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The British Journal of General Practice... Sep 2011Acute infective conjunctivitis is a common problem in primary care, traditionally managed with topical antibiotics. A number of clinical trials have questioned the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Acute infective conjunctivitis is a common problem in primary care, traditionally managed with topical antibiotics. A number of clinical trials have questioned the benefit of topical antibiotics for patients with acute infective conjunctivitis.
AIM
To determine the benefit of antibiotics for the treatment of acute infective conjunctivitis in primary care and which subgroups benefit most.
DESIGN
An individual patient data meta-analysis.
METHOD
Relevant trials were identified and individual patient data gathered for meta-analysis and subgroup analysis.
RESULTS
Three eligible trials were identified. Individual patient data were available from all primary care trials and data were available for analysis in 622 patients. Eighty per cent (246/308) of patients who received antibiotics and 74% (233/314) of controls were cured at day 7. There was a significant benefit of antibiotics versus control for cure at seven days in all cases combined (risk difference 0.08, 95% confidence interval (CI) = 0.01 to 0.14). Subgroups that showed a significant benefit from antibiotics were patients with purulent discharge (risk difference 0.09, 95% CI = 0.01 to 0.17) and patients with mild severity of red eye (risk difference 0.10, 95% CI = 0.02 to 0.18), while the type of control used (placebo drops versus nothing) showed a statistically significant interaction (P=0.03).
CONCLUSION
Acute conjunctivitis seen in primary care can be thought of as a self-limiting condition, with most patients getting better regardless of antibiotic therapy. Patients with purulent discharge or a mild severity of red eye may have a small benefit from antibiotics. Prescribing practices need to be updated, taking into account these results.
Topics: Acute Disease; Anti-Bacterial Agents; Conjunctivitis, Bacterial; General Practice; Humans; Numbers Needed To Treat; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 22152728
DOI: 10.3399/bjgp11X593811 -
Annals of Medicine and Surgery (2012) Aug 2021Cardiac implantable electronic devices (CIEDs), including implantable cardiac defibrillators, pacemakers, and cardiac resynchronization therapy devices, are lifesaving....
BACKGROUND
Cardiac implantable electronic devices (CIEDs), including implantable cardiac defibrillators, pacemakers, and cardiac resynchronization therapy devices, are lifesaving. However, device infections can lead to morbidity and mortality. of this study was to describe the outcome of CIED infections treated at our center, and to identify risk factors for infection in patients with CIEDs. : Single-center study, Prince Sultan Military Medical City, Riyadh, KSA.
METHODS
This case series included all -related CIED infections treated at a tertiary care center between 2009 and 2020. Data on patient demographics, clinical manifestations, predisposing factors, microbiology, treatment regimens, and outcomes were reviewed.
RESULTS
Fifteen patients met the CIED infection criteria. The mean age was 62.2 years, and 80% were males. Common comorbidities included hypertension (73%), diabetes mellitus (67%), ischemic heart disease (47%), and chronic kidney disease (60%). The mean time to infection following the device implantation was 4.8 years (range: 5 months to 13 years). Fever was detected in 53% of patients, device site swelling in 47%, purulent discharge in 33%, and pain in 27%. The blood culture and serology results were positive in 73% and 80% of patients, respectively. All patients were treated with antibiotics, and the infected device was removed. Seven (46.6%) patients underwent reimplantation with a new device. One patient with dual and methicillin-sensitive infection died, and the other 14 patients recovered, with no recurrent infections reported to date.
CONCLUSION
should be considered in CIED infections, particularly in endemic areas. Proper treatment and device removal are essential for good outcomes.
PubMed: 34367635
DOI: 10.1016/j.amsu.2021.102568 -
Medscape Journal of Medicine Apr 2008Rhinosinusitis (RS) is an inflammatory condition of the contiguous nasal and paranasal sinuses that is accompanied by a viral or bacterial infection. Controlling the... (Meta-Analysis)
Meta-Analysis Review
CONTEXT
Rhinosinusitis (RS) is an inflammatory condition of the contiguous nasal and paranasal sinuses that is accompanied by a viral or bacterial infection. Controlling the inflammation will attenuate many of the symptoms of RS, including nasal blockage discharge, facial discomfort, headache, and hyposmia, and promote the clearance of the infectious agent.
OBJECTIVE
The objective is to review the efficacy of symptomatic treatment with intranasal corticosteroids (INS) for the inflammatory component of acute, recurrent, or chronic RS in adults and children.
