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71.
72.
gyrA mutations in ciprofloxacin-resistant Bartonella bacilliformis strains obtained in vitro 下载免费PDF全文
Minnick MF Wilson ZR Smitherman LS Samuels DS 《Antimicrobial agents and chemotherapy》2003,47(1):383-386
We isolated and characterized mutants of Bartonella bacilliformis that are resistant to the fluoroquinolone antibiotic ciprofloxacin, which targets the A subunit of DNA gyrase. Mutants had single point mutations in the gyrA gene that changed either Asp-90 to Gly or Asp-95 to Asn and had 3- or 16-fold higher resistance, respectively, to ciprofloxacin than did wild-type B. bacilliformis. Asp-95 is homologous to Asp-87 of Escherichia coli GyrA and is a common residue mutated in fluoroquinolone-resistant strains of other bacteria. This is the first report of a mutation at an Asp-90 homologue, which corresponds to Asp-82 in E. coli GyrA. 相似文献
73.
Juvenile myasthenia gravis shares a similar pathophysiologic origin with adult myasthenia gravis, but there are important differences, mostly relating to epidemiology, presentation, and therapeutic decision making. Gender ratios and the proportion of seropositive patients differ in the pre‐ and postpubertal age groups. The diagnostic evaluation is similar to that in adults, although special techniques are sometimes necessary to perform single‐fiber electromyography in younger patients. Therapeutic decisions in affected children and adolescents are complicated by the greater long‐term consequences of using steroids, and thus other interventions, such as intravenous immunoglobulin (IVIg) and plasmapheresis, may play a greater therapeutic role in this population than in adults. Steroid‐sparing agents may contribute to the management of refractory cases, but they should be used with caution due to the risk of malignancy. Muscle Nerve, 2008 相似文献
74.
BACKGROUND Previous studies suggest that patients who are more involved in their medical care have better outcomes.
OBJECTIVES We sought to compare health care processes and outcomes for patients with HIV based on their preferred level of involvement
in health decisions.
DESIGN Cross-sectional analysis of audio computer-assisted interviews with patients at an urban HIV clinic.
PATIENTS One thousand and twenty-seven patients awaiting an appointment with their primary care provider.
MEASURES Patients were asked how they preferred to be involved in decisions (doctor makes most or all decisions, doctor and patient
share decisions, patient makes all decisions). We also asked patients to rate the quality of communication with their HIV
provider, and their self-reported receipt of and adherence to HAART.
RESULTS Overall, 23% patients preferred that their doctor make all or most decisions, 63% preferred to share decisions with their
doctor, and 13% preferred to make all final decisions alone. Compared to patients who prefer to share decisions with their
HIV provider, patients who prefer that their provider make all/most decisions were significantly less likely to adhere to
HAART (OR [odds ratio] 0.57, 95% CI 0.38–0.86) and patients who preferred to make decisions alone were significantly less
likely to receive HAART or to have undetectable HIV RNA in unadjusted analyses (OR 0.52, 95% CI 0.31–0.87 for receipt of HAART;
OR 0.64, 95% CI 0.44–0.95 for undetectable HIV RNA). After controlling for potentially confounding patient characteristics
and differences in patient ratings of communication quality, patients who preferred that their provider make all/most decisions
remained significantly less likely to adhere to HAART (OR 0.58, 95% CI 0.38–0.89); however, the associations with receipt
of HAART and undetectable HIV RNA were no longer significant (OR 0.60, 95% CI 0.34–1.05 for receipt of HAART; OR 0.80, 95%
C.I 0.53–1.20 for undetectable HIV RNA).
CONCLUSIONS Although previous research suggests that more patient involvement in health care decisions is better, this benefit may be
reduced when the patient wants to make decisions alone. Future research should explore the extent to which this preference
is modifiable so as to improve outcomes. 相似文献
75.
Quamar Azam MKA Sherwani Mazhar Abbas Rahul Gupta Naiyer Asif AB Sabir 《Indian Journal of Orthopaedics》2007,41(3):204-208
Objective:
Patients often reach the hospital late after passage of golden hours (initial 6 hours) after sustaining high-velocity injuries. The decision of internal fixation in Gustilo''s Type IIIA and IIIB fractures becomes a formidable challenge in patients reaching late. The purpose of the present study was to find out if internal fixation could be safely undertaken in these patients.Materials and Methods:
Sixty-three patients, having 70 compound fractures (46 Type IIIA and 24 IIIB), which were internally fixed after 6h but within 24h after injury, were included in the present analysis. Follow-up ranged from 18 to 48 months with mean of 28 months.Result:
Overall infection rate noted was (n = 11) 15.71% (8.7% in IIIA, and 29.16% in IIIB). The difference in deep infection rate between Type IIIA and Type IIIB was found to be statistically significant (P value < 0.01). Nonunion was seen in five fractures. Functional evaluation using Katenjian''s criteria, showed 62.85% (44 fractures of 70) good to excellent results.Conclusion:
Satisfactory results may be obtained in Gustilo''s Type IIIA and IIIB fractures even if fixed after the golden period, provided strict protocol such as aggressive debridement, prophylactic antibiotic coverage, early soft tissue reconstruction and timely bone grafting is followed. The primary coverage of the wound is discouraged. 相似文献76.
Benjamin D. Fox Sheila M. Smitherman Hassan Amhaz Monica I. Ruiz Emilie Rouah Majdi Radaideh Bruce L. Ehni 《Journal of clinical neuroscience》2009,16(8):1101-1105
Epidermoid cysts are slow growing benign tumors that represent < 1–2% of all intracranial tumors and rarely present as supratentorial, intraparenchymal masses. We present the first report of a supratentorial, hemorrhagic, intraparenchymal epidermoid cyst with its presentation, our operative approach, post-operative course, radiographic features, and a literature review. 相似文献
77.
Treatment of vitiligo with topical imiquimod 总被引:1,自引:0,他引:1
78.
79.
Recent literature shows an interest in the relationship between psychiatric disorders and headache. This relationship is complex
and multifaceted, with existing studies confirming high rates of comorbidity between psychiatric disorders (especially depression
and anxiety) and migraine and tension-type headache, implicating comorbid psychiatric disorders as risk factors for headache
progression and chronification, and underscoring the need for assessment and treatment of relevant disorders. A smaller amount
of literature has focused on headache that presents exclusively during and secondary to a psychiatric disturbance; this phenomenon
has been termed “headache attributed to psychiatric disorder.” We review recent developments in the relationship between psychiatric
conditions and headache, with a particular focus on headaches attributed to psychiatric disorders, and discuss needed areas
for future research. 相似文献
80.
Comorbid psychopathology has been implicated as a risk factor for the chronification and progression of migraine. Although
past research has focused principally on depression and migraine, recent research consistently has confirmed that a disproportionate
number of migraineurs suffer from one or more comorbid anxiety disorders. Moreover, this research has implicated anxiety disorders
as factors potentially associated with migraine intractability and progression; growing evidence suggests that anxiety disorders
may be even more prognostically significant than depression. This article summarizes these recent developments, considers
mechanisms underlying this comorbidity, discusses strategies for assessing and managing comorbid anxiety, and notes directions
for future clinical and empiric work. 相似文献