The American journal of medicine
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Spinal cord injury (SCI) produces profound alterations in lower urinary tract function. Incontinence, elevated intravesical pressure, reflux, stones, and neurological obstruction, commonly found in the spinal cord-injured population, increase the risk of urinary infection. The overall rate of urinary infection in SCI patient is about 2.5 episodes per patient per year. ⋯ SCI patients with symptomatic urinary infections should be treated with the most specific, narrowest spectrum antibiotics available for the shortest possible time. Guidelines for selecting antimicrobial agents in SCI patients are similar to guidelines for the treatment of complicated urinary infections in the general population. Characteristics of the quinolones make them well suited to treating UTI in the SCI patient.
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Results of various epidemiologic studies suggest that bacteriuria and urinary tract infection (UTI) occur more commonly in women with diabetes than in women without this disease. Similar findings have been demonstrated for asymptomatic bacteriuria (ASB), with ASB being a risk factor for pyelonephritis and subsequent decline in renal function. Although ASB is not associated with serious health outcomes in healthy patients, further research needs to be undertaken regarding the impact of ASB in patients with diabetes. ⋯ For seriously ill patients, including patients infected with Pseudomonas spp., such agents as imipenem, ticarcillin-clavulanate, and piperacillin-tazobactam may also be considered. Treatment of ASB in patients with diabetes is often recommended to prevent the risk of symptomatic UTI. However, the management of ASB in patients with diabetes is complex, with no single preferred approach.
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Although inhaled corticosteroids are commonly used to treat patients with chronic obstructive pulmonary disease (COPD), their effect on clinical outcomes such as exacerbation and mortality is unknown. This systematic review was conducted to determine whether inhaled corticosteroids improve clinical outcomes for patients with stable COPD. All placebo-controlled randomized trials of inhaled corticosteroids given for at least 6 months for stable COPD were identified by searching MEDLINE (1966-2000), EMBASE (1980-2001), CINAHL (1982-2000), SIGLE (1980-2000), the Cochrane Controlled Trial Registry, and the bibliographies of published studies. ⋯ No effects were seen on all-cause mortality (RR = 0.84; 95% CI: 0.60 to 1.18) in the five trials that measured this outcome. This systematic review demonstrates a beneficial effect of inhaled corticosteroids in reducing rates of COPD exacerbation. Further research is required to define the long-term effects of these medications and the benefit/risk ratio for patients with COPD.
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Patients with chronic obstructive pulmonary disease (COPD) and elderly individuals are prone to the development of significant lower respiratory tract symptoms from colds caused by viral respiratory pathogens. Longitudinal surveillance studies conducted to assess the impact of viral respiratory tract pathogens on morbidity and mortality in each of these at-risk populations demonstrate that there is a substantial burden of disease from viral respiratory infection (VRI), including rhinovirus infections, with respect to utilization of health-care resources. Despite a similar rate of occurrence of VRI among subjects with COPD and the control group, a cohort with moderate to severe COPD had a 2-fold increase in medical resource utilization, including clinician visits, emergency center visits, and hospitalizations. In surveillance studies of respiratory viruses in the elderly, regular seasonal infections with rhinoviruses cause substantial morbidity, which has been largely underappreciated and underreported.
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Acute respiratory tract infections are the most common illnesses in all individuals, regardless of age or gender. Epidemiologic surveys and community-based studies conducted since the beginning of the 20th century have determined the rates of illness and the pathogens involved in such infections. These studies have shown that rhinoviruses cause the great majority of these respiratory illnesses, and their findings have examined the means of transmission of respiratory illness. More recently, advances in diagnostic techniques have enabled more complete identification of the viruses involved in respiratory infections, which has aided in the ability to direct specific therapeutic agents at the causative pathogens.