Volume 6, Issue 2, 1998
Review
Antibiotic prophylaxis in the surgical patient
Thadepalli Haragopal,
Mandal Ashis K.
Antimicrobial selection for prophylaxis in surgery is based on the site of surgery, likely pathogen involved in addition to the in vitro efficacy, pharmacokinetics and the cost of the drugs used. For example, prophylactic agent in cardiovascular or orthopedic and skin and soft tissue surgery must cover against Staphylococcus aureus as well as the enterobacteriaceae; cephalosporins being adequate. On the other hand, any drug used in cases of urologic surgery must be excreted by the kidney in an active state and should also be active against E. coli, a common uropathogen such as any cephalosporins or penicillin. Drugs like macrolides and tetracyclines accumulate in the prostate and are good for prostate surgery by they are not excreted well by the kidney and therefore useless for urological prophylaxis. It is important to note that even treating minor infections in a neurosurgical patient, we must use an antibiotic that cross blood-brain barrier otherwise meningitis might develop. In cases of gastrointestinal tract, surgery on the colon and appendix requires special coverage against anaerobic bacteria especially Bacteroides fragilis. On the other hand surgery on the stomach, gall-bladder and upper two thirds of small intestine, it is adequate to use drugs to cover aerobic bacteria such as E. coli. Most studies show that a single most effective antibiotic is enough and it is unnecessary to use two or more drug combinations.
Original article
Quantitative Detection of cytomegalovirus (CMV) DNA in leukocytes of patients with HIV infection by using the Digene Hybrid Capture System (DHCS)
Santopadre Paola,
Mastroianni Claudio Maria,
Folgori Filippo,
Forcina Gabriele,
Mengoni Fabio,
Corpolongo Angela,
Magno Maria M.,
Vullo Vincenzo
The aim of the present study was to evaluate the usefulness of the Digene Hybrid Capture System (DHCS) for the detection and quantitation of cytomegalovirus (CMV) DNA in 95 blood samples from 57 HIV-positive patients with low CD4+ T-cell count (<100 cells/µl). The DHCS was compared with pp65 antigenemia assay and the results were correlated with active CMV disease, anti-CMV therapy and occurrence of disease relapses. Our data suggest that the detection of CMV DNA by DHCS seems to be a rapid, sensitive and specific assay for the diagnosis of CMV disease in HIV-infected patients, showing a good correlation with pp65 antigenemia assay. Overall, the DHCS provides a quantitative and objective measure of CMV activity in leukocytes and it may also represent a useful tool for the monitoring of anti-CMV therapy.
Evaluation of in-patient stay appropriateness and of functional independence in a sample of HIV-infected subjects
Starace Fabrizio,
Minaci Federica,
Lorenzo Elvira
The evaluation of in-patient stay appropriateness and of functional independence in subjects infected with HIV has been carried out in a sample of patients admitted to an infectious diseases hospital.
The evaluation of in-patient stay appropriateness has been performed by means of the Appropriateness Evaluation Protocol, whereas functional levels have been assessed by administering the Functional Independence Measure.
In 25% of patients, the appropriateness criteria for in-patient stay were compatible with an extra-mural approach. The availability of day-hospital and of home care assistance is a crucial factor to avoid needless and expensive in-patient stay.
Comparison of amoxicillin with second and third generation cephalosporins in the treatment of acute otitis media
Orhan Cüneyt,
Ziya Mehmet,
Kiliç Ilknur,
Nevzat A.,
Ergin Hacer
The aim of the present study was to compare the efficacy and the tolerability of three different antibiotic regimens for the treatment of acute otitis media in paediatric patients. 75 children, age range 6 months-6 years, divided into three groups, were involved in the study, each group consisting of 25 randomly assigned children (Group 1, amoxicillin 40 mg/kg tid per os for 10 days; Group 2, cefuroxime axetil 30 mg/kg bid per os for 10 days; ceftriaxone 50 mg/kg single-dose i.m.). No statistically significant difference was noted in the clinical efficacy among the different groups. Although amoxicillin is the drug of choice in paediatric otitis media, single dose ceftriaxone might be considered as an interesting alternative regimen when ease of administration and cost of therapy are considered.
Case report
Acute reversible degenerative myopathy complicating Lyme disease: description of a case
Scarti Luca,
Baldoni Daniele,
Morelli Carlo,
Francini Valter,
Bisogni Beatrice,
Cecchi Luigi
Lyme’s disease is a commonly found disorder whose etiological agent is a spirochete named Borrelia burgdorferi. Its clinical presentation is usually well known, and three stages are described. However it may present symptoms which may resemble many infectious or autoimmune diseases as well. The aim of the present study is to describe a case of first stage Lyme’s disease whose main clinical picture is muscoloskeletal involvement, which may mimic dermatomyositis. Many subtle characteristics (age of onset, atypical cutaneous rash) together with the involvement of muscular masses other than scapular or pelvic ones, and the bio-humoral positivity for anti-Borrelia antibodies allowed correct diagnosis to be made. We emphasize that instrumental and invasive examinations, such as electromyography and muscular biopsy, were not diagnostic in such cases.
Cerebral hemorrhagic infarction caused by tubercular arteritis in HIV positive patient: a case report
Crapa Giuseppe Edoardo,
Lavagna Alessandro,
Di Giuli Cinzia,
Lancia Daniela,
Guiducci Antonio,
Bolis Giovan Battista,
Frongillo Renato Franco
A case of cerebral hemorrhagic infarction caused by tubercular arteritis complicating the course of a tubercular meningitis in an HIV-positive patient is described. The atypical clinical course and histopathologic findings of this rare deadly complication of specific meningeal infection are underlined.
Disulfiram-induced hepatitis
Carniato Antonella,
Fuser Rodolfo,
Vaglia Alberto
Overt disulfiram-induced hepatitis is rare; it has a high mortality rate, especially when the etiology is non suspected and when the treatment is not promptly discontinued. The Authors describe a case of disulfiram-induced acute hepatitis and emphasize close clinical and biochemical monitoring.
The Infections in the History of Medicine
The struggle against the variolous poison (Part 2)
Vannozzi Francesca
missing
Sexually transmitted diseases in the History of Medicine
Bernabeo Maria Cecilia
Classic sexually transmitted diseases (syphilis, gonorrhea, condyloma acuminatum, venereal ulcera) were known since ancient times.
Being considered as a “divine punishment” for impure intercourses, they were generally mistaken one for another (except for condylomatosis) until the different pathogenic agents were identified in the course of 19th Century.
It was only with the introduction of antibiotics that their incidence drastically fell, at least up to this last decade, as a number of factors determined their fresh outbreak.
