RESUMO
To eradicate rabies in foxes, almost 97 million oral rabies vaccine baits have been distributed in Germany and Austria since 1983 and 1986, respectively. Since 2007, no terrestrial cases have been reported in either country. The most widely used oral rabies vaccine viruses in these countries were SAD (Street Alabama Dufferin) strains, e.g. SAD B19 (53.2%) and SAD P5/88 (44.5%). In this paper, we describe six possible vaccine-virus-associated rabies cases in red foxes (Vulpes vulpes) detected during post-vaccination surveillance from 2001 to 2006, involving two different vaccines and different batches. Compared to prototypic vaccine strains, full-genome sequencing revealed between 1 and 5 single nucleotide alterations in the L gene in 5 of 6 SAD isolates, resulting in up to two amino acid substitutions. However, experimental infection of juvenile foxes showed that those mutations had no influence on pathogenicity. The cases described here, coming from geographically widely separated regions, do not represent a spatial cluster. More importantly, enhanced surveillance showed that the vaccine viruses involved did not become established in the red fox population. It seems that the number of reported vaccine virus-associated rabies cases is determined predominantly by the intensity of surveillance after the oral rabies vaccination campaign and not by the selection of strains.
Assuntos
Raposas/virologia , Vacina Antirrábica/uso terapêutico , Raiva/imunologia , Ração Animal , Animais , Áustria/epidemiologia , Sequência de Bases , Primers do DNA , Genes Virais , Genoma Viral , Alemanha/epidemiologia , Reação em Cadeia da Polimerase , RNA Viral/genética , Raiva/epidemiologia , Raiva/patologia , Vacina Antirrábica/efeitos adversos , Vacinas Atenuadas/uso terapêuticoRESUMO
Several different strains of classical rabies virus co-circulate in Europe. In order to investigate the roles of the host species and topography on the molecular epidemiology of these viruses, a 400 bp region of the nucleoprotein gene was sequenced and compared with more than 500 European virus isolates. Viruses from 21 European countries were represented including some unique panels of archived isolates from the former Republic of Yugoslavia, Estonia, the Czech Republic, Poland and Austria. Phylogenetic analysis of 198 unique sequences demonstrated numerous groups of viruses clustered at both geographical and host-species levels.
Assuntos
Proteínas do Nucleocapsídeo/genética , Filogenia , Vírus da Raiva/genética , Raiva/epidemiologia , Raiva/genética , Animais , Europa (Continente) , Humanos , Epidemiologia Molecular , Especificidade da EspécieRESUMO
Marketing is an important component of continuing medical education (CME). However, marketing is more than the identification of methods to recover costs of delivering programming. It focuses on meeting the needs and desires of physician participants, identifying an appropriate location, satisfying the goals of a sponsoring institution, and making an effect on the quality of care given by receivers and deliverers of CME. This paper discusses these issues as well as describes results of a survey designed to gather opinions on CME activities from alumni of training programs of a large, referral-based, multispecialty group practice. The data suggest that CME programs should be targeted to certain specialty groups as determined by field of training rather than practice specialty. Physicians' preferences for CME activities held at resort settings should be considered. Finally, participation in CME may itself be a marketing tool for a sponsoring institution to increase referrals.
Assuntos
Comportamento do Consumidor/estatística & dados numéricos , Educação Médica Continuada/organização & administração , Educação Médica , Marketing de Serviços de Saúde , Especialização , Hospitais com 100 a 299 Leitos , Ohio , Área de Atuação Profissional , Encaminhamento e Consulta , Inquéritos e Questionários , Estados UnidosRESUMO
The graduate of a medical training program is in a unique position to evaluate that program in comparison with the realities of medical practice. A survey of alumni of the Cleveland Clinic's graduate training programs was conducted in September 1986. The alumni's perceptions of the quality of their programs and the educational services provided by the Division of Education are discussed in relation to the educational administrative structure and evaluation process at The Cleveland Clinic Foundation. The need for such evaluation methods, as well as additional techniques to provide a comprehensive evaluation system in graduate medical education, is emphasized.
