Infectious disease clinics of North America
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Viruses that affect the cornea produce changes that range from benign, self-limited conjunctivitis to sight-threatening scarring and vascularization of the cornea. In this article, the forms of viral keratitis most commonly encountered by the clinician are reviewed. The epidemiology, clinical presentation, and treatment of infection by Herpes simplex virus, varicella zoster virus, and the adenoviruses are discussed. Also included are other viral infections of the cornea.
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The febrile returning traveler tests a clinician's knowledge of tropical medicine as well as skills in differential diagnosis. A thorough history with special emphasis placed on the patient's travel itinerary and knowledge of the geographic location and incubation times of certain tropical diseases will narrow the diagnostic possibilities. This will allow the clinician to focus the diagnostic work-up and make wise choices of laboratory tests and procedures.
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Although antibiotic therapy is the mainstay of therapy for gram-negative bacillary bacteremia, the amelioration of the underlying conditions, the correction of predisposing factors, the drainage of abscesses, the removal of infected foreign bodies, and adequate supportive care are also of paramount importance for curing the infection and should not be neglected. Beginning in the late 1960s, most of the clinical work on gram-negative infections has focused on the evaluation of new antibiotics. Numerous studies have shown that early, appropriate antibiotic treatment of gram-negative bacteremia significantly improved patients' outcomes and prevented the development of septic shock. ⋯ This literature should however be reviewed with great caution. Indeed, only a minority of studies have included a sufficient number of patients to confidently assess the impact of therapy on patients' outcomes. Obviously, small studies can have a significant risk of type II errors, that is, making false-negative conclusions.(ABSTRACT TRUNCATED AT 400 WORDS)
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Infect. Dis. Clin. North Am. · Dec 1991
ReviewSepsis syndrome. New insights into its pathogenesis and treatment.
Recent insights into the pathogenesis of sepsis and its sequelae have opened up new approaches to treatment. For maximum effectiveness, however, treatment must be given as early as possible in the course of illness--but only to patients who are at high risk of developing shock. The definition of sepsis syndrome outlined in this article provides a method by which to identify such patients before the onset of shock.
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Infect. Dis. Clin. North Am. · Jun 1991
ReviewPublic and private donor financing for health in developing countries.
Among the many variables that influence the outcome of national health status in both developed and developing countries, the availability and efficiency of financing is critical. For 148 developing countries, annual public and private expenditures from domestic sources (1983) were estimated to be approximately $100 billion. For the United States alone, annual public and private costs for medical care are almost five times larger ($478 billion, 1988). ⋯ In perspective, the supply of financing for health greatly exceeds the receipt of well-articulated and officially approved proposals from developing countries. The major constraints that produce this imbalance are unfamiliarity of ministries of health with potential donor sources; passive approaches to external financing; unfamiliarity with proposal preparation; increasing competition within developing countries by competing sectors, such as industry and agriculture; limited numbers of trained personnel; and absence of an international system which is able to support developing countries in mobilizing external financing. Tested solutions to these issues have been applied in one geographic region.(ABSTRACT TRUNCATED AT 400 WORDS)