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Biomedical subjects

Richard Goodgame

Publications and source records attributed to Richard Goodgame.

9 recordsLinked to original sources
PubMed2006

Norovirus gastroenteritis.

Recent epidemiologic studies have shown that norovirus is one of the most frequent causes of acute nonbacterial gastroenteritis. Reverse-transcription polymerase chain reaction and nucleotide sequencing are the means by which the hundreds of norovirus strains have been identified, named, and classified into genogroups and genetic clusters. They are also the means by which a particular strain is traced from the source of an outbreak throughout its spread. These molecular techniques have been combined with classic epidemiology to investigate norovirus outbreaks in diverse settings, including hospitals, nursing homes, dining locations, schools, daycare centers, and vacation venues. Outbreaks are difficult to control because of the apparent ease of transmission through food, water, person-to-person contact, and environmental surfaces. Almost all patients with norovirus gastroenteritis recover completely, but hospital and nursing home outbreaks have been associated with morbidity and mortality. The diagnostic and management approach to an individual patient is to use clinical and epidemiologic findings to rule out "not norovirus." At the first sign that there is an outbreak, strict compliance with cleaning, disinfection, and work release guidelines is important to prevent further spread.

Caliciviridae Infections↗
PubMed2006

A Bayesian approach to acute infectious diarrhea in adults.

Acute infectious diarrhea is a yearly occurrence for most Americans, and is associated with 1 million hospitalizations and about 6000 deaths in the United States annually. Up to 80% of acute infectious diarrhea is caused by noroviruses, which produce a clinically mild illness with a predictable short course and good outcome that make laboratory testing and antimicrobial treatment unnecessary. Most diarrhea-causing bacteria and protozoa can cause a clinical illness "like norovirus"; when they do so in healthy adults neither specialized testing nor antimicrobials is required. The presence or absence of epidemiologic evidence (such as travel, hospitalization, antibiotic use, other exposures)and clinical evidence (such as diarrhea frequency and duration, severity of abdominal pain and fever, character of stool, presence of chronic illness or immune deficiency) can change the probability of "not norovirus" from as low as 8% to as high as 100%. Such probabilities guide the use of laboratory testing and antimicrobial therapy in patients who have acute infectious diarrhea.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Emerging Causes of Traveler's Diarrhea: Cryptosporidium, Cyclospora, Isospora, and Microsporidia.

Travel is a risk factor for acquiring infection with a spore-forming protozoa: Cryptosopridium, Cyclospora, Microsporidia, and Isospora. Certain travel destinations have a high disease burden and intense exposure. Patients present with persistent diarrhea and a history of recent travel to a developing country in the tropics. Very mild infections may be underdiagnosed and may cause typical traveler's diarrhea. In a patient with a history of travel and persistent diarrhea unresponsive to the usual antibiotic and antidiarrhea treatment, stool studies for all four of these protozoa infections should be performed. If immune status is normal and the disease is mild, symptomatic therapy may suffice. Effective treatment is available for Cyclospora, Microsporidia, and Isospora.

Journal Article↗
PubMedDate not supplied

The role of the discriminant factor in the assessment and treatment of alcoholic hepatitis.

GOALS: To evaluate the role of the discriminant factor in predicting mortality and deciding on treatment in acute alcoholic hepatitis. BACKGROUND: Current guidelines on the treatment of alcoholic hepatitis restrict the use of corticosteroids to patients with discriminant factor > 32 (severe disease) because of the toxicity of steroids. Less toxic forms of therapy, such as proxyphylline, may have a role in patients with lower discriminant factor, if mortality without therapy is common. STUDY: We performed a 5-year retrospective analysis comparing the outcomes of patients with mild and severe alcoholic hepatitis. Receiver operator characteristic curves were used to study the accuracy of the discriminant factor to predict short-term mortality. RESULTS: Among the 41 patients with severe alcoholic hepatitis (discriminant factor > 32) and 48 with mild alcoholic hepatitis, 16 (39%) and 8 (16.7%), respectively, died within 28 days of admission. Only 11 (32%) actually received corticosteroid therapy. The sensitivity and specificity of the discriminant factor in predicting mortality was 66.7% and 61.5%, respectively. A receiver operator characteristic curve of the discriminant factor gave the optimal value for the discriminant factor as 33, with the area under the curve being 0.666 (P = 0.0078; 95% CI = 0.531-0.801). CONCLUSIONS: Using the value of around 32 maximizes sensitivity and specificity of the discriminant factor in predicting mortality in alcoholic hepatitis. However, there is a high mortality in patients with alcoholic hepatitis and a discriminant factor less than 32. Alternative effective agents should be considered in patients with milder alcoholic hepatitis.

Adrenal Cortex Hormones↗