20 results

Change from intravenous to oral antibiotics is possible, even in cases of endocarditis or bone and joint infections

A study from Denmark by Iversen and colleagues that included 400 patients with left side endocarditis compared two groups. Their sample was composed by randomized patients who used the usual regimen of intravenous antibiotics for longer periods versus those who changed intravenous antibiotics to oral antibiotics after 10 days.(1) There was no inferiority and curiously side effects of the antibiotics were the same in both groups. Ho-Kwong and his team studied a larger group including 1,554 patients who were also […]

Acute infection and myocardial infarction

The risk of myocardial infarction after infection is well known, and for inpatients with pneumococcal pneumonia, it is 7 to 8%. This risk is higher at the onset of infection, is proportional to severity of pneumonia, and persists for at least 5 weeks. The risk declines slowly after this period but persists for several years. The explanation for this fact is complex.  Some individuals may suffer from type 2 infarction, when there are atherosclerosis and plaques in coronary arteries, but […]

Hard to treat multi-resistant gram negative bacteremia

First line antibiotics for gram negative bacteremia were defined as simultaneous to all carbapenems, all other beta lactams and all fluoroquinolones. In a sample including 173 American hospitals and 45,011 patients with gram negative bacteremia, a total of 471 (1%) had what the authors called difficult-to-treat resistance in gram negative bacteremia; 79 % of those patients received parentheral aminoglicosides, polymixin B or tigeciline. Mortality among them was 43.3 % higher than in simple carbapenem resistance. This difficult- to-treat gram negative bacteremia […]

The future of Medicine in the time of artificial intelligence

A report published in The Lancet, Chilamkurthy et al report impressive results using deep learning to interpret critical findings on head CT scans. The sensitivity of the algorithms using artificial intelligence was compared to radiologists’ interpretation; specificity was a little – not much – less precise. It could be – and in the future will be – cheaper, faster and almost equivalent. There are not – yet – clinical trials in real life comparing artificial intelligence with human interpretation. But […]

Armadillos as vectors of Hansen’s disease

Zoonotic transmission of Mycobacterium leprae to humans by 9 banded armadillos was reported in the Southern United States of America, mainly in Texas, Louisiana and Florida. Armadillos’ meat are consumed in some areas of Brazil, including Para state.  This consumption includes a kind of ceviche using raw liver of armadillos. Researchers detected in the study genetic material of Mycobacterium leprae by PCR in 10 of the 16 animals included, in addition antibodies to a Mycobacterium leprae specific antigen, phenolic glycolipid, was […]

Isolation time of patients with tuberculosis

One of the difficulties of managing tuberculosis in hospitalized patients is the maintenance of isolation time. The golden standard diagnostic test is culture negative for Mycobacterium tuberculosis. AFB stain can still be positive with non-viable bacteria, leading to more isolation time than necessary. The morphological characteristics of bacilli are useful: broken bacteria with gaps in staining are probable dead bacteria, but this information is rarely used to define the isolation time. The Chaisson LH et al study, done at Zuckerberg […]

Laboratory assay of ADAMS 13

ADAMS 13 is a metalloprotease responsible for cleavage of Von Willebrand ultra large multimers. Severe deficiency of this protease, either by auto-antibodies against it or by complement lead to severe thrombotic diseases, such as thrombotic thrombocytopenic purpura or hemolytic uremic syndrome. There are some evidences that less blatant deficiencies of this protease can play a role in other thrombotic diseases, e.g., ischemic stroke and coronary artery disease. The assay of ADAMS13 is usually unavailable at clinical laboratories, and can be […]

Reducing hospital toxicity: impact on patient outcomes

Circadian rhythms are disrupted by routine hospital care. There is also a loss of personal control of health. This loss can lead to adverse outcomes. The authors evaluated 3,425 consecutive patients admitted to a medical-surgical unit with a control wing (n=2,240) and an intervention wing (n=2,240) over a 2.5 year period. Efforts were made among intervention patients for not disturbing their sleep by reducing nighttime noise, delay of routine phlebotomy to more convenient times (not at 4 AM), monitoring of […]

Flouroquine use and risk of aortic aneurysm and dissection: nationwide cohort study

Using the excellent Swedish medical record system a study analyzed medical charts of all patients treated with fluoroquinone between July 2006 and December 2013. The study reported that within 60 days after fluorquinolone use the ratio of aortic aneurysm and dissection was 1.2 cases/1000 persons compared to 0.7 cases/1000 persons who were amoxicillin users. The size of both samples was impressive: 360,088.00 fluoroquinone users (78 % ciprofloxacin) and 360,088.00 matched ampicillin users . The relative hazard risk for both aortic […]

Should you stop wearing neckties?- wearing a tight necktie reduces cerebral blood flow.

Deficits in flow are expected when jugular veins and carotid arteries are compressed. An evidence already exist that neckties increase intraocular pressure. To many professions, including  those from the medical field in the USA, neckties are part of the dress code. A study conducted at Schleswig Holstein University, Kiel campus, included thirty volunteers who were divided into two groups: one wearing tight neckties and other without this “socially imposed semi-strangulation”. During a magnetic resonance imaging test and after tightening the […]

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