DATA SOURCES
Published English-language articles identified in the PubMed and MEDLINE databases.
STUDY SELECTION
Only studies about clinical trials that were randomized, double-blind, and controlled for either placebo or active comparator were selected as valid evidence of the efficacy and tolerability of symptomatic treatment. Studies of INS use as monotherapy or adjunctive therapy with an antibiotic were consulted.
DATA EXTRACTION
Data from clinical studies included size of patient population, efficacy endpoints, systemic and topical adverse events, and criteria for confirming a diagnosis of RS.
DATA SYNTHESIS
Data showed that INS improved many of the symptoms of RS, including nasal blockage and purulence, facial discomfort, and headache. Significant improvement compared with placebo was demonstrated in most studies in adults and children with acute RS and in adults with recurrent or chronic RS, whether INS were used as monotherapy or adjunctive treatment. INS were shown to be well tolerated in all of these studies.
CONCLUSION
INS reduce local inflammation and improve drainage, effects that are critical to the resolution of acute RS.
Topics: Administration, Intranasal; Adrenal Cortex Hormones; Adult; Age Distribution; Anti-Inflammatory Agents; Child; Clinical Trials as Topic; Comorbidity; Drug Delivery Systems; Humans; Rhinitis; Risk Assessment; Risk Factors; Sinusitis; Treatment Outcome
PubMed: 18504478
DOI: No ID Found -
International Journal of Burns and... 2021Prosthetic joint infection (PJI) is a devastating complication in total knee arthroplasty (TKA) surgeries and prompt diagnosis and treatment are vital; however, no study...
BACKGROUND
Prosthetic joint infection (PJI) is a devastating complication in total knee arthroplasty (TKA) surgeries and prompt diagnosis and treatment are vital; however, no study has been conducted to determine the relationship between characteristics and duration of surgical site discharge and PJI.
METHODS
This is a longitudinal observational study that was performed at Al-Zahra and Kashani and Sadi university hospitals from 2017 until 2019. A total of 961 elective TKA were performed on 850 consecutive patients. Patients were followed up for two years after surgery. Data regarding the occurrence of discharges, types of discharges, duration of discharges, the incidence of PJI and superficial infections were collected.
RESULTS
The rate of superficial and prosthetic joint infection was 0.3% and 0.3%. Patients with infections (either PJI or superficial) had a longer duration of discharge (14.6 days and 13.3 days in PJI and superficial infections respectively, compared to 7.7 days in all of the study population); Bloody-purulent discharge was associated with the development of prosthetic and superficial infections.
CONCLUSION
Bloody purulent discharge reaching seven days postsurgical in TKA patients is highly suggestive of an underlying infection (PJI or superficial infection) but type and duration of discharge could not be used to differentiate between PJI and superficial infection. Other risk factors for PJI or superficial infection include women's gender, longer surgical duration, longer hospitalization and longer discharge duration.
PubMed: 33824787
DOI: No ID Found -
Journal of Dairy Science Mar 2021The objective of this study was to quantify the efficacy of a second intrauterine cephapirin treatment administered 14 d after the initial one on subsequent reproductive...
The objective of this study was to quantify the efficacy of a second intrauterine cephapirin treatment administered 14 d after the initial one on subsequent reproductive performance of postpartum dairy cows affected by purulent vaginal discharge (PVD) or endometritis (ENDO). In total, 4,140 Holstein cows from 30 commercial herds were enrolled in a randomized clinical trial. At 36 (±7) d in milk, cows were examined using the Metricheck device to diagnose PVD. An endometrial cytology sample was also collected from each cow to perform a leukocyte esterase test for diagnosing ENDO. Diagnosis of PVD and ENDO was done cow-side. Cows diagnosed with PVD or ENDO were assigned to receive 1 of 2 treatments: (1) a single intrauterine cephapirin infusion (500 mg of cephapirin benzathin; Metricure, Merck Animal Health, Kirkland, QC, Canada) at the time of initial examination or (2) a single intrauterine infusion at the time of initial examination and a second one 14 d later. Subsequent reproductive and culling events were collected until 200 d in milk. Statistical analyses were performed using univariable and multivariable mixed logistic regression models. In cows affected by PVD, a second intrauterine cephapirin infusion increased the pregnancy risk at first insemination in comparison with cows that only received one treatment (28.0 vs. 38.8%). In cows affected by ENDO, a second treatment also increased the pregnancy risk at first insemination compared with cows that only received one treatment (30.3 vs. 39.2%). Overall, these results demonstrate that administering a second intrauterine cephapirin infusion 14 d after the initial treatment in postpartum cows affected by PVD or ENDO did improve their subsequent reproductive performance.
