{"title":"Linezolid (Zyvox)","authors":"Jessica Hillard MD","doi":"10.1016/S1068-607X(02)00114-2","DOIUrl":"https://doi.org/10.1016/S1068-607X(02)00114-2","url":null,"abstract":"<div><p><span><span>Linezolid (Zyvox) is a member of the first new category of antibiotics in 35 years. It is an </span>oxazolidinone that blocks bacterial protein synthesis by a method unlike any other antibiotic, making cross-resistance unlikely. It is available in oral and intravenous formulations and can be used to treat infections caused by gram-positive organisms resistant to most other antibiotics, including vancomycin-resistant enterococci and methicillin-resistant </span><em>Staphylococcus aureus</em>. As with any medication, adverse effects have been noted with linezolid, but they usually are mild to moderate in intensity. Most commonly seen are headache, nausea, vomiting, and diarrhea. Linezolid is a very expensive antibiotic and should be used only for treatment of serious infections caused by microorganisms that are resistant to other antibiotics. Linezolid is a Pregnancy Category C drug. Physicians should use the antibiotic with caution in pregnant and lactating women and only when the benefit clearly outweighs the potential risk to the fetus or infant.</p></div>","PeriodicalId":80301,"journal":{"name":"Primary care update for Ob/Gyns","volume":"9 5","pages":"Pages 178-180"},"PeriodicalIF":0.0,"publicationDate":"2002-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1068-607X(02)00114-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137230238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael L Pearl MD , Ann Buhl MD , Paul A DiSilvestro MD , Fidel A Valea MD , Eva Chalas MD
{"title":"Superior venacava syndrome","authors":"Michael L Pearl MD , Ann Buhl MD , Paul A DiSilvestro MD , Fidel A Valea MD , Eva Chalas MD","doi":"10.1016/S1068-607X(02)00109-9","DOIUrl":"10.1016/S1068-607X(02)00109-9","url":null,"abstract":"<div><p>Superior vena cava syndrome<span> (SVCS) affects approximately 15,000 people annually in the United States. Currently, mediastinal malignancies, primarily small cell lung cancer<span>, account for the majority of cases of SVCS. Iatrogenic causes, predominantly long-term central venous catheters, account for approximately 7% of cases of SVCS, and the incidence is increasing. Historically, SVCS was considered an oncologic emergency that required urgent treatment. It is now evident that SVCS is rarely a true emergency and that treatment may be safely provided in a deliberate fashion to the majority of patients. This article provides an overview of the etiology, presentation, diagnosis, and management of SVCS.</span></span></p></div>","PeriodicalId":80301,"journal":{"name":"Primary care update for Ob/Gyns","volume":"9 5","pages":"Pages 160-163"},"PeriodicalIF":0.0,"publicationDate":"2002-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1068-607X(02)00109-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74756443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Appreciating the differences between immunoassays used to diagnose maternal parvovirus B19 infection: understanding the antigen before interpreting the results","authors":"Jeanne A Jordan PhD","doi":"10.1016/S1068-607X(02)00108-7","DOIUrl":"10.1016/S1068-607X(02)00108-7","url":null,"abstract":"<div><p><span><span>Human parvovirus B19 (B19) capsid contains two structural proteins, VP1 and VP2. During infection, immune-competent individuals produce antibodies against both linear and conformational epitopes of VP1 and VP2. However, the emergence and duration of these antibodies differ; those recognizing linear epitopes appear and decline before those made against conformational epitopes. The platforms most commonly used for detecting B19-specific immunoglobin M or immunoglobin G include enzyme immunoassays, immunofluorescent assays, and Western blots. Because suitable culture systems do not exist to produce sufficient native virus, manufacturers must rely on </span>recombinant proteins<span><span> to detect B19-specific antibodies. These proteins are most commonly expressed in Escherichia coli or baculovirus-based vectors, as linear or conformational antigens, respectively. Differences in timing of the antibodies being produced against linear and conformational epitopes can lead to differences in immunoassay performance. Using an immunoassay with a high degree of sensitivity, specificity, and </span>positive and negative predictive values can provide an accurate picture of a patient’s immune status. This is critical for the physician faced with making decisions on the extent to which follow-up care, including </span></span>fetal ultrasound, is necessary. Not only are these additional tests and procedures inconvenient to the patient, but they also add unnecessary expense to an already overburdened healthcare system. Ultimately, a serologic assay that produces far fewer inaccurate results will be more cost effective.