Decision making by analogy

Article Abstract:

The coexistence of pericarditis, a risk of bleeding, and blood clots in the deep veins of the legs may complicate a decision to use anticoagulant therapy, but such therapy may be beneficial in treating blood clots, especially when a blood clot in the lungs is suspected. Pericarditis is an inflammation of the sac surrounding the heart. An analysis of the complicated case of a 27-year-old woman with sharp chest pain, productive cough, shortness of breath, and nausea may illustrate the difficulty in deciding whether to administer anticoagulant therapy. The pericarditis was finally explained by a diagnosis of systemic lupus erythematosus on the sixth hospital day. The decision whether to administer anticoagulant therapy such as heparin may not be made easier by the diagnosis of lupus. When the risk of treatment for a particular condition is unknown, doctors may estimate the risk by identifying an analogous disorder for which treatment risks are known. In this patient, the risk of blood clots in the legs and lungs may have been worse than the possibility of bleeding in the pericardium.

Methods, Practice, Clinical medicine, Physicians, Medical professions

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Bartonella (Rochalimaea) quintana bacteremia in inner-city patients with chronic alcoholism

Article Abstract:

Bartonella quintana may be the cause of fever, bacteria in the blood, and endocarditis in HIV-negative, homeless, inner-city patients with chronic alcoholism. B. quintana has been identified as the cause of epidemics of trench fever among soldiers in Europe during World War I. Endocarditis is an inflammation of the lining of the heart. B. quintana was isolated from 34 blood cultures from 10 HIV-negative patients between January and June 1993 in Seattle. A retrospective case-control study of the blood samples using polymerase chain reaction-restriction-fragment-length polymorphism (PCR-RFLP) analysis suggested that the patient's cases were linked to a common source. The mode of transmission of B. quintana may have been close body contact among the patients, who were all homeless and whose chronic alcoholism and homelessness may have contributed to poor hygiene. All of the patients were nonwhite. The transmitter of B. quintana is the human body louse. Only one patient was observed to have lice upon hospitalization.

Causes of, Homeless persons, Endocarditis, Bacterial, Bacterial endocarditis, Bacteremia, Bartonella, Alcoholics, Trench fever

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Smoking and pneumococcal infection

Article Abstract:

Many smokers may benefit from receiving the pneumococcal vaccine. One study found that smoking quadrupled the risk of developing invasive pneumococcal infection. People exposed to second-hand smoke also had a higher than normal risk of invasive pneumococcal infection. Smoking damages the respiratory tract, increasing its permeability and allowing the bacterium to invade it. This could be one reason why many otherwise healthy people develop invasive pneumococcal infection. In one study, more than half of the healthy people with invasive pneumococcal infection were smokers.

Editorial, Streptococcal infections, Risk factors, Smoking

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