The American journal of medicine
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Randomized Controlled Trial Clinical Trial
Prophylaxis of urinary tract infection in persons with recent spinal cord injury: a prospective, randomized, double-blind, placebo-controlled study of trimethoprim-sulfamethoxazole.
To determine the efficacy of trimethoprim-sulfamethoxazole (TMP-SMX) for prophylaxis of urinary tract infection in persons with recent spinal cord injury, during the first 4 months of intermittent catheterization. ⋯ Prophylaxis with TMP-SMX significantly reduces bacteriuria and symptomatic urinary tract infection in persons with recent acute spinal cord injury during bladder retraining using intermittent catheterization. However, adverse reactions attributable to TMP-SMX are common in this population. Colonization and breakthrough bacteriuria with TMP-SMX-resistant organisms are frequent and may seriously limit the usefulness of this strategy, particularly in an institutional setting.
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Noninvasive monitors are finding increased use in the intensive care unit both as labor-saving tools and as a means to reduce complications associated with invasive techniques. The current technology allows for the replacement of a number of invasive devices with a noninvasive counterpart capable of providing similar information. The potential reduction in morbidity and mortality realized with a greater reliance on noninvasive monitors should result in widespread application of these modalities.
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To determine the benefits of cardiopulmonary resuscitation (CPR) in nursing home patients and assess possible prearrest and arrest predictors of survival. ⋯ We conclude that only a small percentage of nursing home patients who sustain cardiac arrest will benefit from CPR. However, greater than 25% of nursing home patients whose arrest is witnessed and who demonstrate ventricular fibrillation will survive. This is comparable to the survival rate of elderly community-dwelling persons who sustain cardiac arrest. Our data suggest that CPR should be initiated only in nursing home patients whose cardiac arrest is witnessed and should only be continued in patients whose initial documented cardiac rhythm is ventricular fibrillation or ventricular tachycardia.
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Case Reports
Acute pulmonary coccidioidomycosis mimicking bacterial pneumonia and septic shock: a report of two cases.
Two patients with acute pulmonary coccidioidomycosis presenting as acute bacterial pneumonia and sepsis are described. One patient died despite appropriate antifungal therapy, whereas the diagnosis in the other patient was only established after postmortem examination. In both cases, coccidioidomycosis had disseminated beyond the lungs. Factors leading to overwhelming coccidioidomycosis are discussed, and the relation of the sepsis syndrome to coccidioidomycosis is reviewed.