Biomedical subjects

John R Ebright

Publications and source records attributed to John R Ebright.

7 recordsLinked to original sources

PubMed2006

The impact of chronic venous insufficiency and leg function on the quality of life of HIV-positive persons.

Chronic venous insufficiency and subsequent difficulties in leg function are causally linked to injection drug use and quality of life. Because injection drug use is a risk factor for human immunodeficiency virus infection, chronic venous insufficiency would be expected to occur with a higher prevalence in HIV-positive persons, yet the impact of chronic venous insufficiency on quality of life has not been investigated in this population. A cross-sectional design with quota sampling was used to enroll 73 HIV-positive participants-- 46 injection drug users and 27 non-injection drug users -- in this quality-of-life study. Questionnaires were read to participants and their legs were assessed for evidence of chronic venous insufficiency. Leg function scores, comprising assessment of leg pain, interference, and difficulty in using legs, were significantly related (P <.05) to quality-of-life scores, controlling for comorbid health problems. Chronic venous insufficiency, injection drug use, and leg function were interrelated. The legs of HIV-positive persons who have injected drugs should be assessed for manifestations of chronic venous insufficiency and other functional impairments. Further research involving a larger sample and assessment of chronic venous insufficiency treatments, including quality of life and leg function in HIV-positive persons, is needed.

Activities of Daily Living↗

PubMed2005

Microbiology of chronic leg and pressure ulcers: clinical significance and implications for treatment.

Chronic pressure ulcers and leg ulcers are common, especially in the elderly, and are a source of much distress and disability. Health care providers must distinguish between clinically unimportant but predictable colonization of these wounds and clinically relevant infection.Infection may present as increased local pain, cellulitis, local abscess,necrotizing fasciitis, osteomyelitis, bacteremia, or sepsis. For most of these conditions, systemic antibiotics are necessary. The use of topical antimicrobial agents as a means of promoting healing in clinically uninfected wounds is a subject of active investigation at this time. Currently, evidence is insufficient to support routine use of anti-microbial agents for this purpose. A quantitative tissue culture taken from the ulcer bed, revealing greater than 10(5) organisms/g of tissue appears to increase the risk of failure of ulcer wound closure by graft or flap. A short course of topical or systemic antibiotics before surgery in these instances is advisable.

Chronic Disease↗

PubMed2004

Clinical experience with Staphylococcus lugdunensis bacteremia: a retrospective analysis.

We report a retrospective review of all cases of Staphylococcus lugdunensis bacteremia identified during a period of more than 10 years (January 1990 to May 2002) in a large medical center. Twenty-one cases occurred over that period; 20 cases were available for review. In six instances, the organism appeared to be clinically significant and was most commonly related to a vascular line infection. No deaths, secondary suppurative complications, prolonged bacteremia, or prolonged fever appeared to be caused by S. lugdunensis in our experience. Twenty-five percent of our isolates were resistant to multiple antibiotics, including oxacillin.

Adult↗

PubMed2003

Emerging infectious diseases in Mongolia.

Since 1990, Mongolia's health system has been in transition. Impressive gains have been accomplished through a national immunization program, which was instituted in 1991. Nevertheless, the country continues to confront four major chronic infections: hepatitis B and C, brucellosis, tuberculosis, and sexually transmitted diseases (STDs). As of 2001, only two cases of HIV infections had been detected in Mongolia, but concern grows that the rate will increase along with the rising rates of STDs and increase in tourism. Other infectious diseases of importance in Mongolia include echinococcosis, plague, tularemia, anthrax, foot-and-mouth, and rabies.

Animals↗

PubMed2002

Skin and soft tissue infections in injection drug users.

