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Biomedical subjects

R A Smego

Publications and source records attributed to R A Smego.

At least 19 recordsLinked to original sources
PubMed1991

Use of acyclovir for varicella pneumonia during pregnancy.

Twenty-one cases (five new and 16 literature) of varicella pneumonia of pregnancy were retrospectively reviewed to evaluate the benefits and risks of intravenous acyclovir on maternal and fetal outcomes. All women were in their second (12 cases) or third (nine cases) trimester. Mean gestational ages at the onset of pneumonia and time of delivery were 27 and 36 weeks, respectively. Twelve patients required mechanical ventilation. The mean duration of treatment was 7 days. No definite adverse drug effects were noted. Three women (14%) died of uncontrolled infection or complications. Two infants died (whose mothers also died): One was stillborn at 34 weeks' gestation, and the other died from prematurity shortly after birth at 26 weeks. No child was born with features of congenital varicella syndrome, and none developed active perinatal varicella infection. Onset of pneumonia during the third trimester was a risk factor associated with fatal maternal outcome. Intravenous acyclovir may reduce maternal morbidity and mortality associated with varicella pneumonia occurring during pregnancy, and appears to be safe for the developing fetus when given during the latter trimesters.

Acyclovir↗
PubMed1991

Acinetobacter peritonitis in patients receiving continuous ambulatory peritoneal dialysis.

Little is written on peritonitis caused by Acinetobacter species in patients receiving continuous ambulatory peritoneal dialysis (CAPD). A retrospective review of medical records, dialysis unit charts, and microbiology culture logbooks identified 18 such patients treated at our hospital. All cases were community-acquired, and no common epidemiologic link between cases was detected. The most common manifestations were abdominal pain or tenderness (13 patients) and cloudy dialysate (six patients); only two patients had fever. Peritonitis without localized intra-abdominal abscess formation occurred in all instances. Intraperitoneal aminoglycoside therapy for 3 to 14 days (mean 10.7 days) eradicated infection in 14 cases. Two patients were successfully treated with 4 days of intraperitoneal gentamicin followed by 8 days of oral ciprofloxacin; another was cured with 10 days of IV ceftriaxone. Tenckhoff catheter removal was necessary in only one patient. Unlike pseudomonal or fungal peritonitis associated with CAPD, infection due to Acinetobacter species is generally responsive to antimicrobials alone.

Acinetobacter Infections↗
PubMed1988

Epidemic non-A non-B hepatitis in urban Karachi, Pakistan.

An outbreak of icteric non-A non-B (NANB) hepatitis occurred in a residential community of urban Karachi, Pakistan, from August 1986 through October 1986. Of the 114 cases reported from this community during the 1986 calendar year, a clustering of 85 cases was seen during the above period. Twenty-seven percent of 226 households and 9% of 1,250 individuals were affected. Five persons were hospitalized and 1 death occurred in a young pregnant woman. Cases occurred predominantly in the less than or equal to 29-year-old age group (72%), with a male:female ratio of 1.8:1. Thirty-four cases occurred singly within households, while in 28 households multiple cases were seen. Analysis of the epidemic curve and intervals of onset of multiple cases within households suggested prolonged common source exposure rather than secondary person-to-person transmission. No single water source was implicated but a contaminated municipal supply was presumed. Information collected from several other communities and from a university hepatitis reference laboratory suggested that the outbreak was part of a larger urban epidemic of NANB hepatitis. Based upon this investigation and data from recently published reports, it is concluded that NANB hepatitis is endemic in Pakistan.

Adolescent↗
PubMed1988

Multiply-resistant Salmonella and Shigella isolates.

Emerging patterns of antimicrobial resistance of Salmonella species are of serious concern in several parts of the world where enteric fever and other forms of salmonellosis are endemic. A retrospective review of clinical microbiology culture logbooks at our institution identified 16 isolates of multiply-resistant Salmonella (15) and Shigella (1) species during the period from October 1985 to February 1987. All organisms were resistant to ampicillin, chloramphenicol and trimethoprim-sulfamethoxazole, using a disk diffusion technique. Clinical sources of isolation included blood, stool, and urine. The resistant Salmonella strains represented 4% of blood cultures positive for this organism during the study period. Medical records of patients from whom organisms were recovered were reviewed to determine the clinical relevance of these isolates. The emergence of multiresistant Salmonella strains has important clinical and public health implications for populations at risk.

Drug Resistance, Microbial↗
PubMed1986

Hydatid cyst: preoperative sterilization with mebendazole.

An infected echinococcal cyst of the liver was diagnosed in a 48-year-old male immigrant from Spain. After preoperative treatment with mebendazole, microscopic examination of the operative cyst contents showed no viable scoleces or brood capsules of Echinococcus. We recommend the preoperative use of mebendazole in the management of hepatic hydatid cysts.

Combined Modality Therapy↗
PubMed1985

Home intravenous antimicrobial therapy provided by a community hospital and a university hospital.

A home intravenous antimicrobial program that was implemented at both a private community hospital and a university hospital with a wide rural referral base is described. Over an 18-month period, 63 patients were screened and selected for home i.v. antimicrobial management according to stringent criteria. The hospital pharmacies and two home health-care companies were used as the central points for coordinating the preparation and distribution of drug products and providing specialty nursing services. Predischarge inhospital education for each patient was conducted by a pharmacist and a nurse. On-call pharmacists and nurses were available to monitor and assist the patients, and the patients were seen regularly by physicians during the period of home therapy. The 63 patients received a total of 1108 days of home i.v. antimicrobial therapy; the mean duration of therapy was 17.6 days. Heparin-lock peripheral cannulae were used for 51 patients, while 12 patients received their treatment through central-subclavian or Hickman catheters. Home i.v. antimicrobial treatment seemed to be as effective as comparable inpatient management for each type of infection. Drug- and i.v. catheter-related adverse effects were uncommon and seemed similar in type and frequency to those of hospitalized patients. The estimated cost savings per treatment course was $3,514 for a total net savings of $221,406 over the 18-month study period. Home i.v. antimicrobial treatment programs can be successfully implemented in both community-based and tertiary-care settings. Home therapy is a safe, efficacious, and cost-effective alternative to prolonged hospitalization for a variety of infectious diseases.

Anti-Infective Agents↗
PubMed1985

Endemic nosocomial Acinetobacter calcoaceticus bacteremia. Clinical significance, treatment, and prognosis.

The medical records of 27 patients with blood cultures positive for Acinetobacter calcoaceticus over a recent five-year period (0.7% of all positive blood cultures) were reviewed retrospectively to determine the epidemiologic and clinical significance of these isolates. Eighteen isolates represented true bacteremias, 16 of which were hospital acquired. Patients most frequently were located in an intensive care unit or on a surgical ward. A seasonal July-to-September peak incidence was noted. The most common site of primary infection was the respiratory tract. Aminoglycosides, alone or in combination with a second agent, were used to treat all but one infection. Bacteriologic cure was achieved in 15 cases (88%); six patients had polymicrobial sepsis that carried a higher mortality than pure A calcoaceticus bacteremia (50% vs 0%). Acinetobacter, a low-virulence opportunistic pathogen, may be an infrequent but potentially serious endemic agent of nosocomial bacteremia in some institutions. The prognosis of bacteremia, when appropriately treated, appears to be good.

Acinetobacter Infections↗