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1621. Urethral catheter or suprapubic aspiration to reduce contamination of urine samples in young children?

. 3/13 contaminated (23.1%) No significant difference in contamination between UC and SPA More success in getting adequate urine volumes in babies over 34 weeks If the child was better by the time the result was available then it was considered as contaminant but we assumed all patients were started on empirical antibiotics (not specified in paper) which could have changed clinical outcome Babies were cleaned with aqueous chlorhexidine before catheter and SPA samples were taken Study terminated

2009 BestBETS

1622. Calcific Uremic Arteriolopathy (CUA)

, violaceous skin lesions with ulceration on both thighs. The lesions worsened and became increasingly painful over the last 6 months. Her extensive four month hospital course has been complicated by numerous episodes of superinfection and sepsis with methicillin resistant Staph aureus treated by intravenous antibiotics and wound debridement and negative pressure wound dressings. Over the last several weeks, her exquisitely painful skin ulcerations continue to worsen and have expanded to involve her trunk (...) spectrum antibiotics, anti-thrombolytic therapy, and sevelemar, our patient S.J. eventually succumbed to her CUA, likely secondary to sepsis as a result of wound superinfection. Unfortunately, none of the therapies for CUA offer a definitive cure or are consistently successful. The number of randomized controlled trials looking at outcomes also continues to be very limited. One hopes that some of the recent discoveries related to the pathogenesis of CUA will lead to the development of new strategies

2009 Clinical Correlations

1623. Salmonella Update

with fever and gastrointestinal symptoms within hours to days of exposure, and lasts days, and up to one week. The illness may be self-limiting or require supportive hydration. In certain populations, such as the very young or very old, or those who are immunocompromised, there is higher risk of systemic infection, which can be fatal if not treated promptly with antibiotics. There are also connections between Salmonella infection and development of reactive arthritis in Reiter’s syndrome (...) foods to their origin. Dr. Maki goes on further to call for the discontinuation of antibiotics in animal feeds which leads to microbial resistance, more hygienic food preparation, as well as routine irradiation of high risk foods. References CDC. Investigation Update: Outbreak of Salmonella Typhimurium Infections, 2008–2009. FDA. Peanut Product Recalls: Salmonella Typhimurium. Rabin, RC. Peanut Plant Had History of Health Lapses. New York Times

2009 Clinical Correlations

1624. Should All Patients with Cellulitis Be Treated for Community-Acquired Methicillin-Resistant Staphylococcus Aureus?

(MSSA) and methicillin-resistant (MRSA) strains. Empiric therapy for management of cellulitis has traditionally included antibiotics with activity against beta-hemolytic streptococci and MSSA such as penicillinase-resistant penicillins or first generation cephalosporins, unless the patient was known to have a previous MRSA infection or in cases of severe systemic toxicity. Over the past decade there has been a steady rise in the incidence of community-acquired methicillin-resistant S. aureus (CA (...) in patients without the traditional risk factors for MRSA, is usually more susceptible to different antibiotic classes, has a unique chromosomal cassette containing a smaller resistance gene thought to result in more efficient transmission, and usually contains a virulence factor, Panton-Valentine leukocidin (PVL) [3]. PVL produces cytotoxins, causing tissue necrosis and leukocyte destruction, which can result in serious infections such as necrotizing fasciitis and pyomyositis. However, most CA-MRSA

2009 Clinical Correlations

1625. Diseases 2.0: Sepsis

diagnostic tests will help ensure earlier interventions, improved protocols will improve the quality of interventions, and new pharmaceuticals will be available for treatment of both complications of sepsis and the dysfunctional inflammatory state of sepsis itself. Continued success in sepsis research may mean that at some point in the no-so-distant future, a sepsis diagnosis will be as simple as a blood test, and pharmaceutical treatment will be as straight forward as antibiotics and an inflammatory (...) . That is still controversial. Re clinical mgt of septic patients, it is impt to stress that at present there is only one treatment parameter that has been proven to significantly reduce mortality in bacterial sepsis and that has been demonstrated in many clinical trials since 1964–that is, the earliest possible use of an “effective” antibiotic regimen, defined as one that proves active (by standardized in vitro senstivity testing) against the ultimately isolated pathogen, That gets into the need to optimize

2009 Clinical Correlations

1626. Why is Syphilis Still Sensitive to Penicillin?

Why is Syphilis Still Sensitive to Penicillin? Why is Syphilis Still Sensitive to Penicillin? – Clinical Correlations Search Why is Syphilis Still Sensitive to Penicillin? July 30, 2009 5 min read | | 4 comments on “ Why is Syphilis Still Sensitive to Penicillin? ” Very interesting… Well, this is supposed to be how antibiotics work, by punching a hole in the cell wall of the bacteria. Caprillic acid in coconut oil does the same thing. But why theorized? With the current technology