Assuntos
Educação de Pós-Graduação em Medicina , Atitude do Pessoal de Saúde , Estudos de Avaliação como Assunto , Humanos , Ohio , Inquéritos e QuestionáriosRESUMO
Granulomatous lesions of the skin and tendon sheaths after exposure to fish tank or aquarium water are frequently caused by non-tuberculous so-called atypical mycobacteria. Mycobacterium marinum is the species most often isolated from such lesions. Rarely, other non-tuberculous species of mycobacteria may be isolated. In contrast to swimming-pool granuloma as the epidemic form of Mycobacterium marinum infection of man, fish tank granuloma seems to be a rare sporadic human disease that is often misdiagnosed. We report eight cases of fish tank granuloma. Five patients had sporotrichoid lesions, and one patient had a singular lesion. Three patients presented with tenosynovitis. Culture-proven Mycobacterium marinum infection was found in four patients, in one patient the causative organism isolated from the biopsy specimen was identified as Mycobacterium kansasii. In three patients with typical appearance of the lesions and exposure to fish tank water, biopsy specimens for culture were not available, and the diagnosis was histopathologically confirmed. Surgical treatment had an unfavourable outcome in two of three patients. Conservative antimicrobial therapy was evaluated in six patients. Similar to published reports, the treatment with rifampicin in combination with other agents seemed to be a useful therapy. Complete remission was, however, also achieved with doxycycline monotherapy. Microbiological diagnosis should be attempted in suspected cases of fish tank granuloma, and, if therapy is indicated, we strongly suggest primary medical treatment.
Assuntos
Dermatite Ocupacional/microbiologia , Peixes/microbiologia , Infecções por Mycobacterium não Tuberculosas/microbiologia , Infecções por Mycobacterium/microbiologia , Dermatopatias Infecciosas/microbiologia , Adulto , Animais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Micobactérias não Tuberculosas/isolamento & purificação , Sinovite/microbiologiaRESUMO
Research has shown that characteristic attitudes can be attributed to certain medical specialties and can affect specialty selection. The purpose of this study was to develop an attitude scale that would discriminate between family practice and other physician groups on current health care issues. From a sample of 490 randomly selected physicians, 40 percent (N = 193) responded to the study instrument, a 44-item, five-point Likert scale in which physicians were asked their level of agreement on various statements. One-way analyses of variance were performed on responses to each item by family centered nature of practice and specialty. Ten statements were found to significantly differentiate physicians who were family centered from physicians who were not family centered. Statements showed that family centered practitioners were confident in their competence and in their role as an essential medical practitioner. They also expressed more awareness of a patient's response and total well-being. Responses also suggest that there is acknowledgement of supposed family medicine issues by all physicians.
Assuntos
Atitude do Pessoal de Saúde , Medicina de Família e Comunidade/tendências , Médicos de Família/psicologia , Saúde da Família , Inventário de Personalidade , Relações Médico-PacienteRESUMO
Twelve National Reference Laboratories (NRLs) for rabies have undertaken a comparative assay to assess the comparison of fluorescent antibody test (FAT) results using five coded commercial anti-rabies conjugates (Biorad, Bioveta, Fujirebio, Millipore, and SIFIN conjugates). Homogenized positive brain tissues infected with various lyssavirus species as well as negative samples were analyzed blindly using a standardized FAT procedure. Conjugates B, C, D, and E were found to be significantly more effective than conjugate A for GS7 (French RABV) diluted samples (1/8 and 1/100) while the frequency of concordant results of conjugates C and D differ significantly from conjugates A, B and E for CVS 27. For detection of EBLV-1 strains, conjugates C and D also presented a significantly lower frequency of discordant results compared to conjugates A, B and E. Conjugates B, C and D were found to be significantly more effective than conjugates E and A for EBLV-2 and ABLV samples. In view of these results, conjugates C and D set themselves apart from the others and appeared as the most effective of this 5-panel conjugates. This study clearly demonstrates that the variability of conjugates used by National Reference Laboratories can potentially lead to discordant results and influence assay sensitivity. In case of false negative results this could have a dramatic impact if the animal under investigation is responsible for human exposure. To avoid such situations, confirmatory tests should be implemented.
Assuntos
Antígenos Virais , Imunofluorescência/métodos , Imunofluorescência/normas , Raiva/diagnóstico , Animais , Humanos , Cooperação InternacionalAssuntos
Anticorpos Antibacterianos/análise , Coxiella/imunologia , Febre Q/epidemiologia , Animais , Bovinos , Humanos , Quênia , Febre Q/imunologiaAssuntos
Atenção à Saúde , Assistência Odontológica , Educação em Odontologia , Necessidades e Demandas de Serviços de Saúde , Pesquisa sobre Serviços de Saúde , Idoso , Assistência Odontológica para a Pessoa com Deficiência , Acessibilidade aos Serviços de Saúde , Serviços de Saúde para Idosos , Serviços de Assistência Domiciliar , Humanos , Institucionalização , Indigência MédicaAssuntos
Odontólogos , Prótese Total , Adulto , Idoso , Prótese Total/economia , Honorários Odontológicos , Odontologia Geral , Humanos , Indiana , Pessoa de Meia-Idade , Prática ProfissionalRESUMO
The persistance of human bacterial infections is influenced by different factors and varies in duration. Besides genetical defects of the immune system the persistance of bacteria may also be enfavored by underlying diseases also. Regarding the duration of the persistance the long or even life long lasting infections are of special clinical, epidemiological and public health interest. The topic deals with present problems only, the tuberculosis is excluded and discussed in another presentation.
