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老年婦女多(59%)，平均66歲 而且症狀不太一樣 NTMthrive within the biofilm of municipal water systems and likely infect susceptible hosts via aerosolization 最近遇到兩個NTM，一個是天天游泳的老人家，請他莫再游了 is it ok to check the swimming pool water supply? MAC佔多，klaricid + EMB + Rif? Atypical Mycobacterial Infections Might Be on the Rise Pulmonary infections are now more common than pulmonary tuberculosis. Pulmonary infections with "atypical" nontuberculous mycobacteria have been recognized for decades, but reliable estimates of their prevalence are elusive for several reasons: These infections are tricky to diagnose, geographically variable, and untracked by local or federal health departments. Several reports from around the country now suggest that infection rates are rising. Investigators reviewed all clinical isolates of nontuberculous mycobacteria obtained from Oregon residents during 2005 and 2006. Estimated prevalence of pulmonary infection was 8 to 11 cases per 100,000, with a prevalence in older people (ag...

Guidelines for Preventing Recurrent Stroke Issued Updated guidelines on preventing recurrent ischemic stroke have been issued by the American Heart Association and the American Stroke Association. The document, published in Stroke, offers recommendations in a variety of areas, for example, management of risk factors such as smoking and obesity. The use of antithrombotic therapy after an intracranial hemorrhage also receives much attention. There are several new strong recommendations, based on high levels of evidence. Among them: Although the utility of screening patients for metabolic syndrome has not been established, the dyslipidemic and hypertensive features of the syndrome should be singled out for preventive care. In addressing glycemic control and hypertension in diabetes, targets in existing U.S. guidelines should be used. https://docs.google.com/fileview?id=0B278nGJMQBk7YTJmOTE5ODQtYTlmOC00ZDUwLTk2ZmUtYzU5YmZmMWQ3ZTk4&hl=zh_TW

健保資料庫文章 接受牙科手術後一個月，1.5倍 vascular events 六個月後降到baseline 平時吃aspirin的，手術後要吃回去 Invasive Dental Treatment Linked to Vascular Events? Invasive dental treatment might be associated with a short-term increase in vascular risk, according to a self-controlled study in the Annals of Internal Medicine. Using Medicaid databases, researchers identified some 1200 adults who both underwent invasive dental procedures (e.g., periodontal therapy, extractions) and also experienced a myocardial infarction or stroke from 2002 to 2006. They found that vascular events were more common in the month after dental treatment than at other times during the observation period (incidence ratio, 1.5). Risk gradually returned to baseline by 6 months after dental treatment. The authors point to acute inflammation as a potential underlying mechanism. They add that "the absolute risks are minimal, and the long-term benefits on vascular health will probably outweigh the short-lived adverse effects." Meanwhile, ed...

台灣的regimen不太一樣 基本上能不用fluroquinolone就不會用 Treatment of Multidrug-Resistant Tuberculosis In an observational study, a gatifloxacin-containing regimen for at least 9 months had the highest cure rate. Multidrug-resistant tuberculosis (MDRTB) is defined as infection caused by an organism resistant to both isoniazid and rifampin. Currently recommended treatment regimens are long, often poorly tolerated, and difficult to monitor. Treatment standardization has been recommended for MDRTB in low-income areas, which generally have low levels of resistance to second-line drugs. As part of a TB treatment program in Bangladesh, researchers conducted a prospective observational study from May 1997 through December 2007 to examine the effectiveness of this strategy. Patients with laboratory-confirmed MDRTB were treated with one of six regimens based on enrollment date (i.e., without randomization). Each regimen differed from the previous one, usually by a single change. All regimens contained a fluoroq...

競爭壓力改變族群 19A容易造成invasive disease and resistance Explaining the Increase in Pneumococcal Serotype 19A Heptavalent conjugated pneumococcal vaccine is associated with increased carriage of pneumococcal serotype 19A strains. Heptavalent conjugated pneumococcal vaccine (PCV-7) was incorporated into routine U.S. childhood vaccination schedules in 2001. Since then, reports have surfaced about outbreaks or clusters of children with invasive Streptococcus pneumoniae serotype 19A disease (JW Pediatr Adolesc Med May 23 2007 and JW Infect Dis Nov 7 2007). This serotype is known for its tendency to cause invasive disease and its resistance to antibiotics. Is the increase in serotype 19A disease a result of natural fluctuation in serotypes or introduction of the PCV-7 vaccine? To find out, investigators in the Netherlands conducted a post hoc analysis of data from a randomized study of PCV-7 dosing schedules conducted before routine use of the vaccine. Researchers compared the cumulative proportion ...

1/3人類H5N1病例在印尼，所以有理由相信印尼的豬也有問題 是地，豬是健康的帶菌者!! H5N1 Influenza A Infection of Pigs in Indonesia In areas with H5N1 influenza outbreaks in poultry, the virus was isolated from healthy-appearing pigs. About one third of all confirmed human H5N1 infections worldwide have occurred in Indonesia. Because pigs are believed to be "mixing vessels" for avian and human influenza viruses, investigators assessed whether pigs in Indonesia were being infected with H5N1 and whether the virus was changing receptor specificity. The researchers sampled nasal, fecal, and serum samples from healthy-appearing pigs in various districts of the country during three rainy seasons between 2005 and 2009. Among 702 nasal specimens obtained in 2005 and 2007, H5N1 was isolated from 52 (7.4%). Culture-positive pigs showed no signs of influenza-like illness. Among 300 pigs tested in 2008–2009, none were culture positive, although 3 (1%) had neutralizing antibodies to H5N1 virus. Viral sequences of the hemagglut...

CAP，多一點information多一點好處! Pneumococcal Urinary Antigen Screening in Hospitalized Patients with Community-Acquired Pneumonia Such screening could optimize antibiotic therapy. Although community-acquired pneumonia (CAP) is common, our ability to determine its etiology is limited. This determination is extremely important in ensuring appropriate therapy. A pneumococcal urinary antigen (PUA) test has been available for some time and has been used in CAP, but its role is not clearly defined. To explore this issue, researchers conducted a prospective evaluation of such screening. The study was performed at a single medical center in Spain and included all consecutive adults (age, ≥16 years) who were hospitalized for CAP between February 2007 and January 2008. Definite determination of CAP etiology was defined as isolation of a pathogen from a normally sterile sample (blood or pleural fluid); a positive result on a urinary antigen test for detection of Legionella pneumophila; a fourfold increa...

Smoking Ban Improves Asthma Rates in Children In Scotland, asthma hospital admission rates in children have dropped 18% per year since the smoking ban was instituted in 2006. In March 2006, Scotland banned smoking in enclosed public places, including restaurants and pubs. Investigators used a national database to tally all asthma hospital admissions for children younger than 15 years in Scotland between January 2000 and October 2009. Before the smoking ban, admission rates for asthma in children increased by a mean of 5.2% per year. After the ban, the annual rate declined by 18.2% relative to the rate in March 2006. In adjusted analyses, rates of decline were similar among preschool (–18.4%) and school-age (–20.8%) children. Comment: The authors discuss potential limitations of this observational study, including lack of data for individual patients and for those with asthma exacerbations who did not require hospitalization, and the possibility that other factors reduced hospital admis...