2009 Clinical Correlations

1627. A Primer on H1N1

different from previous strains. Unfortunately at this time, there are still more questions than answers, but the take home message remains the same: cover your mouth when you cough or sneeze, wash your hands frequently with antibacterial soaps or alcohol based cleansers, avoid close contact with sick people, and stay home if you are sick. As of July 12 2009 at 11:00 AM ET, the CDC reports 37,246 confirmed and probable cases and 211 deaths in the United States. 3 WHO reports 94512 Cases with 429 deaths

2009 Clinical Correlations

1628. Grand Rounds: Genomic Medicine: Hope, Hype and Reality

of Genetics and Genomic Sciences at the Mount Sinai School of Medicine. Dr. Desnick began with therapeutic revolutions in the 20 th century which include the discovery of antibiotics, vaccines, transplant medicine, laporoscopic and robotic surgeries and finally, genome based medicine. Gene discovery has enabled us to elucidate the pathophysiology of diseases, predict and prevent diseases and discover new interventions and therapies. These have collectively allowed us to provide individualized

2009 Clinical Correlations

1629. A Multivitamin a Day - Does It Really Keep the Doctor Away?

number of contacts with primary care physicians due to illness, self-reported infection, and quality of life. The results of this study showed no statistically significant change between the treatment and placebo groups with regard to any of the primary outcomes. Likewise, no difference was seen in secondary outcomes, which included the number of antibiotic prescriptions written and number of hospital admissions. Of note, the participants were older patients living in the community and as such were

2009 Clinical Correlations

1630. Treating Chlamydia in Pregnancy

of membranes were the primary outcomes that were examined. Preliminary studies found that preterm birth occurred among approximately 10% of the described population yearly. Prevalence of specific infections and other variables were compared between infected and non-infected black women. 66% of women with trichomonas, 45% of women with bacterial vaginosis and 65% of women with Chlamydia received appropriate antimicrobial treatment. The intervening use of antibiotics was controlled by limiting the dataset (...) with chlamydia infection] is [antibiotic treatment] effective in [reducing the incidence of miscarriage or preterm labor]? Clinical Scenario A patient presents to the Emergency Department with complaints of abdominal pain and vaginal discharge. You find out she is pregnant and has chlamydia; will antibiotic treatment help decrease the incidence of miscarriage and/or preterm labor? Search Strategy MEDLINE 1950 to September 2008 using OVID interface, Cochrane Library (2008) [(exp chlamydia and exp chlamydia

2009 BestBETS

1631. Distinguishing between septic arthritis of the hip and transient synovitis in children

. Non-weightbearing 3. ESR >40 mm/hr 4. sWCC >12 x 10 to the power of 9 Probability of SA with number of predictors present: 0 - 2% 1 - 9.5% 2 - 35% 3 - 73% 4 - 93% No CRP Luhmann et al, 2004, USA 163 patients who underwent hip aspiration for evaluation of acute hip pain (47 with SA, 118 with TrS) Level I (Validation/diagnostic study) Predictors: 1. History of fever >38.5°C 2. Gender 3. Duration of symptoms 4. Refusal to weightbear 5. Recent antibiotic use 6. Temperature on admission 7. ESR 8. sWCC (...) features but the treatment and potential for negative sequelae are significantly different. Whereas transient synovitis runs a benign self-limiting course that can be managed with observation and NSAIDS, septic arthritis needs urgent diagnosis, operative irrigation and antibiotics. Poor outcomes are associated with diagnostic delays, and negative sequelae include osteonecrosis of the femoral head, growth arrest and sepsis (Fabry, Lunseth). There is much debate amongst clinicians over how best

2009 BestBETS

1632. Does oral aciclovir improve clinical outcome in immunocompetent children with primary herpes simplex gingivotomatitis?

children. Pediatr Emerg Care 2006;22:268–9. Ducoulombier H, Cousin J, Dewilde A, et al. Herpetic stomatitis-gingivitis in children: controlled trial of aciclovir versus placebo. Ann Pediatr (Paris) 1988;35:212–16. Aoki FY, Law BJ, Hammond GW, et al.. Acyclovir suspension for treatment of acute herpes simplex virus gingivostomatitis in children: a placebo controlled double blind trial. Abstract no. 1530. In: Program and abstracts of the 33rd Interscience Conference on Antimicrobial Agents

