The American journal of medicine
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Continuing problems of antimicrobial resistance have prompted the initiation of several surveillance programs. Few, if any, of these programs focus on community-acquired respiratory tract infections seen in routine office-based practices. The Respiratory Surveillance Program (RESP; 1999-2000) in 674 community-based physician office practices in the United States determined the frequency of potential bacterial pathogens including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in patients diagnosed clinically with community-acquired pneumonia, acute exacerbations of chronic bronchitis, and sinusitis throughout all 9 US census/geographic regions. ⋯ Although the susceptibility of H influenzae and M catarrhalis to the tested antimicrobials did not vary with the type of infection, beta-lactamase-mediated resistance to ampicillin among H influenzae ranged from 15% in New England to 32% in the East South Central region. The fluoroquinolones were highly active against these cultured isolates from community-acquired respiratory tract infection patients, with >99% of all S pneumoniae, H influenzae, and M catarrhalis strains susceptible to gatifloxacin (MIC(90), 0.5 microg/mL) and levofloxacin (MIC(90), 2 microg/mL). The extended-spectrum fluoroquinolones appear well suited for community-acquired respiratory tract infection therapy, including pathogens other than pneumococcus, H influenzae, and M catarrhalis.
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To evaluate the prevalence of typical pathogens, level of resistance, and risk factors associated with community-acquired pneumonia (CAP) in the outpatient primary care setting and define current antibiotic treatment for office-based CAP, the Respiratory Surveillance Program (RESP) recruited 1,200 primary care clinics during the 1999-2000 respiratory infection season. Participating community-based physicians submitted sputum samples from patients presenting with a community-acquired respiratory infection including community-acquired pneumonia (CAP). All patients were aged > or =18 years. ⋯ All S pneumoniae isolates were sensitive to gatifloxacin, vancomycin, and levofloxacin. Other less common organisms isolated were staphylococci, streptococci, Enterobacteriaceae, Pseudomonas spp, and Acinetobacter spp. The choice of antibiotic to treat outpatient CAP varies from practice to practice and does not appear to be influenced by the patient's age, the patient's history of smoking, or comorbidity.
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Gastroesophageal reflux (GER) has been associated with a number of interstitial lung diseases, including systemic sclerosis and idiopathic pulmonary fibrosis. Systemic sclerosis results in both pulmonary and esophageal manifestations, and studies have shown a correlation, but no causal relation, between GER and pulmonary fibrosis in this condition. ⋯ Aggressive, long-term therapy of GER and evaluation of its effect on pulmonary disease will allow determination of the real influence of GER on idiopathic pulmonary fibrosis. Additional outcomes-based studies and therapeutic trials are needed to clarify the association between GER and interstitial lung diseases.
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Several reflexes are initiated in the fetus and newborn when hypochloremic or strongly acidic solutions contact the epithelium that surrounds the entrance to the laryngeal airway. These reflexes, known collectively as the laryngeal chemoreflex (LCR), include startle, rapid swallowing, apnea, laryngeal constriction, hypertension, and bradycardia. Many studies have shown that prolonged apnea associated with the LCR may be life threatening and might conceivably be a cause of sudden infant death syndrome. ⋯ The LCR develops in the fetus, in an all-aqueous environment, during a period in which aspiration of amniotic fluid poses a serious threat to life. This and other considerations suggest that the transformation in LCR responses from fetal to adult life can be viewed as functionally appropriate to their primary role in defending the airway from aspiration. The laryngeal "water receptors" that initiate the LCR in infants and adults alike appear to be the primary sensory mechanism for defending the airway from aspiration of liquids.
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Meta Analysis
The effect of interventions to prevent cardiovascular disease in patients with type 2 diabetes mellitus.
Cardiovascular complications account for over 50% of mortality among patients with type 2 diabetes mellitus. We quantify the cardiovascular benefit of lowering cholesterol, blood pressure, and glucose levels in these patients. ⋯ The evidence from these clinical trials demonstrates that lipid and blood pressure lowering in patients with type 2 diabetes is associated with substantial cardiovascular benefits. Intensive glucose lowering is essential for the prevention of microvascular disease, but improvements in cholesterol and blood pressure levels are central to reducing cardiovascular disease in these patients.