Skin and soft tissue infections are the most common cause for hospital admission of injection drug users. Cutaneous and subcutaneous abscesses are the most frequent type of SSTI and occur most commonly when drug users are no longer able to inject intravenously and resort to injection directly into skin or muscle. Abscesses may be difficult to differentiate from uncomplicated cellulitis or may be confused with pseudoaneurysms, hematoma, phlegmon, or thrombosed vein. Special studies, including ultrasonography; CT scans, and MR imaging; or careful incision and inspection may be necessary to clarify the extent of infection and the presence of abscess. These procedures may also help differentiate a subcutaneous abscess from a vascular structure. Uncomplicated cellulitis most commonly responds to antibiotic therapy directed toward Staphylococcus aureus and Streptococcus spp. In several recent studies, cutaneous and subcutaneous abscesses have been found to be caused by polymicrobial infections and to include anaerobic organisms as well as aerobic gram-positive cocci in a little more than 50% of cases. Complete, often repeated, incision and drainage is a prerequisite for successful outcome in these cases. Complications of SSTI are many and are potentially life threatening. They include direct extension of subcutaneous abscess into vital areas or structures, necrotizing fasciitis and myositis, bacteremia, and sepsis. An outbreak of a highly lethal SSTI that recently occurred in Scotland, Ireland, and England seems to have resulted from infection with Clostridia spp, including C. novyi and C. perfringens. A rare but well-documented SSTI in injection drug users is pyomyositis, an abscess-forming infection of skeletal muscle. More than 20 cases have been reported in temperate climates to date. Although not life-threatening, chronic cutaneous venous ulcers of the lower extremities are common and debilitating, requiring long-term multidisciplinary care for successful healing.

Humans↗

PubMedDate not supplied

Ankle mobility in relation to chronic venous insufficiency in HIV-positive persons with and without a history of injection drug use.

The purpose of this study was to examine ankle mobility in relation to chronic venous insufficiency (CVI) in HIV-positive persons with and without a history of injection drug use (IDU) and to examine the extent to which peripheral neuropathy further reduced ankle mobility. A cross-sectional, stratified design with quota sampling was used to recruit 27 persons with no history of IDU and 46 with a history of IDU from an infectious diseases clinic. Goniometric measurements of forefoot inversion-eversion and dorsiflexion-plantar flexion were obtained. CVI was assessed on a clinical scale. Peripheral neuropathy was identified from chart review and self-report. Injection drug users had less ankle flexion-extension right, inversion-eversion left and right, and total ankle motion than those who did not inject drugs (p < .05). Neuropathy was not associated with less mobility of the ankle joint (p < .01). A causal model supported the hypothesis of ankle mobility as a mediator of the effect of IDU on CVI.

Adult↗

PubMedDate not supplied

Chronic venous insufficiency in HIV-positive persons with and without a history of injection drug use.

OBJECTIVE: To examine chronic venous insufficiency in human immunodeficiency virus-positive persons with and without a history of injection drug use and to examine the extent to which neuropathy further increased the risk of chronic venous insufficiency. DESIGN: Cross-sectional stratified design with quota sampling. SETTING: Infectious diseases clinic in a large, urban midwestern city. PARTICIPANTS: Human immunodeficiency virus-positive persons, 27 with no history of injection drug use and 46 with a history of injection drug use, who met the inclusion criteria, including being 30 to 65 years of age, not pregnant, and willing to respond to a questionnaire and have their lower legs examined, were enrolled until the quota for each stratum (no injection drug use and injection drug use) was filled. MAIN OUTCOME MEASURES: Chronic venous insufficiency clinical classification, injection drug use history, and presence of peripheral neuropathy. MAIN RESULTS: Sixty-one percent of injection drug users (28/46) presented with severe chronic venous insufficiency compared with 11% (3/27) of noninjection drug users (P< .001). The presence of lower extremity neuropathy was not significantly related to chronic venous insufficiency classification. CONCLUSIONS: This is the first study to report the high risk of chronic venous insufficiency in human immunodeficiency virus-infected persons who inject drugs. Chronic venous insufficiency should be assessed in human immunodeficiency virus-positive persons when there is a history of injection drug use, and measures to protect the legs should be implemented.

Adult↗