Background: Hospital based studies of occupational risk factors for knee disorders are complicated by the possibility of selective referral to hospital of people whose work is made difficult by their symptoms. Aims: To explore the extent of such bias and to assess the association of meniscal injury with occupational activities. Methods: A questionnaire was mailed to a community sample of 2806 men aged 20-59 years in southern England. This asked about lifetime occupational and sporting activities, and any history of knee symptoms lasting 24 hours or longer. Rates of hospital referral were compared in symptomatic men according to their occupational activities. In a nested case-control investigation, the occupational activities of 67 men who reported meniscectomy were compared with those of 335 controls. Results: Among 1404 men who responded to the questionnaire, the lifetime prevalence of knee symptoms was 54%, and in 70% of cases the symptoms had started suddenly, usually while playing sport. Symptomatic men whose work entailed kneeling or squatting were more likely to be referred to an orthopaedic surgeon than the average (28% and 31% versus 24%), especially if they experienced locking of the knee (69% and 73% versus 43%). In the nested case-control study, meniscectomy was associated with playing soccer and work that involved regular kneeling or squatting. Conclusions: Results suggest that hospital referral for knee symptoms is influenced to some extent by patients' occupational activities. Playing soccer is confirmed as a strong risk factor for knee cartilage injury.
This prospective, randomized, multicenter trial compared the efficacy of two antibiotic regimens for treatment of foot infections in diabetic adults. Patients with infections requiring hospitalization were randomized to receive either intravenous ofloxacin followed by oral ofloxacin or intravenous ampicillin/sulbactam followed by oral amoxicillin/clavulanate (the aminopenicillin regimen) for 14-28 days. Patients with osteomyelitis were eligible for the study if the infected bone was to be removed. Of 108 patients enrolled in the study, 88 who were evaluable had various skin and softtissue infections, and 24% had osteomyelitis. For the ofloxacin and aminopenicillin regimens, the mean duration of intravenous therapy was 7.8 and 7.1 days, respectively, the mean duration of oral therapy was 13.2 and 12.0 days, respectively, the rate of eradication of pathogens was 78% and 88%, respectively, and the overall rate of clinical cure or improvement was 85% and 83%, respectively. Thus, about 3 weeks of therapy with either regimen was well tolerated and effective in treating these diabetic foot infections.Lower-extremity infections are a frequent problem in diabetic patients and are now the most common cause of hospitalization [1][2][3][4]. Although some patients can be treated exclusively as outpatients, most are hospitalized initially for diagnostic studies and parenteral antibiotic therapy. In the past two decades, studies have helped to define the etiologic agents of these infections [1], but there have been surprisingly few investigations of antimicrobial therapy [1][2][3].Among the previously published reports on the efficacy of antibiotic therapy for diabetic foot infections, only four were randomized, controlled trials: one exclusively enrolled outpatients with relatively mild infections [4], two involved hospitalized patients with peripheral vascular disease [5,6], and one included only patients with limb-threatening infections [7].A variety of antibiotics, ranging from narrow-spectrum oral agents to broad-spectrum parenteral agents, were employed. Thus, few data are available to help clinicians determine the optimal choice of antimicrobial(s), the need for parenteral vs. oral agents, and the duration of therapy required for these infections. To address these issues, we conducted a prospective, Received 30 May 1996; revised 7 November 1996. Informed consent was obtained from the patients, and the guidelines for human experimentation of the U.S. Department of Health and Human Services and the authors' institutions were followed in the conduct of this clinical research.Financial randomized, multicenter study of the efficacy of two relatively broad-spectrum therapeutic regimens administered parenterally initially and then orally. MethodsPatients who had diabetes mellitus and a foot infection that required antibiotic therapy, as evidenced by purulent drainage, erythema, and swelling, and who were 18 years of age or older were potentially eligible for enrollment in the study. Patients were initially hospitalized usually...
The use of condom catheters is less likely to lead to bacteriuria, symptomatic UTI, or death than the use of indwelling catheters. This protection is especially apparent in men without dementia.
Hematophagous arthropods are capable of transmitting human and animal pathogens worldwide. Vector-borne diseases account for 17% of all infectious diseases resulting in 700,000 human deaths annually. Repellents are a primary tool for reducing the impact of biting arthropods on humans and animals. N,N-Diethyl-meta-toluamide (DEET), the most effective and long-lasting repellent currently available commercially, has long been considered the gold standard in insect repellents, but with reported human health issues, particularly for infants and pregnant women. In the present study, we report fatty acids derived from coconut oil which are novel, inexpensive and highly efficacious repellant compounds. These coconut fatty acids are active against a broad array of blood-sucking arthropods including biting flies, ticks, bed bugs and mosquitoes. The medium-chain length fatty acids from C8:0 to C12:0 were found to exhibit the predominant repellent activity. In laboratory bioassays, these fatty acids repelled biting flies and bed bugs for two weeks after application, and ticks for one week. Repellency was stronger and with longer residual activity than that of DEET. In addition, repellency was also found against mosquitoes. An aqueous starch-based formulation containing natural coconut fatty acids was also prepared and shown to protect pastured cattle from biting flies up to 96-hours in the hot summer, which, to our knowledge, is the longest protection provided by a natural repellent product studied to date.
We have reviewed the clinical syndrome of diabetic bullae and presented brief clinical details of these cases; we offer several vignettes and photographs of these lesions to remind clinicians of what we believe is a not so rare cutaneous disorder.
Both patients and nursing staff prefer condom to indwelling catheters for patient comfort, but they recognize that dislodgment and leaking are major drawbacks of condom catheters. A more secure condom catheter would greatly improve the management of male incontinence.
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