Abstract:
:Fluoroquinolone-resistant variants of pandemic clones Spain(23F)-1, Spain(6B)-2, Spain(9V)-3, and Spain(14)-5 have been seen in various regions of the United States and the world, leading to the speculation that fluoroquinolone resistance among US Streptococcus pneumoniae may increase because of clonal spread. Using levofloxacin as a representative of the fluoroquinolone class, all 196 levofloxacin-resistant pneumococci from a total of 22 794 isolates in the Tracking Resistance in the United States Today (TRUST) 5-8 studies (2001-2004) were subjected to pulsed-field gel electrophoresis (PFGE), serotyping, and sequencing of parC/E and gyrA/B quinolone resistance-determining regions (QRDR) to measure the extent of clonality. In addition, susceptibility testing of these isolates to ciprofloxacin, gatifloxacin, levofloxacin, and moxifloxacin was performed. ATCC type strains of Spain(23F)-1, Spain(6B)-2, Spain(9V)-3, and Spain(14)-5 clones were included as comparators. Levofloxacin-resistant isolates with Spain(23F)-1-related PFGE patterns decreased from 28% of the resistant isolates in 2001 to 6% in 2004. These isolates, with serotypes 23F (n = 17), 19F (n = 17), or 19A (n = 1), had 15 different QRDR profiles and were all ciprofloxacin- and gatifloxacin-resistant. Levofloxacin-resistant isolates with Spain(9V)-3-related PFGE patterns decreased from 13% of the resistant isolates in 2001 to 2% in 2004. The Spain(9V)-3-related isolates were serotype 9V (n = 9), 9A (n = 2), and 9N (n = 1) and exhibited 6 different QRDR profiles. All were resistant to all fluoroquinolones tested. None of the levofloxacin-resistant isolates had PFGE patterns related to Spain(6B)-2 or Spain(14)-5. Resistance to respiratory fluoroquinolones among pneumococci has remained constant at about 1% (0.8%-1.1%) since 2001, and there has been a decrease in the prevalence of levofloxacin-resistant isolates similar to Spain(23F)-1 or Spain(9V)-3. Considerable QRDR variability among these strains appears to be the result of sporadic independent mutational events as opposed to clonal expansion.
journal_name
Postgrad Medjournal_title
Postgraduate medicineauthors
Davies TA,Yee YC,Goldschmidt R,Sahm DF,Evangelista ATdoi
10.3810/pgm.2008.09.suppl52.283subject
Has Abstractpub_date
2008-09-01 00:00:00pages
39-45issue
3 Suppl 1eissn
0032-5481issn
1941-9260journal_volume
120pub_type
杂志文章abstract::Bleeding from esophagogastric varices carries a high mortality rate. Active variceal bleeding can usually be temporarily controlled medically with a combination of intravenous vasopressin and nitroglycerin, with balloon tamponade, or with endoscopic sclerotherapy. Because of the high likelihood of recurrence, long-ter...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1991.11700924
更新日期:1991-05-01 00:00:00
abstract::Dementia is one of the most devastating illnesses that affect the elderly. The progressive decline in memory, judgment, intellectual function, and adaptive ability places an immense burden on families, healthcare providers, and communities. Because advancing age is the leading risk factor for most types of dementia, t...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:
更新日期:1994-04-01 00:00:00
abstract::In the Western world, diabetes is the biggest cause of peripheral neuropathy, usually distal symmetric polyneuropathy but some times another polyneuropathy or a focal neuropathy. In addition, hypothyroidism and acromegaly can cause carpal tunnel syndrome and other sensory complaints. A complete blood cell count, nerve...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1997.09.318
更新日期:1997-09-01 00:00:00
abstract::Metformin is a first-line pharmacological treatment for patients with type 2 diabetes mellitus because of its favorable overall profile, including its glucose-lowering ability, weight-neutral effects, and low risk of hypoglycemia; however, gastrointestinal (GI) intolerance may limit use in some patients. Extended-rele...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2011.01.2241
更新日期:2011-01-01 00:00:00
abstract::When a patient presents with involuntary weight loss, the etiologic considerations can be overwhelming. To plan a cost-effective workup, physicians need to be aware of the most common causes of weight loss and the tests that yield the most pertinent data. Drs Wise and Craig review the clinical studies on unintentional...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1994-03-01 00:00:00
abstract::Preview Although the early symptoms of Parkinson's disease can be ameliorated, the illness is relentlessly progressive. Studies have therefore been conducted in hopes of finding therapy to delay its disabling course. In this article, Dr Ahlskog examines recent proposals and their application in cases of early and adva...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1994.11945830
更新日期:1994-05-01 00:00:00
abstract:OBJECTIVE:To evaluate the pharmacokinetics of lisdexamfetamine dimesylate (LDX), a long-acting prodrug stimulant, and mixed amphetamine salts extended-release (MAS XR), alone or with omeprazole, a proton pump inhibitor (PPI). METHODS:This open-label, randomized, 4-period crossover study enrolled healthy adults (18-45 ...
