Biomedical subjects

M L Bennish

Publications and source records attributed to M L Bennish.

40 records · Page 3Linked to original sources

PubMedDate not supplied

Potentially lethal complications of shigellosis.

Complications that can lead to death during shigellosis include intestinal as well as systemic manifestations. The former include intestinal perforation, toxic megacolon, and dehydration, and the latter include sepsis, hyponatremia, hypoglycemia, seizures and encephalopathy, hemolyticuremic syndrome, pneumonia, and malnutrition. Data on the frequency of these complications come primarily from hospital-based studies, in which sepsis-either with Shigella or with other Enterobacteriaceae-and hypoglycemia are the most common causes of death. Management of these two complications requires broad-spectrum empiric antibiotic treatment of all severely ill, malnourished patients with shigellosis as well as frequent feedings to prevent hypoglycemia. Unfortunately, in developing countries, access to parenteral broad-spectrum antimicrobial agents is often limited, and frequent feedings are often precluded by the severe anorexia that is characteristic of shigellosis. Realistic approaches to the reduction of mortality from shigellosis must continue to focus on prevention and early antimicrobial therapy rather than on treatment of established complications.

Brain Diseases↗

PubMedDate not supplied

Antimicrobial therapy for shigellosis.

In controlled clinical trials, which were first performed with use of the sulfonamides, antimicrobial agents have been shown to shorten the duration of symptoms and lessen the excretion of pathogens during episodes of shigellosis. Not all antimicrobial agents that are active in vitro against Shigella are effective in vivo, and efficacy of an agent can only be assessed by properly conducted clinical trials. Resistance to both ampicillin and trimethoprim-sulfamethoxazole, the drugs of choice for the treatment of shigellosis, is now common among Shigella dysenteriae type I isolates in Africa and Asia and is increasing among isolates of other Shigella species, including Shigella sonnei in the United States. Nalidixic acid, the newer quinolones, and amnidocillin pivoxil are additional agents that have been found to be effective in controlled clinical trials. There is a need, however, for more data on the safety of the quinolones before they can be routinely administered to children. Newer agents that deserve evaluation include the orally administered to children. Newer agents that deserve evaluation include the orally administered second- and third-generation cephalosporins, which are highly active in vitro against most strains of Shigella.

Anti-Infective Agents↗

PubMedDate not supplied

Current practices for treatment of dysentery in rural Bangladesh.

A rural area of Bangladesh with a population of 191,000 had 643 health care providers, of whom 324 (50%) practiced allopathic (Western) medicine, 152 (24%) were spiritualists, 109 (17%) were herbalists, and 58 (9%) were homeopaths. Two hundred eight (64%) of the allopaths had no formal training, and only 18 (6%) were graduates of medical school. In a community-based study of 480 children with bloody diarrhea and 480 children with nonbloody diarrhea, allopathic treatment was the most common care provided. Furazolidone and metronidazole were the two most commonly prescribed drugs, given to 26% and 23% of children, respectively, who were seen by a practitioner. Only 25% of children had received oral rehydration therapy. We conclude that in this region of Bangladesh care of acute diarrhea is provided mostly by private medical practitioners who have little or no training; that such care currently is largely irrational; and that the provision of rational care will require the development of simple algorithms that these practitioners can implement for treatment of this disease.

Bangladesh↗

PubMedDate not supplied

Mortality, morbidity, and microbiology of endemic cholera among hospitalized patients in Dhaka, Bangladesh.

Mortality and morbidity associated with cholera acquired in a modern endemic setting have not been well defined. In Dhaka, Bangladesh from 1986 to 1996, we found that causative agents of cholera shifted over time, varying by serogroup, biotype, and serotype. At the International Centre for Diarrhoeal Disease Research (ICDDR,B: Centre for Health and Population Research) in 1996, 19,100 cholera patients were treated, 887 (4.6%) were admitted, and 33 died (mortality rate = 3.7% of cholera inpatients, 0.14% of all cholera patients). When cholera inpatients who were discharged improved were compared with those who died, bacteremia (odds ratio [OR] = 10.5, 95% confidence interval [CI] = 2.9-37.9), radiographic evidence of pneumonia (OR = 3.1, 95% CI = 1.2-7.7), and acidosis as estimated by the serum bicarbonate value (OR = 0.893, 95% CI = 0.825-0.963) were independently associated with death by multivariate analysis. Pneumonia was the leading cause of death and accounted for two-thirds of all deaths among individuals with cholera in this study. Death in hospitalized patients with cholera acquired in a modern endemic setting is, therefore, extremely rare, and most frequently due to concomitant infection, especially pneumonia.

Adolescent↗