Topics: Animals; Canada; Cattle; Cattle Diseases; Cephapirin; Endometritis; Female; Postpartum Period; Pregnancy; Reproduction; Vaginal Discharge
PubMed: 33358808
DOI: 10.3168/jds.2020-19537 -
Taiwanese Journal of Obstetrics &... Dec 2007Nasopharyngeal carcinoma, particularly during pregnancy, rarely comes to medical attention before it spreads to the regional lymph nodes.
OBJECTIVE
Nasopharyngeal carcinoma, particularly during pregnancy, rarely comes to medical attention before it spreads to the regional lymph nodes.
CASE REPORT
We report a 26-year-old Taiwanese woman who suffered from persistent headache and purulent nasal discharge during mid-pregnancy. Magnetic resonance imaging examination showed a large soft tissue mass measuring 3 x 2 x 2 cm in the left nasopharynx at 31 weeks of gestation. Punch biopsy of the tumor was done, and the histopathologic report revealed poorly differentiated, non-keratinizing type of squamous cell carcinoma (T4N2M0). A female infant weighing 1,790 g was delivered by cesarean section at 33 weeks of gestation with Apgar scores of 5 and 8 at 1 and 5 minutes, respectively. The patient received chemotherapy and radiation therapy after delivery. She was disease-free for 3 years. Subsequently, the patient delivered a second healthy infant weighing 3,084 g in a consecutive pregnancy, with a 3-year birth interval. Her first and second child showed normal psychomotor development at 3 years and 6 months of age, respectively.
CONCLUSION
The possibility of rare nasopharyngeal carcinoma should be considered in any pregnant woman with presenting symptoms of persistent headache and abnormal nasal discharge, and a detailed thorough investigation is indicated. Successful pregnancy outcome can be achieved after tailored use of a combination of chemotherapy and radiotherapy.
Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Squamous Cell; Combined Modality Therapy; Female; Humans; Infant, Newborn; Nasopharyngeal Neoplasms; Pregnancy; Pregnancy Complications, Neoplastic; Radiotherapy, Adjuvant; Withholding Treatment
PubMed: 18182351
DOI: 10.1016/s1028-4559(08)60015-7 -
International Medical Case Reports... 2022To report a case series of lacrimal duct obstruction and infection associated with non-traumatic corneal perforation.
PURPOSE
To report a case series of lacrimal duct obstruction and infection associated with non-traumatic corneal perforation.
CASE SERIES
This study included 6 eyes in 6 patients with non-traumatic corneal perforation treated between April 2019 and March 2021. All 6 cases were associated with lacrimal duct obstruction and infection. Purulent discharge caused by lacrimal duct infection was observed in all 6 patients (100%). However, three of the 6 patients (50%) did not show purulent discharge at initial examination and lacrimal duct obstruction was therefore not initially recognized. Dry eye was observed in five of the 6 patients (83%) and may have caused corneal deterioration, increasing susceptibility to perforation. Further, dry eye masks symptoms of lacrimal duct obstruction and infections, such as epiphora and regurgitation of purulent discharge, making the association with lacrimal duct obstruction and infection difficult to determine. All patients were treated for both corneal perforation and lacrimal duct disease, and conditions improved, with no recurrence of either corneal perforation or lacrimal duct disease.
CONCLUSION
In patients with a combination of lacrimal duct disease and corneal perforation, treatment of both diseases resulted in stabilization of patient condition. Dry eyes may mask symptoms of lacrimal duct diseases, such as epiphora and purulent discharge, and lacrimal duct disease may thus be underdiagnosed.
PubMed: 35769810
DOI: 10.2147/IMCRJ.S363034 -
Journal of Family Medicine and Primary... Dec 2020An umbilical cerebrospinal fluid (CSF) fistula following a ventriculoperitoneal (VP) shunt is an extremely rare complication. The shunt can get blocked and infected and...
An umbilical cerebrospinal fluid (CSF) fistula following a ventriculoperitoneal (VP) shunt is an extremely rare complication. The shunt can get blocked and infected and present as purulent umbilical discharge. We report an 11-month-old female infant who presented with recurrent purulent umbilical discharge, 6 months after VP shunt operation for hydrocephalus. After relevant investigations, she underwent exploratory laparotomy which revealed an umbilical CSF fistula with a blocked VP shunt. VP shunt removal was done with excision of the fistulous tract. The post-op period was uneventful and umbilical discharge ceased. She is further planned for endoscopic third ventriculostomy. Umbilical discharge in a neonate may be due to several pathologies. The family physician is the first point of contact in the majority of the cases before they seek a specialist. Hence, recurrent umbilical discharge not responding to conservative management must be evaluated carefully, referred promptly, and the underlying pathology to be treated.
