scholarly journals Recurrent Herpes Gladiatorum: Should we be Screening Our Service Members Prior to Close Combat Training?

2019 ◽  
Vol 185 (5-6) ◽  
pp. e904-e908
Author(s):  
Robert D Field ◽  
Bradley M Taylor
Keyword(s):  
Skin Diseases ◽  
Treatment Guidelines ◽  
Treatment Protocol ◽  
Primary Care Providers ◽  
Active Duty ◽  
Care Providers ◽  
Herpes Simplex Virus 1 ◽  
Combat Training ◽  
Skin Contact ◽  
Hsv 1

Abstract A 19-year-old active duty Marine presented to clinic with a history of a reoccurring vesicular rash on left side of his forehead. The lesion was cultured and identified as herpes simplex virus 1 (HSV-1). Herpes gladiatorum is a recurrent cutaneous infection caused by HSV-1 and spread by skin-to-skin contact. Serious complications have been reported, including blindness from acute retinal necrosis. Outbreaks of herpes gladiatorum have been observed in the high school and collegiate wrestling community for years and to prevent the spread, screening, and treatment guidelines have been implemented by governing bodies of these organizations. Active duty members who participate in the Marine Corps Martial Arts Program and the Army and US Air Force Combatives programs are exposed to similar conditions; however, no uniform screening or treatment protocol exists. To minimize the spread of skin infections, we propose adopting a uniform screening procedure and implementing a standardized form to assist primary care providers in the evaluation and treatment of herpes gladiatorum and other communicable skin diseases commonly seen in close combat training.

scholarly journals Colorectal Cancer in the Young: Epidemiology, Prevention, Management

2020 ◽  
pp. e75-e88 ◽  
Author(s):  
Rebecca L. Siegel ◽  
Christopher Dennis Jakubowski ◽  
Stacey A. Fedewa ◽  
Anjee Davis ◽  
Nilofer S. Azad
Keyword(s):  
Colorectal Cancer ◽  
Young Patients ◽  
Treatment Protocol ◽  
Primary Care Providers ◽  
The United States ◽  
Rectal Disease ◽  
Care Providers ◽  
Early Screening ◽  
Related Factors ◽  
Cancer Management

Colorectal cancer (CRC) incidence rates in the United States overall have declined since the mid-1980s because of changing patterns in risk factors (e.g., decreased smoking) and increases in screening. However, this progress is increasingly confined to older adults. CRC occurrence has been on the rise in patients younger than age 50, often referred to as early-onset disease, since the mid-1990s. Young patients are more often diagnosed at an advanced stage and with rectal disease than their older counterparts, and they have numerous other unique challenges across the cancer management continuum. For example, young patients are less likely than older patients to have a usual source of health care; often need a more complex treatment protocol to preserve fertility and sexual function; are at higher risk of long-term and late effects, including subsequent primary malignancies; and more often suffer medical financial hardship. Diagnosis is often delayed because of provider- and patient-related factors, and clinicians must have a high index of suspicion if young patients present with rectal bleeding or changes in bowel habits. Educating primary care providers and the larger population on the increasing incidence and characteristic symptoms is paramount. Morbidity can further be averted by increasing awareness of the criteria for early screening, which include a family history of CRC or polyps and a genetic predisposition.

scholarly journals Treatment of Dermatological Conditions Associated with HIV/AIDS: The Scarcity of Guidance on a Global Scale

2016 ◽  
Vol 2016 ◽  
pp. 1-21 ◽  
Author(s):  
Suchismita Paul ◽  
Rachel Evans ◽  
Toby Maurer ◽  
Lulu M. Muhe ◽  
Esther E. Freeman
Keyword(s):  
Health Care Providers ◽  
Skin Diseases ◽  
Treatment Guidelines ◽  
Global Scale ◽  
Hiv Care ◽  
Care Providers ◽  
Treatment Information ◽  
Evidence Quality ◽  
Skin Conditions ◽  
Hiv Aids

