Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 5 de 5
Filtrar
1.
J Infect Dis ; 208(4): 559-63, 2013 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-23633406

RESUMO

BACKGROUND: After completion of the Shingles Prevention Study (SPS; Department of Veterans Affairs Cooperative Studies Program Number 403), SPS participants who had initially received placebo were offered investigational zoster vaccine without charge. This provided an opportunity to determine the relative safety of zoster vaccine in older adults following documented herpes zoster (HZ). METHODS: A total of 13 681 SPS placebo recipients who elected to receive zoster vaccine were followed for serious adverse events (SAE) for 28 days after vaccination. In contrast to the SPS, a prior episode of HZ was not a contraindication to receiving zoster vaccine. The SPS placebo recipients who received zoster vaccine included 420 who had developed documented HZ during the SPS. RESULTS: The mean interval between the onset of HZ and the receipt of zoster vaccine in the 420 recipients with prior HZ was 3.61 years (median interval, 3.77 years [range, 3-85 months]); the interval was <5 years for approximately 80% of recipients. The proportion of vaccinated SPS placebo recipients with prior HZ who developed ≥ 1 SAE (0.95%) was not significantly different from that of vaccinated SPS placebo recipients with no prior history of HZ (0.66%), and the distribution of SAEs in the 2 groups was comparable. CONCLUSIONS: These results demonstrate that the general safety of zoster vaccine in older persons is not altered by a recent history of documented HZ, supporting the safety aspect of the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices recommendation to administer zoster vaccine to all persons ≥ 60 years of age with no contraindications, regardless of a prior history of HZ.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Vacina contra Herpes Zoster/administração & dosagem , Vacina contra Herpes Zoster/efeitos adversos , Herpes Zoster/imunologia , Idoso , Idoso de 80 Anos ou mais , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
2.
BMJ Case Rep ; 15(4)2022 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-35414576

RESUMO

We describe a case of a man in his 70s who presented with tachycardia and several weeks of right lower quadrant pain 3 months after partial right hepatectomy for hepatocellular carcinoma. Initial laboratory findings were significant for elevated C reactive protein and normal white cell count. CT revealed right pleural effusion and 5.8 cm fluid collection with air pocket adjacent to the surgical margin of the partial hepatectomy. Aspirate of the fluid collection grew Cutibacterium acnes Following percutaneous drainage and a short course of antibiotics, the patient recovered with eventual radiologic and symptomatic improvement. This, to the best of our knowledge, is one of two cases where C. acnes was involved in a possible delayed presentation of a surgical site infection after hepatic surgery.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Abscesso/cirurgia , Carcinoma Hepatocelular/cirurgia , Hepatectomia/efeitos adversos , Humanos , Neoplasias Hepáticas/cirurgia , Masculino , Propionibacterium acnes
3.
AIDS Read ; 17(11): 555-60, 2007 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-18170919

RESUMO

We present the case of a 55-year-old-man with AIDS who had disseminated Mycobacterium avium-intracellulare (MAI) infection who was nonadherent to antiretroviral treatment and prophylaxis for opportunistic infections. The patient acquired HIV via intravenous drug sue; he had a CD4+ cell count of 4/microL (1%) and an HIV RNA level of 114,000 copies/mL at the time of his HIV diagnosis. He presented with MAI bacteremia and had rapidly evolving and resolving cutaneous lesions caused by MAI. Concomitant nonspecific brain lesions presented a diagnostic challenge, but they improved with MAI treatment. In persons with HIV/AIDS who have cutaneous lesions, biopsy of superficial lesions has proved helpful. MAI infection should be considered in the differential diagnosis of cutaneous and brain lesions in persons with HIV/AIDS.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/transmissão , Doenças do Sistema Nervoso Central/etiologia , Infecções por HIV/complicações , Infecção por Mycobacterium avium-intracellulare/transmissão , RNA Viral/sangue , Úlcera Cutânea/etiologia , Infecções Oportunistas Relacionadas com a AIDS/líquido cefalorraquidiano , Antirretrovirais/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Complexo Mycobacterium avium/patogenicidade , Infecção por Mycobacterium avium-intracellulare/líquido cefalorraquidiano , Úlcera Cutânea/patologia
5.
Acad Med ; 91(5): 669-72, 2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-26839944

RESUMO

In this article, the authors reexamine the Ambulatory Diagnostic and Treatment Center (ADTC) model, which uniquely combines the education of trainees with the care of referred patients at one Veterans Affairs medical center. As an ambulatory clinic with an inpatient mind-set, the ADTC uses a series of closely spaced outpatient appointments that are longer than typical ambulatory visits, offering a VIP-level of evaluation with the patient-centered goal of expedited diagnosis and treatment. Faculty triage patients by weighing factors such as urgency, educational value, complexity, and instability of diseases in conjunction with the resources, availability, and appropriateness of other services within the medical center.The ADTC's unique focus on the education of trainees in comparison with other clinical rotations is evident in the ratio of learning to patient care. This intensive training environment expects postgraduate year 2 and 3 internal medicine residents and fourth-year medical students to read, reflect, and review literature daily. This mix of education and care delivery is ripe for reexploration in light of recent calls for curriculum reform amidst headlines exposing delays in veterans' access to care.A low-volume, high-intensity clinic like the ADTC can augment the clinical services provided by a busy primary care and subspecialty workforce without losing its emphasis on education. Other academic health centers can learn from this model and adapt its structure in settings where accountable care organizations and education meet.


Assuntos
Assistência Ambulatorial/organização & administração , Educação de Pós-Graduação em Medicina/métodos , Educação de Graduação em Medicina/métodos , Hospitais de Veteranos/organização & administração , Modelos Educacionais , Modelos Organizacionais , Ambulatório Hospitalar/organização & administração , Boston , Competência Clínica , Continuidade da Assistência ao Paciente , Humanos , Qualidade da Assistência à Saúde , Encaminhamento e Consulta
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA