Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: EC:3.4.16.2 (PCP)
 3,761 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

BACKGROUND: Breast abscesses account for 15% of surgical day cases seen in the UTH. Nearly all of these cases occur in lactating women. Pre-natal HIV prevalence among women seeking care at UTH was estimated at 25% as of 2004. Baseline surveys have shown that up to 60% of soft tissue infections presenting to the UTH are HIV related. OBJECTIVES: To determine if HIV infection is a risk factor for the development of breast abscesses in women presenting to the University Teaching Hospital (UTH) in Lusaka, Zambia. Secondary objective was to identify bacteriological aetiologies and drug sensitivity patterns associated with breast abscesses at UTH. STUDY DESIGN: A case-control study of 110 consecutive breast-feeding mothers diagnosed with breast abscess upon presentation to the UTH surgical service (cases) and 110 representative controls recruited from the UTH postnatal clinic. MAIN OUTCOMES: HIV seropositivity and CD4 counts (if HIV positive) among cases and controls. RESULTS: Fifty-four out of 110 (49.1%) lactating women with breast abscess had positive serologic tests for HIV. Only 25 of 110 (23%) control women tested HIV positive. This difference was statistically significant, with an odds ratio of 3.28 (95% CI 1.83 - 5.87; p = 0.001). Mean CD4 counts in cases were lower than in controls (338 vs. 568, p<0.001). Staphyloccocus aureus was the main causative agent (91.8%) of isolates. Among S. aureus isolates, 70 of 101 (69.3%) were oxacillin susceptible. Forty-three of 50 (86.0%) specimens from HIV positive patients were resistant to SMX-TMP compared with only 61% of specimens from HIV negative patients (p=0.004). CONCLUSIONS: HIV infection appears to be a significant risk factor in the development of breast abscess in lactating women in Zambia. Staphylococcus aureus remains the main causative agent, with MRSA accounting for 30.7% of isolates. SMX-TPM resistance likely stems from the wide spread use of the drug for PCP prophylaxis in HIV positive patients. It therefore should not be used for treatment of acute bacterial infections. HIV related breast infections could be considered as a possible entry point to HIV treatment now that the CD4 treatment guidelines have been adjusted to 350cells/cmm, although this requires further studies for validation.
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PMID:ASSOCIATION OF HIV WITH BREAST ABSCESS AND ALTERED MICROBIAL SUSCEPTIBILITY PATTERNS. 2317 38

Hospitalists, known as physicians, are an emerging group in the medical field that is focused on the general medical care of hospitalized patients. Specializing in hospital medicine, they often attract a mix of appreciation and criticism. In the present manuscript, we review the pros and cons of a hospitalist in the health-care system. Although experts agree that hospitalists add value to the health-care system by reducing costs, streamlining administrative processes, and contributing to improved health-care outcomes, there is a large degree of disagreement regarding the extent of hospitalist contribution to overall improvements on health-care outcomes. In this paper, new strategies to overcome reported shortcomings and to further improve the quality of health care are discussed. Abbreviations: SHM: Society of Hospital Medicine; BOOST: Better Outcomes by Optimizing Safe Transitions; RED: Re-Engineered Discharge; CHF: chronic heart failure; MI: myocardial infarction; ICU: intensive care unit; PACT: post-acute care transitions; MRSA: methicillin-resistant Staphylococcus aureus; CINAHL: The Cumulative Index to Nursing and Allied Health Literature; PCP: primary care physician.
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PMID:Era of hospitalists. 2944 Nov 60