</p></div>","PeriodicalId":80301,"journal":{"name":"Primary care update for Ob/Gyns","volume":"9 5","pages":"Pages 154-159"},"PeriodicalIF":0.0,"publicationDate":"2002-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1068-607X(02)00108-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78202558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Smokingcessation in women","authors":"Sheila Kilbane MD , Eric Knudtson MD , Kathy Vesha RN","doi":"10.1016/S1068-607X(02)00110-5","DOIUrl":"10.1016/S1068-607X(02)00110-5","url":null,"abstract":"<div><p><span><span>“It is a testament to the power of tobacco addiction that millions of tobacco users have been unable to overcome their dependence and save themselves from its consequences: perpetual worry, unceasing expense, and compromised health” (Fiore MC, Bailey WC, Cohen SJ, et al., 2000). Nearly one quarter of the women in this country smoke, and it is the leading cause of preventable death in U.S. women. Smoking during pregnancy contributes significantly to medical complications suffered by both mother and fetus. Despite these statistics, many medical schools and residency programs do not give adequate training on smoking cessation interventions. The U.S. </span>Public Health Service<span> has outlined an effective and fairly simple strategy that can be integrated into any office setting. An organized clinical approach<span> with properly trained staff can improve the quality of life for thousands of women and infants and save millions of dollars across the country. It takes a few extra minutes of a physician’s time, but those few minutes have a significant impact on a patient’s quitting success. This article describes current trends in smoking prevalence, the latest facts about nicotine replacement therapy, and the U.S. Public Health Service’s and the American College of </span></span></span>Obstetricians and Gynecologists’ (ACOG) approved recommendations for smoking cessation.</p></div>","PeriodicalId":80301,"journal":{"name":"Primary care update for Ob/Gyns","volume":"9 5","pages":"Pages 164-168"},"PeriodicalIF":0.0,"publicationDate":"2002-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1068-607X(02)00110-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80428185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E.Rebecca Pschirrer MD, MPH , Susan M Ramin MD , Larry C Gilstrap III MD
{"title":"Mitral valve prolapse","authors":"E.Rebecca Pschirrer MD, MPH , Susan M Ramin MD , Larry C Gilstrap III MD","doi":"10.1016/S1068-607X(02)00111-7","DOIUrl":"10.1016/S1068-607X(02)00111-7","url":null,"abstract":"<div><p><span>Mitral valve prolapse (MVP) is commonly encountered in women and has been estimated to occur in up to 21% of healthy young women.</span><span>1</span><span> In the Framingham study, it was noted that 7.6% of its female population had MVP confirmed by echocardiography; of those women, 17% were between the ages of 20 and 29, 7.5% between 50 and 59 years, and only 1% were in their 7th decade.</span><span>2</span> This variation in distribution of MVP ensures that a population of women in their childbearing years seen by the general obstetrician–gynecologist will have the highest prevalence of MVP. It is, therefore, important to understand the mechanism, causes, and possible complications of MVP.</p></div>","PeriodicalId":80301,"journal":{"name":"Primary care update for Ob/Gyns","volume":"9 5","pages":"Pages 169-173"},"PeriodicalIF":0.0,"publicationDate":"2002-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1068-607X(02)00111-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85048665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Fads and fashions: the price women pay","authors":"Sharon T Phelan MD","doi":"10.1016/S1068-607X(02)00105-1","DOIUrl":"https://doi.org/10.1016/S1068-607X(02)00105-1","url":null,"abstract":"<div><p>Over the past 100 years, women’s fashions have undergone great change but rarely have been practical or logical, whether they consist of the tight corset, platform shoes, or the deep golden tan. The principle behind fashions is that the current “look” makes a statement of what society wants a woman to be and establishes the social hierarchy. Each of the fashion trends serves a cultural purpose, but also may have a price for the women who try to achieve the fashionable look. Health care providers for women need to be aware of fashion trends and adjust health screening and counseling appropriately.</p></div>","PeriodicalId":80301,"journal":{"name":"Primary care update for Ob/Gyns","volume":"9 4","pages":"Pages 138-143"},"PeriodicalIF":0.0,"publicationDate":"2002-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1068-607X(02)00105-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91762833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anthrax: diagnosis, treatment, prevention","authors":"Whitney E. Jamie","doi":"10.1016/S1068-607X(02)00100-2","DOIUrl":"https://doi.org/10.1016/S1068-607X(02)00100-2","url":null,"abstract":"","PeriodicalId":80301,"journal":{"name":"Primary care update for Ob/Gyns","volume":"1 1","pages":"117-121"},"PeriodicalIF":0.0,"publicationDate":"2002-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89604156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eugene C Toy MD , Joseph B Johns MD , Benton Baker III MD , Patti Jayne Ross MD , Larry C Gilstrap III MD
{"title":"The effect of a clinical problem-solving curriculum on medical student examination performance","authors":"Eugene C Toy MD , Joseph B Johns MD , Benton Baker III MD , Patti Jayne Ross MD , Larry C Gilstrap III MD","doi":"10.1016/S1068-607X(02)00104-X","DOIUrl":"10.1016/S1068-607X(02)00104-X","url":null,"abstract":"<div><p><span>The objective of this study was to determine whether a clinical problem-solving curriculum during the third-year obstetrics/gynecology clerkship would affect National Board Medical Examiners (NBME) subject test performance. During the 1999–2000 academic year, 184 third-year medical students rotated through the obstetrics/gynecology clerkship. They were assigned to one of three clinical training sites. Thirty-six students were assigned to a community hospital, whereas the remaining 148 students were assigned to either a private university hospital or a county hospital. In July 1, 1999, the community hospital adopted a problem-solving curriculum designed to stimulate a better understanding of underlying mechanisms of disease rather than the memorization of facts. Each morning, an attending physician spent 20 minutes on interactive conferences. At the end of the clerkship, each student took the NBME subject test for obstetrics and gynecology. A test score of 80 was chosen as the honors level. Students who participated in the problem-solving curriculum scored significantly higher than did those taught by the traditional program, based on median NBME subject test scores, 79.0 (interquartile range, 74.0–82.0) versus 71.0 (interquartile range, 65.0–76.5), </span><em>P</em> < .001, and the proportion with subject scores ≥80, (44.4% versus 10.1%, <em>P</em> < .001). A clinical problem-solving curriculum may lead to higher NBME test scores.