journal_title:Postgraduate medicine
pub_type: 杂志文章,随机对照试验
doi:10.3810/pgm.2009.09.2048
更新日期:2009-09-01 00:00:00
abstract::A hepatitis B vaccine derived from the plasma of carriers of hepatitis B virus has recently become generally available in the United States. Its use is recommended in groups considered to be at high risk of hepatitis B because of their exposure to potentially infectious blood, saliva, or semen. Experience in more than...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1983.11697828
更新日期:1983-05-01 00:00:00
abstract::Auscultation is the core of pediatric cardiovascular evaluation and should be performed according to a routine. The four heart sounds should be sought in order at their usual locations, with particular attention to the second sound because of its important diagnostic role in congenital cyanotic heart disease. The next...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1982.11716128
更新日期:1982-07-01 00:00:00
abstract::In a series of 123 children with disorders of defecation, constipation was the main problem in 89 and fecal incontinence in 34. All but three of the latter also had constipation. The principal physical findings were abdominal protuberance with palpable stool in the bowel and the presence of a fecal mass in the rectal ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1979.11715223
更新日期:1979-08-01 00:00:00
abstract::Difficult or painful coitus is a symptom, not a pathologic entity. It may be caused by a congenital anomaly, an organic lesion, or a functional disorder of the vulva or vagina, or it may be psychic in origin. Although its cause can usually be determined relatively easily, a conditioned reflex created by a preexisting ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1983.11697774
更新日期:1983-02-01 00:00:00
abstract::This article reviews the definition, mechanisms, epidemiology, and clinical sequelae of the metabolic syndrome and explores potential relationships between the metabolic syndrome, type 2 diabetes, and cardiovascular disease. Definitions for the metabolic syndrome proposed by the World Health Organization and the Natio...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.12.2003.suppl31.175
更新日期:2003-12-01 00:00:00
abstract::The sexual addiction model enables physicians to understand the self-destructive behavior of patients whose actions may otherwise appear inexplicable. When a person is preoccupied with sex and continues to engage in compulsive sexual activity despite adverse consequences (eg, loss of marriage, job, health, freedom), h...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1991.11701111
更新日期:1991-11-01 00:00:00
abstract::GRATEFUL MED is a computer program for searching the medical literature, designed with the novice in mind. It contains an extensive list of medical subject headings, so the user does not have to page through an index of key words before starting the search. Because of its efficiency and ease of operation, the program ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1988.11700124
更新日期:1988-01-01 00:00:00
abstract::Many patients with significant carotid artery stenosis are candidates for endarterectomy, a procedure now proved to reduce the incidence of future stroke and death. In this article, Drs Jaigobin and Perry describe an approach to patients with both symptomatic and asymptomatic carotid stenosis and review current indica...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1994-10-01 00:00:00
abstract::Twenty of 24 hypertensive patients, six of whom had severe disease, had a reduction in standing blood pressure to less than 140/90 mm Hg after six weeks of treatment with prazosin alone or prazosin plus other antihypertensive drugs. The absence of significant side effects was impressive. ...
