Bacterial Multidrug Tolerance and Persisters: Understanding the Mechanisms, Clinical Implications, and Treatment Strategies

E. coli is the first organisms to be sequenced as genome and the classification within the DEC pathotypes has epidemiologic and clinical implications for managing diarrheal diseases. In many developing countries E.coli leads to cause of diarrhea in children. where the mode of transmissions takes place via food and water. based on their pathogenic phenotype and diseases they cause it can be classified into 6 groups. consequently, our awareness of the spectrum of diseases and syndromes that they cause is quite limited. Also, because we cannot readily identify infected patients, there are many complexities in defining the modes of attainment, prevention and treatment strategies, and estimating the burden of infectious squealed. These infections create many challenges, and no progress will take place until the diagnostic potential for these agents got improved. Identifying E. coli isolate co-express LA reiterates the difficulty of assigning bacteria to groups on the basis of their adherence phenotype or genotype. Therefore the analysis of E -coli with molecular methods demonstrates that strains carry will represent more characteristics of typical EPEC and also the lack of AggR regulon, we propose a novel classification approach for classifying E-coli therefore to recognize pathogens. In addition, the ability to simultaneously induce attaching effacing lesions and biofilm production may enhance the potential of the strains to cause diarrhea and prolong bacterial residence in the intestines, thus worsening malnutrition in the patients.

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Survey of expert second opinions in a tertiary psychiatric out-patient clinic in the Yorkshire region between 1988 and 2000

Psychiatric Bulletin ◽

10.1192/pb.27.11.416 ◽

2003 ◽

Vol 27 (11) ◽

pp. 416-420 ◽

Cited By ~ 4

Author(s):

Pratibha Nirodi ◽

Alex J. Mitchell ◽

Richard H. S. Mindham

Keyword(s):

Clinical Case ◽

Treatment Strategies ◽

Analysis Data ◽

Second Opinion ◽

Clinical Implications ◽

Specialist Care ◽

Detailed Review ◽

Case Evaluation ◽

New Diagnosis

Aims and MethodA medical second opinion is an expert clinical case evaluation requested by a colleague for a patient already under specialist care. There is no literature on the provision for second opinions in psychiatric practice other than those relating to the Mental Health Act 1983, and the availability of clinics offering second opinions varies greatly from one area to another. We undertook a survey of an expert second opinion service in Leeds over the period 1988–2000 and examined the case notes of 103 referred patients, of whom 71 were included in the analysis data.ResultsIn the majority of cases diagnoses were not changed, but alternative treatment strategies were suggested. The exception was for patients with a diagnosis of personality disorder, in whom neither a new diagnosis nor alternative management was commonly suggested. Half of the assessments were completed in a single visit, but a substantial minority required further evaluation as outpatients, close follow-up or even hospital admission for detailed review.Clinical ImplicationsWe believe that a second opinion service offers clinicians valuable support and expertise, especially in sector psychiatry. Evidence presented suggests that further therapeutic options are available for many patients regarded as ‘difficult to treat’. In some cases this may involve a period of observation free of all psychotropic medication. As in other specialities, psychiatrists should be aware of the value of further advice for patients with particularly refractory or unusual disorders.

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When Aortic Stenosis Is Not Alone: Epidemiology, Pathophysiology, Diagnosis and Management in Mixed and Combined Valvular Disease

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.744497 ◽

2021 ◽

Vol 8 ◽

Author(s):

Francesca Mantovani ◽

Diego Fanti ◽

Elvin Tafciu ◽

Simone Fezzi ◽

Martina Setti ◽

...

Keyword(s):

Aortic Stenosis ◽

Aortic Regurgitation ◽

Treatment Strategies ◽

Valve Disease ◽

Clinical Implications ◽

Diagnosis And Management ◽

Valve Prostheses ◽

Transcatheter Valve ◽

Valvular Lesion ◽

Valve Diseases

Aortic stenosis (AS) may present frequently combined with other valvular diseases or mixed with aortic regurgitation, with peculiar physio-pathological and clinical implications. The hemodynamic interactions between AS in mixed or combined valve disease depend on the specific combination of valve lesions and may result in diagnostic pitfalls at echocardiography; other imaging modalities may be helpful. Indeed, diagnosis is challenging because several echocardiographic methods commonly used to assess stenosis or regurgitation have been validated only in patients with the single-valve disease. Moreover, in the developed world, patients with multiple valve diseases tend to be older and more fragile over time; also, when more than one valvular lesion needs to address the surgical risk rises together with the long-term risk of morbidity and mortality associated with multiple valve prostheses, and the likelihood and risk of reoperation. Therefore, when AS presents mixed or combined valve disease, the heart valve team must integrate various parameters into the diagnosis and management strategy, including suitability for single or multiple transcatheter valve procedures. This review aims to summarize the most critical pathophysiological mechanisms underlying AS when associated with mitral regurgitation, mitral stenosis, aortic regurgitation, and tricuspid regurgitation. We will focus on echocardiography, clinical implications, and the most important treatment strategies.

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