Internal medicine journal
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Internal medicine journal · Dec 2005
ReviewEpidemiology, clinical features and management of infections due to community methicillin-resistant Staphylococcus aureus (cMRSA).
Methicillin-resistant Staphylococcus aureus (MRSA) was initially confined to hospitals, but in the late 1970s appeared in the community in the USA, primarily among intravenous drug users. In the 1990s, community MRSA (cMRSA) strains appeared in multiple areas of the world, and spread extensively. Initially, there were problems with the definition of 'community-acquired', which was exacerbated by the fact that if a time-based definition was used without stratification for risk factors, patients with healthcare-associated MRSA would be counted. ⋯ While cMRSA strains are usually susceptible to most non-beta-lactam antimicrobials, there is a lack of clinical trial data indicating which drugs have superior clinical efficacy. DNA fingerprinting methods have become more sophisticated over the last decade, and have determined that cMRSA strains have probably arisen from virulent methicillin-susceptible strains, most likely by horizontal transfer of methicillin-resistance genes from coagulase negative staphylococci to S. aureus on a limited number of occasions, and these clones have spread extensively throughout the world by person-to-person transmission. In Australia, the dominant cMRSA clones are the Western Australia, Oceania and Queensland strains.
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Internal medicine journal · Dec 2005
ReviewRecognition and management of Staphylococcus aureus toxin-mediated disease.
The ubiquitous human pathogen Staphylococcus aureus is capable of producing a formidable range of extracellular toxins that can have significant deleterious effects on the host. Toxic shock syndrome (TSS) results from infection or colonization with a strain of S. aureus that produces staphylococcal enterotoxin(s). The key features of TSS are widespread erythroderma occurring in association with profound hypotension and multiple organ dysfunction. ⋯ Staphylococcal scalded skin syndrome (SSSS) results from colonization or infection with a strain of S. aureus that produces epidermolytic toxin(s). SSSS ranges in severity from trivial focal skin blistering to extensive, life-threatening exfoliation. This review discusses the epidemiology, pathogenesis, diagnosis, and management of TSS, SFD and SSSS.
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Internal medicine journal · Nov 2005
Why do acute myocardial infarction patients not call an ambulance? An interview with patients presenting to hospital with acute myocardial infarction symptoms.
Studies from overseas indicate that patients with acute myocardial infarction (AMI) symptoms often fail to use the emergency services as recommended, thereby depriving themselves from life-saving treatment in case of cardiac arrest and delaying the time to myocardial reperfusion in the presence of a coronary occlusion. ⋯ A large proportion of patients with AMI symptoms refrain from calling the emergency services because they do not consider themselves critically ill. Education programmes appear to be warranted because more appropriate use of emergency services will save lives.
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Internal medicine journal · Oct 2005
ReviewCautionary tales in the clinical interpretation of therapeutic trial reports.
Practising clinicians are assailed daily with reports of new therapeutic clinical trials. The evidence-based medicine movement has developed critical appraisal methods for assessing the validity and impact of such studies. However, challenges persist in regards to the appropriate interpretation and application of trial results within everyday clinical settings. Using selected examples from recently published literature, we illustrate 15 cautionary themes for translating research evidence from therapeutic trials into clinical practice.