Biomedical subjects
Emil Lesho
Publications and source records attributed to Emil Lesho.
Evidence base for using corticosteroids to treat HIV-associated immune reconstitution syndrome.
Most of the evidence supporting the use of corticosteroids (steroids) for immune reconstitution syndrome (IRS) comes from case reports or retrospective series and is of low quality. However, when steroids are used, they have usually been associated with clinical improvement or resolution of IRS. Except in the case of hepatitis B- or C-associated IRS, there have been no reports of worsening of the IRS or adverse outcome due to steroid use. After ruling out other conditions which can mimic IRS, clinicians should strongly consider steroids when managing IRS associated with mycobacterial or fungal pathogens when there is severe disease, or when other measures have failed.
Fatal Acinetobacter baumannii infection with discordant carbapenem susceptibility.
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An AIDS patient with fever and rash.
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Role of inhaled antibacterials in hospital-acquired and ventilator-associated pneumonia.
Inhaled antibiotics are not usually considered outside the setting of cystic fibrosis or Pneumocystis jiroveci prophylaxis. However, because they deliver high drug concentrations at the site of infection with negligible systemic absorption and toxicity, they are logical compliments to standard intravenous therapy for severe nosocomial pneumonias -- particularly those caused by multiresistant organisms. Older studies that have shown marginal or no benefit have either applied inhaled antibiotics indiscriminately to low risk populations, or have used crude delivery systems, such as hand atomizers or poured it into the endotracheal tube. Although inhaled antibiotics cannot be recommended for prevention of nosocomial pneumonia at this time, a few studies involving prophylaxis have shown promising trends, particularly in high-risk patients with predisposing conditions. The greatest potential of inhaled antibiotics lies in the treatment of severe healthcare-associated pneumonia caused by a multiresistant organism. The method of delivery is extremely important. Trials that have shown the most benefit, even against pathogens most difficult to eradicate and in damaged lungs, have used optimized delivery systems. Most authorities recommend using ultrasonic or vibrating disk nebulizers to generate particle sizes between 1 and 5 microm that are crucial for deposition in terminal bronchioles and alveoli. Inhaled liposomal amphotericin has also demonstrated encouraging results in animal trials. Recently, inhaled phytochemicals were successfully employed in the treatment of a patient with primary pulmonary tuberculosis. When used selectively in high-risk patients, or in the treatment of established pneumonia, inhaled antibiotics have not been associated with development of resistant organisms.
A pathophysiological approach to antiretroviral therapy.
A discussion of the pathophysiology of HIV infection is important not only to understand both routine and novel therapeutic approaches, but also to appreciate the challenges of long-term control and viral eradication. This article will first briefly review certain pathophysiologic principles of HIV infection that have particular therapeutic implications, and then discuss general tenets of antiretroviral therapy, followed by new developments in the field.
Sudden death following a ventral hernia repair.
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The low impact of screening electrocardiograms in healthy individuals: a prospective study and review of the literature.
OBJECTIVE: To determine how often screening electrocardiograms (EKGs), which are required by military regulation, change management or disclose cardiac disease in healthy people. METHODS: A total of 1,718 consecutive EKG interpretations, whether or not the screening EKG led to further testing, disclosed serious or potentially serious cardiac disease, or changed management or disposition of the patient, were prospectively recorded. RESULTS: Thirty-four percent of the screening EKGs was abnormal. Seven (0.67%) of these abnormal EKGs altered management by leading to further consultation or testing. No screening EKG disclosed serious underlying cardiac disease. Two cases of potentially serious cardiac disease were discovered by the screening EKGs. At an average follow-up time of 34 months, neither of these two patients has developed serious cardiac disease. Our findings are similar to studies of other populations. CONCLUSION: Screening EKGs rarely caused a change in management. No adverse outcome would have occurred nor would serious cardiac disease have been missed if the routine screening EKG were not performed. The military should consider abandoning practice of performing screening EKGs in young, healthy individuals.
Disease prevalence among Moldovan orphans and other considerations for future humanitarian aid.
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