</p></div>","PeriodicalId":80301,"journal":{"name":"Primary care update for Ob/Gyns","volume":"9 4","pages":"Pages 135-137"},"PeriodicalIF":0.0,"publicationDate":"2002-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1068-607X(02)00104-X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85858603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anthrax: diagnosis, treatment, prevention","authors":"Whitney E Jamie MD","doi":"10.1016/S1068-607X(02)00100-2","DOIUrl":"https://doi.org/10.1016/S1068-607X(02)00100-2","url":null,"abstract":"<div><p>Anthrax is a zoonotic disease caused by <span><em>Bacillus anthracis</em></span><span><span>. Herbivores are the natural host. Humans acquire the disease incidentally by contact with infected animals or animal products. The incidence of disease has decreased dramatically in developed countries as a result of animal vaccination programs<span> and improved industrial hygiene. Clinical disease in humans presents in three distinct forms: cutaneous, gastrointestinal, and inhalational. More than 90% of naturally occurring cases of anthrax in the United States are of the cutaneous form. </span></span>Eschar formation and edema at the site of inoculation characterize cutaneous anthrax. Gastrointestinal anthrax has never been reported in this country. Inhalational anthrax results from inhalation of </span><em>B. anthracis</em><span><span><span> endospores. The spores germinate in mediastinal lymph nodes<span> before hematogenous dissemination. Disease progresses rapidly from nonspecific symptoms to death in the majority of cases. Diagnosis can be made by Gram stain or by culture of body fluids or lesions. </span></span>Serologic tests<span> including enzyme-linked immunosorbent assay and polymerase chain reaction<span><span><span><span> are available in specialized laboratories. Marked widening of the mediastinum on chest radiograph is the most characteristic clinical finding. </span>Penicillin is the drug of choice for the treatment of anthrax infections. Other acceptable alternatives include </span>ciprofloxacin<span> and doxycycline. Supportive care in an </span></span>intensive care unit is a critical part of treatment for all but uncomplicated cutaneous infections. A vaccine is available for anthrax. Persons with high-risk occupations, such as laboratory workers and military forces, should receive the vaccine. In the case of suspected bioterrorism, ciprofloxacin or doxycycline should be given as </span></span></span>chemoprophylaxis. The vaccine should be given concurrently, if available.</span></p></div>","PeriodicalId":80301,"journal":{"name":"Primary care update for Ob/Gyns","volume":"9 4","pages":"Pages 117-121"},"PeriodicalIF":0.0,"publicationDate":"2002-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1068-607X(02)00100-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91762831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Smallpox","authors":"Jennifer Elizabeth Warren MD","doi":"10.1016/S1068-607X(02)00101-4","DOIUrl":"https://doi.org/10.1016/S1068-607X(02)00101-4","url":null,"abstract":"<div><p><span><span>Smallpox is caused by the </span>variola virus<span><span>, a large DNA virus that is unique to humans. Upon entering the host, the virus replicates and settles in the blood vessels of the skin and mucous membranes of the </span>oropharynx and </span></span>nasopharynx<span><span><span>. Direct contact and respiratory droplets are the primary means of spread. The incubation period of this virus averages 12 days after exposure. The initial </span>prodrome of smallpox includes fever, </span>myalgias<span><span>, and fatigue. Within 4 days after these symptoms, a characteristic vesicular rash appears, most prominent on the face and extremities. Within 3 to 4 weeks, scabs develop, separate, and fall off. Infected persons remain contagious until all lesions have healed. The diagnosis of smallpox is based primarily on physical examination; however, laboratory testing is available for unknown or atypical cases. Currently, no cure for smallpox exists. The most effective means of controlling this illness is prevention—by isolation of infected patients and </span>vaccination of susceptible contacts. Antibiotics and supportive care can be used to prevent secondary complications. Little is known about the effects of smallpox on pregnancy. Pregnant women experience a more severe infection, but fetal complications have not been well defined. Vaccination during pregnancy is not recommended unless there is known exposure to the virus. In light of recent terrorist threats, the potential for an epidemic with enormous public health impact secondary to the intentional release of smallpox has spawned efforts by the Centers for Disease Control and Prevention and other agencies in the United States to prepare for such disaster.</span></span></p></div>","PeriodicalId":80301,"journal":{"name":"Primary care update for Ob/Gyns","volume":"9 4","pages":"Pages 122-124"},"PeriodicalIF":0.0,"publicationDate":"2002-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1068-607X(02)00101-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137002807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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