2009 BestBETS

1633. Systemic Metronidazole Is An Effective Adjunct To S&RP In Generalized Aggressive Periodontitis Patients

Systemic Metronidazole Is An Effective Adjunct To S&RP In Generalized Aggressive Periodontitis Patients UTCAT266, Found CAT view, CRITICALLY APPRAISED TOPICs University: | | ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM View the CAT / Title Systemic Metronidazole Is An Effective Adjunct To S&RP In Generalized Aggressive Periodontitis Patients Clinical Question Will scaling & root planning plus systemic antibiotic (metronidazole + amoxycillin) be more effective than scaling & root planning alone (...) with generalized aggressive periodontitis randomized into 4 groups: 1. SRP + metronidazole & amoxicillin RCT Key results All treatments result in improvement of probing depth, attachment level, bleeding on probing. Administration of metronidazole plus amoxycillin or metronidazole alone resulted in greater reduction of sites >6mm. Evidence Search Pubmed: scaling and root planing aggressive periodontitis antibiotic, Limits: RCT, English Comments on The Evidence All forms of treatment provided some improvement

2009 UTHSCSA Dental School CAT Library

1634. Single-Visit and Multiple Visit Endodontics Provide Same Healing Rates in Healthy Patients

Search PubMed - “endodontics” and “single visit” and “calcium hydroxide” and (meta-analysis [ptyp] or randomized controlled trial[ptyp]) Comments on The Evidence Although this study was a meta-analysis, only 3 randomized controlled trials met the inclusion criteria and the resulting 146 cases represent a very small sample. The results seem to create a cognitive dissonance. We know that bacterial infection causes periapical periodontitis and that calcium hydroxide is antibacterial. Placing the slow

2009 UTHSCSA Dental School CAT Library

1635. Limited evidence for the effectiveness of burn wound dressings

in the management of superficial and partial thickness burns. These include hydrocolloid, silicon nylon, antimicrobial (containing silver), polyurethane film and biosynthetic dressings. The benefit relates to time to wound healing, the number of dressing changes and the level of pain experienced. Caveat Most of the trials were small (only 6 had more than 80 patients), and many had methodological limitations. Many of the trials failed to adequately assess the depth of burns. The use of silver sulphadiazine (SSD

2009 Publication 410

1636. Ventilation tubes (Grommets) effective for recurrent acute otitis media

of total number of episodes of recurrent AOM but in both studies more than 50% of children were AOM free, while only a handful were rendered AOM free in the antibiotic arm. Caveat This review involved only 2 small studies. Further research is required to investigate the effect of grommets beyond 6 months. Clinicians should take into account an individual patient's circumstances, the possible adverse effects of grommet insertion and the potential complications of AOM before surgery is undertaken (...) . Context AOM is one of the most common infectious diseases in childhood. Recurrent AOM is defined for the purposes of this review as either 3 or more acute infections of the middle ear cleft in a 6-month period, or at least 4 episodes in a year. Strategies for managing AOM include the assessment and modification of risk factors where possible, repeated courses of antibiotics for each new infection, antibiotic prophylaxis and the insertion of grommets. Cochrane Systematic Review McDonald S et al

2009 Publication 410

1637. The Pillar Procedure: for the treatment of obstructive sleep apnoea and snoring

-reusable delivery tool, which are disposed of in the same manner as medical sharps. Patients may resume normal diet and exercise on the same day, and should be prescribed antibiotics as a prophylaxis against infection and an anti-inflammatory medication if required (Nordgard et al 2004; Restore Medical Inc 2006). Figure 2 Schematic drawing of the Pillar ® implant system (printed with permission Restore Medical). The Pillar ® palatal implant system for the treatment of OSA and snoring 5Intended purpose

2006 Australia and New Zealand Horizon Scanning Network

1638. Point-of-Care influenza diagnostic tests

when compared to patients who received standard care. When only influenza positive patients from the two groups were compared, the majority of studies reported a significant decrease in the amount of time spent in the emergency department, a decrease in the administration of antibiotics and an increase in the administration of antivirals in patients who received POCT. Although all of the included studies reported on the immediate effect of POCT for influenza on patient management within

2008 Australia and New Zealand Horizon Scanning Network

1639. Long QT Syndrome

. This increased risk is thought to be related to an increase in the level of oestrogen and progesterone in addition to an increase in sympathetic nerve activity, which may increase the number of mutated ion channel proteins, precipitating a cardiac event (Wehrens et al 2002). In addition to the congenital forms, LQTS may be acquired via exposure to particular drugs, including antipsychotics, antihistamines, methadone, antiemetic agents and certain antibiotics. Approximately 50 drugs listed by the Food

2007 Australia and New Zealand Horizon Scanning Network

Evidence-based Synopses

Synopses are typically easily digested, critical commentaries of articles e.g. critically appraised topics.