PubMed: 33681077
DOI: 10.4103/jfmpc.jfmpc_814_20 -
Skin Health and Disease Feb 2024Hidradenitis Suppurativa (HS) is a chronic inflammatory skin condition with recurrent nodules and abscesses that culminate in purulent discharge and scarring. It has...
BACKGROUND
Hidradenitis Suppurativa (HS) is a chronic inflammatory skin condition with recurrent nodules and abscesses that culminate in purulent discharge and scarring. It has significant physical, psychological and financial impact.
OBJECTIVES
This study plans to analyse patient costs associated with HS. Direct costs include prescription items. Indirect or out-of-pocket costs include dressings, analgesia, and healthcare-related travel costs. This study will also assess disease impact on quality-of-life (QOL).
METHODS
Patients with HS diagnosis attending dermatology OPD at our public tertiary centre were invited to participate. Ethical approval was secured, and informed consent was obtained. Participants completed an anonymous survey which was analysed to identify costs associated with HS as well as demographics and QOL impact.
RESULTS
A total of 25 patients completed the survey; median age was 29% and 80% were female. Median time from HS onset to diagnosis was 2 years, with 24% waiting >10 years to be diagnosed. In the past 3 months, 20% spent >€200 in both categories; prescription and non-prescription items. In the non-prescription category, 36% of patients reported expenditure >€100 in the past 3 months. Dressings were the most common out-of-pocket expense (in 15/25 patients), followed by analgesia and protective clothing. Attendance at medical appointments cost 24% of patients €50-€200. Four participants reported difficulty accessing HS treatments due to associated costs. Mean number of absence days from work/education as result of HS was 8.7 in the past 3 months. Two patients reported being on disability allowance, and two on unemployment benefit as result of their skin disorder. In the QOL question; 96% reported disease impact on QOL, and 11 participants reported that it affected their life 'very much'.
CONCLUSIONS
HS is a chronic inflammatory skin condition with significant financial burden alongside the well-analysed biopsychosocial disease impact. Financial burden can be divided into direct prescription costs and indirect costs such as non-prescription items, protective clothing and travel costs which we have explored in this study. Further research is needed in this area to identify and optimise both the financial and QOL implications of HS in acute flares and chronic disease management.
PubMed: 38312251
DOI: 10.1002/ski2.306 -
Indian Journal of Otolaryngology and... Nov 2019Odontogenic etiology accounts for 10-12% of cases of maxillary sinusitis. Although uncommon, direct spread of dental infections into the maxillary sinus is possible due...
Odontogenic etiology accounts for 10-12% of cases of maxillary sinusitis. Although uncommon, direct spread of dental infections into the maxillary sinus is possible due to the close relationship of the maxillary posterior teeth to the maxillary sinus. An odontogenic infection is a polymicrobial aerobic-anaerobic infection, with anaerobes out numbering the aerobes. Diagnosis requires a thorough dental and clinical evaluation, including radiographs. Management of sinus disease of odontogenic origin often requires medical treatment with appropriate antibiotics, surgical drainage when indicated, and treatment to remove the offending dental etiology. A 35-year-old, non-smoking woman visited our clinic, with a history of 6 months of facial pain, purulent nose discharge, and a foul taste in her mouth. The patient was otherwise healthy. Nasal endoscopy showed purulent discharge coming from the left middle meatus with a congested nasal mucosa and with a past history of dental treatments. CT PNS showed fractured free floating and an impacted foreign body through the premolar tooth and a right maxillary polyp with evidence of similar dental procedure done bilaterally. Functional endoscopic sinus surgery with extraction of the affected tooth and closure of oroantral fistula was done. The association between an odontogenic condition and maxillary sinusitis requires a thorough dental examination of patients with sinusitis. Concomitant management of the dental origin and the associated sinusitis will ensure complete resolution of the infection and may prevent recurrences and complications. A combination of a medical and surgical approach is generally required for the treatment of odontogenic sinusitis. An endoscopic shaver-assisted approach to is a reliable, minimally invasive method associated with less morbidity and lower incidence of complications.
PubMed: 31763250
DOI: 10.1007/s12070-017-1167-5