Assuntos
Infecções Bacterianas/fisiopatologia , Saúde Pública , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/transmissão , Doença Crônica , Reservatórios de Doenças , HumanosRESUMO
Two cases of bacteremic infection due to aerococci in granulocytopenic patients with acute leukemia and oral mucositis are described. Strains isolated from blood cultures of both patients were resistant to the antibiotics given orally for prophylaxis. One patient died in septic shock; surveillance cultures from oral washings in the other repeatedly showed high concentrations of aerococci. Aerococci were also isolated from surveillance cultures taken from 5 of 17 other patients with acute leukemia; however, their viable counts were lower than in the surviving patient.
Assuntos
Agranulocitose/complicações , Sepse/etiologia , Streptococcaceae/isolamento & purificação , Adulto , Resistência Microbiana a Medicamentos , Feminino , Humanos , Leucemia Linfoide/complicações , Leucemia Mieloide Aguda/complicações , Mucosa Bucal , Estudos Retrospectivos , Sepse/microbiologia , Estomatite/complicações , Streptococcaceae/efeitos dos fármacosRESUMO
Resin-containing aerobic and anaerobic blood culture media (NR 16A and NR 17A) for use with the new BACTEC infrared blood cultures system were compared with standard BACTEC media (NR 6A and NR 7A) in their efficacy to detect bacteremia in febrile granulocytopenic patients receiving antimicrobial treatment. A total of 1185 sets of blood cultures obtained from 341 patients during a 12-month period were evaluated. There were 109 positive cultures (9.2%) with 128 pathogenic organisms isolated from 52 patients (15.2%). Statistically significant differences were found between aerobic media, but not between anaerobic media. Aerobic resin bottles (NR 16A) were more often positive (90 versus 78, p less than 0.05) than standard aerobic bottles (NR 6A). They yielded a higher number of microorganismS (98 versus 80, p less than 0.05) per culture and per culture-positive patient (53 versus 42, p less than 0.01). NR 16A cultures also were more often positive after 1-day incubation (44% versus 21%, p less than 0.01) than NR 6A cultures and allowed earlier subcultivation. The use of NR 16A medium instead of resin-free aerobic NR 6A medium may enhance the detection of bacteremia in selected groups of patients receiving antimicrobial treatment, and can shorten the time until detection of bacteremia.
Assuntos
Agranulocitose/complicações , Resinas Vegetais , Sepse/diagnóstico , Meios de Cultura , Humanos , Valor Preditivo dos Testes , Sepse/complicações , Sepse/microbiologiaRESUMO
Twenty-nine adult patients with acute myelogenous leukemia AML who received 40 treatment courses with high dose cytosine arabinoside (HD-A), alone or combined with other cytotoxic drugs, for remission induction (RI) or postremission intensive consolidation (IC) were retrospectively analysed for types and severity of infectious complications. In this paper, we report the unusually high rate of streptococcal septicemia in our patients. Of 13 bacteremic infections in a total of 45 infectious episodes, 10 were caused by streptococci (9 viridans streptococci, 1 group B hemolytic streptococcus). Three of them were lethal. After reviewing all documented cases of streptococcal septicemia in the same study period, four additional cases among adult patients with AML were identified. Three of them have had antileukemic chemotherapy without HD-A, while one have had HD-A as a conditioning regimen for bone marrow transplantation. Only three cases were documented to occur in adult patients with AML. Patients treated with HD-A for RI or IC had a significantly lower risk of streptococcal septicemia during previous chemotherapy-associated febrile neutropenic episodes (1/55 vs 10/45; P = 0.01). Neither prophylactic regimens including trimethoprim-sulfamethoxazole nor those without it were effective in preventing streptococcal septicemia. Further studies are needed to confirm these data before the value of additional or alternative prophylactic antibiotics is proven necessary.