journal_title:Postgraduate medicine
pub_type: 临床试验,杂志文章
doi:
更新日期:1975-11-01 00:00:00
abstract::Phencyclidine (PCP) is a dissociative anesthetic whose abuse is a growing problem. Historically, its effects have been considered remarkably like those of the schizophrenic state, but in vitro and in vivo neuropharmacologic data are somewhat inconsistent with the dopaminergic hypothesis of schizophrenia. The physiolog...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1980.11715603
更新日期:1980-11-01 00:00:00
abstract::Gastroesophageal reflux disease is a very common condition that is usually manifested by heartburn or regurgitation. Reflux esophagitis, caused by mucosal exposure to the backflow of caustic gastric contents, is primarily a result of lower esophageal sphincter dysfunction. Diagnostic workup varies but commonly include...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1991.11700938
更新日期:1991-05-15 00:00:00
abstract:OBJECTIVE:Chronic kidney disease is a global public health concern. Glomerular filtration rate (GFR) prediction based on serum creatinine is used to assess renal function in the elderly. The Cockcroft-Gault (CG) formula, based on body surface area (CG/BSA formula), and the Modified Diet and Renal Disease formula (MDRD ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.3810/pgm.2010.11.2221
更新日期:2010-11-01 00:00:00
abstract::Spirometry is a simple but underutilized test that is particularly well suited for office practice. With it, the physician can distinguish among different types of ventilatory impairment and follow the patient's course. It also permits detection of small-airway disease at an early stage, when measures to prevent devel...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1978.11714724
更新日期:1978-01-01 00:00:00
abstract::A concerted national effort has reduced cardiovascular mortality rates in the general US population. Unfortunately, not all ethnic groups have benefited equally from these improvements in our national health. The author presents insights into social and clinical factors that affect cardiovascular disease among Hispani...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1992.11701252
更新日期:1992-03-01 00:00:00
abstract::Although evidence indicates that the incidence of stroke has declined over the past 30 years, stroke remains one of the leading causes of disability and death in the United States. Prevention appears to be the best treatment. According to the Straub Stroke Registry, 52% of strokes in its patient population can be attr...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1986.11699535
更新日期:1986-09-15 00:00:00
abstract::Fear of the needle is a real issue with some patients and may be an obstacle to inducing anesthesia before minor surgical procedures are performed. Adults may express this fear verbally or, out of embarrassment, even avoid coming to the physician's office. Children may become intensely anxious and hysterical. In this ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1991.11700843
更新日期:1991-02-15 00:00:00
abstract::Genetic syndromes that convey a significant risk of breast cancer are responsible for a small but significant percentage of these cancers. However, the vast majority of breast cancers occur in women with no family history of the disease. Nongenetic risk factors include age, previous breast disease, breast tissue densi...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2004.10.1595
更新日期:2004-10-01 00:00:00
abstract::In view of all the controversy surrounding travelers' diarrhea, how should patients be counseled regarding its prevention and treatment? First, all patients should be instructed on the importance of eating and drinking only safe food and water and on methods of dietary manipulation and oral rehydration therapy. The tr...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1985.11698933
更新日期:1985-03-01 00:00:00
abstract::The goal of screening for colorectal cancer is to find early, asymptomatic cancers and adenomatous polyps that are 1 cm or more in diameter or that are villous or tubulovillous histologically. A study using fecal occult blood testing with rehydration and no sigmoidoscopy found that deaths from colorectal cancer can be...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1994-07-01 00:00:00
abstract::Primary adrenal insufficiency due to tumor involvement is very rare. We herein report a case of adrenal insufficiency caused by cancer metastasis to a remaining single adrenal gland in a renal cell carcinoma patient who had undergone radical nephrectomy including removal of the right adrenal gland. The patient present...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.2019.1696581
更新日期:2020-04-01 00:00:00
abstract::Patients "lucky" enough to have a nondisabling transient ischemic attack as a warning sign of impending stroke deserve the best possible prophylactic treatment in an attempt to avert that catastrophe. Dr Edmeads provides a step-by-step discussion of diagnostic studies and therapeutic regimens that help avoid stroke in...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1992.11701427
更新日期:1992-08-01 00:00:00
abstract::Self-assessment case studies illustrating prudent selection of antimicrobial agents in septic shock following urinary catheterization, bacteremia and skin lesions in an immunocompromised patient, and endocarditis in a patient with a prosthetic heart valve. ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1978.11714791
更新日期:1978-03-01 00:00:00
abstract:OBJECTIVES:Multilevel noncontiguous thoracic and lumbar spinal tuberculosis (MNST) is a relatively rare entity. The objective of this retrospective study was to investigate whether a technique involving a one-stage posterior debridement and decompression, combined with an intervertebral fusion and posterior instrumenta...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.2019.1552824
更新日期:2019-01-01 00:00:00