective endocarditis, evaluation and treatment of culture-negative endocarditis, and short-term and long-term management of patients during and after completion of antimicrobial treatment. To assist physicians who care for children, pediatric dosing was added to each treatment regimen. Conclusions— The recommendations outlined in this summary should assist physicians in all aspects of patient care in the diagnosis, medical and surgical treatment, and follow-up of infective endocarditis, as well as management of associated complications. Clinical variability and complexity in infective endocarditis, however, dictate that these guidelines be used to support and not supplant physician-directed decisions in individual patient management.
Although the landmark investigational period for anaerobic pathogens occurred more than 20 years ago, pleuropulmonary infections caused by these pathogens remain an important cause of morbidity and ...mortality. Despite heightened awareness of pathogenicity and new diagnostic methods, the actual incidence of anaerobes in pulmonary infections--especially those occurring in hospitalized patients--remains controversial. Further complicating the management of these infections is the changing antimicrobial susceptibility of oral anaerobes, which has mandated the abandonment of penicillin monotherapy in seriously ill patients. This article reviews the pathogenesis of anaerobic pulmonary infections, their clinical presentations, and current management issues.PUBLICATION ABSTRACT
Despite advances in medical, surgical, and critical care interventions, infective endocarditis remains a disease that is associated with considerable morbidity and mortality. The continuing evolution ...of antimicrobial resistance among common pathogens that cause infective endocarditis creates additional therapeutic issues for physicians to manage in this potentially life-threatening illness.
This work represents the third iteration of an infective endocarditis "treatment" document developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. It updates recommendations for diagnosis, treatment, and management of complications of infective endocarditis. A multidisciplinary committee of experts drafted this document to assist physicians in the evolving care of patients with infective endocarditis in the new millennium. This extensive document is accompanied by an executive summary that covers the key points of the diagnosis, antimicrobial therapy, and management of infective endocarditis. For the first time, an evidence-based scoring system that is used by the American College of Cardiology and the American Heart Association was applied to treatment recommendations. Tables also have been included that provide input on the use of echocardiography during diagnosis and treatment of infective endocarditis, evaluation and treatment of culture-negative endocarditis, and short-term and long-term management of patients during and after completion of antimicrobial treatment. To assist physicians who care for children, pediatric dosing was added to each treatment regimen.
The recommendations outlined in this update should assist physicians in all aspects of patient care in the diagnosis, medical and surgical treatment, and follow-up of infective endocarditis, as well as management of associated complications. Clinical variability and complexity in infective endocarditis, however, dictate that these guidelines be used to support and not supplant physician-directed decisions in individual patient management.
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