RESUMO
BACKGROUND: Equine neuroborreliosis (NB), Lyme disease, is difficult to diagnose and has limited description in the literature. OBJECTIVE: Provide a detailed description of clinical signs, diagnostic, and pathologic findings of horses with NB. ANIMALS: Sixteen horses with histologically confirmed NB. METHODS: Retrospective review of medical records at the University of Pennsylvania and via an ACVIM listserv query with inclusion criteria requiring possible exposure to Borrelia burgdorferi and histologic findings consistent with previous reports of NB without evidence of other disease. RESULTS: Sixteen horses were identified, 12 of which had additional evidence of NB. Clinical signs were variable including muscle atrophy or weight loss (12), cranial nerve deficits (11), ataxia (10), changes in behavior (9), dysphagia (7), fasciculations (6), neck stiffness (6), episodic respiratory distress (5), uveitis (5), fever (2), joint effusion (2), and cardiac arrhythmias (1). Serologic analysis was positive for B. burgdorferi infection in 6/13 cases tested. CSF abnormalities were present in 8/13 cases tested, including xanthochromia (4/13), increased total protein (5/13; median: 91 mg/dL, range: 25-219 mg/dL), and a neutrophilic (6/13) or lymphocytic (2/13) pleocytosis (median: 25 nucleated cells/µL, range: 0-922 nucleated cells/µL). PCR on CSF for B. burgdorferi was negative in the 7 cases that were tested. CONCLUSION AND CLINICAL IMPORTANCE: Diagnosis of equine NB is challenging due to variable clinical presentation and lack of sensitive and specific diagnostic tests. Negative serology and normal CSF analysis do not exclude the diagnosis of NB.
Assuntos
Doenças dos Cavalos/microbiologia , Neuroborreliose de Lyme/veterinária , Animais , Feminino , Doenças dos Cavalos/patologia , Cavalos , Neuroborreliose de Lyme/patologia , Masculino , Estudos RetrospectivosRESUMO
While visiting Jamaica, a 50-year-old woman stumbled on an outdoor wooden staircase and sustained an injury to the right leg. The wound was cleaned topically and the patient was given antibacterial therapy. Five weeks later, in Canada, she presented with an ulcer at the injury site. An excisional biopsy showed copious broad, septate, melanized fungal filaments penetrating into tissue. Culture yielded a nonsporulating melanized mycelium. The isolate was strongly inhibited by cycloheximide and benomyl but grew at 37 degrees C. After 16 weeks cultivation on modified Leonian's agar at 25 degrees C, it developed pycnidia characteristic of Lasiodiplodia theobromae, a common tropical phytopathogen mainly known previously as a rare agent of keratitis and onychomycosis in humans. The patient was not given antifungal chemotherapy, and the ulcer, which had been broadly excised in the biopsy procedure, ultimately resolved after treatment with saline compresses. The six-month follow-up showed no sign of infection. This case, interpreted in light of previously reported cases, shows that on rare occasions L. theobromae is able to act as an agent of subcutaneous phaeohyphomycosis and that, when this occurs, debridement alone may be sufficient to eradicate it.
Assuntos
Ascomicetos/isolamento & purificação , Micoses/microbiologia , Micoses/cirurgia , Antifúngicos/uso terapêutico , Benomilo/uso terapêutico , Cicloeximida/uso terapêutico , Feminino , Humanos , Jamaica , Pessoa de Meia-Idade , Micoses/patologia , Tela Subcutânea/microbiologia , Tela Subcutânea/patologia , ViagemRESUMO
The Medicare population remains largely unmanaged despite its increasing cost burden. With a few notable exceptions, health maintenance organizations (HMOs) have historically avoided serving this expensive segment. In many cases, the inability to control costs results from failing to understand the importance of specialist reimbursement mechanisms. This article examines the importance of these mechanisms and describes how to successfully capitate specialty physicians in a Medicare risk program. The article also includes a case study on a successful capitation agreement between an HMO and a specialty group.
Assuntos
Economia Médica , Sistemas Pré-Pagos de Saúde/economia , Medicare Part B/organização & administração , Especialização , Idoso , Capitação , Serviços Contratados/economia , Humanos , Medicare Part B/economia , New Mexico , Métodos de Controle de Pagamentos , Mecanismo de Reembolso/economia , Estados UnidosRESUMO
"This paper presents the results of exploratory efforts to examine the determinants of the structure of households in urban areas of Mexico, focusing on those of women with young children.... The empirical analysis uses two cross-sectional national surveys of Mexico, the 'Encuesta Nacional Demografica' 1982 and the 'Encuesta Nacional de Fecundidad y Salud' 1987...." (SUMMARY IN ENG)
Assuntos
Características da Família , População Urbana , América , Demografia , Países em Desenvolvimento , América Latina , México , América do Norte , População , Características da PopulaçãoRESUMO
Culture is defined and discussed as an important ingredient to treatment planning. Components of culture are identified and examples of how they pertain to treatment are given through a brief case example.
RESUMO
The pharmacokinetic parameters of furosemide were measured in 14 premature newborn infants, one to 20 days of age, and in 12 older infants, aged one to 4 months, following a single intravenous dose of 1 mg/kg of furosemide. Furosemide levels were determined by a high pressure liquid chromatographic method which required 3 microliter of plasma. The volume of distributuion for furosemide was calculated to be 0.24 +/- 0.03 l/kg (mean +/- SE) in all infants studied, regardless of postnatal age. The half-life in the first three weeks of life was found to be 19.9 +/- 3.0 hours. Thus, the half-life of furosemide in the premature infant is considerably longer than in adults or older children, but the volume of distribution is similar. The bioavailability of oral furosemide in infants appeared to be low. The findings of this study indicate that furosemide, 1 mg/kg parenterally, given with a frequency of more than twice daily to the premature infant in the immediate neonatal period, or in parenteral dosages in excess of 2 mg/kg, may lead to plasma levels associated with ototoxicity.