Background. Skin diseases associated with Human Immunodeficiency Virus (HIV) infection are associated with significant morbidity and mortality. In resource-limited settings, nondermatologists and lay health care providers on the front line of HIV care provide much of the treatment for these conditions.Objective. To evaluate guidelines for treatment of HIV-related skin conditions and assess their accessibility, comprehensiveness, and quality of evidence employed.Methods. A review was undertaken of all national and society guidelines which included treatment information on the ten highest burden HIV-related skin conditions. The search strategy included gray and peer-reviewed literature.Results. Of 430 potential guidelines, 86 met inclusion criteria, and only 2 were written specifically to address HIV-related skin diseases as a whole. Treatment information for HIV-related skin conditions was embedded within guidelines written for other purposes, primarily HIV/AIDs treatment guidelines (49%). Development of guidelines relied either partially or completely on expert opinion (62%). Only 16% of guidelines used gradation of evidence quality and these were primarily from high-income countries(p=0.001).Limitations. Due to the nature of gray literature, not all guidelines may have been identified.Conclusion. This review highlights the need for evidence-based summary guidelines that address treatment for HIV-related skin conditions in an accessible format.

scholarly journals Lower‐Intensity Statins Contributing to Gaps in Care for Patients With Primary Severe Hypercholesterolemia

2021 ◽  
Author(s):  
Wael E. Eid ◽  
Emma Hatfield Sapp ◽  
Elijah Flerlage ◽  
Joseph R. Nolan
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Treatment Guidelines ◽  
Primary Care Providers ◽  
Lipid Lowering ◽  
Moderate Intensity ◽  
Lipid Lowering Therapy ◽  
Care Providers ◽  
Group 2 ◽  
Group 1

Background Although severe hypercholesterolemia confers a 5‐fold increased long‐term risk for coronary artery disease, treatment guidelines may not be fully implemented, leading to underdiagnosis and suboptimal treatment. To further understand the clinical features and gaps in treatment approaches, we analyzed electronic medical record data from a midwestern US multidisciplinary healthcare system, between 2009 and 2020. Methods and Results We retrospectively assessed the prevalence, clinical presentation, and treatment characteristics of individuals currently treated with statin therapy having a low‐density lipoprotein cholesterol (LDL‐C) value that is either (1) an actual maximum electronic medical record–documented LDL‐C ≥190 mg/dL (group 1, n=7542) or (2) an estimated pretreatment LDL‐C ≥190 mg/dL (group 2, n=7710). Comorbidities and prescribed lipid‐lowering therapies were assessed. Statistical analyses identified differences among individuals within and between groups. Of records analyzed (n=266 282), 7% met the definition for primary severe hypercholesterolemia. Group 1 had more comorbidities than group 2. More individuals in both groups were treated by primary care providers (49.8%–53.0%, 32.6%–36.4%) than by specialty providers (4.1%–5.5%, 2.1%–3.3%). High‐intensity lipid‐lowering therapy was prescribed less frequently for group 2 than for group 1, but moderate‐intensity statins were prescribed more frequently for group 2 (65%) than for group 1 (52%). Conclusions Two percent of patients in our study population being treated with low‐ or moderate‐intensity statins have an estimated LDL‐C ≥190 mg/dL (indicating severe hypercholesterolemia), but receive less aggressive treatment than patients with a maximum measured LDL‐C ≥190 mg/dL.

Antimicrobial Resistance Education in the Primary Care Setting

2016 ◽  
Vol 9 (2) ◽  
pp. 217-225
Author(s):  
Jenna Oesterle ◽  
Meghan Sternemann ◽  
Tiffany Sande ◽  
Christina Aplin-Kalisz ◽  
Diane Towers
Keyword(s):  
Primary Care ◽  
Antimicrobial Resistance ◽  
Educational Intervention ◽  
Treatment Guidelines ◽  
Primary Care Providers ◽  
National Committee ◽  
Antibiotic Prescribing ◽  
Care Providers ◽  
Prescribing Practices ◽  
Convenience Sample

Background:Antimicrobial resistance has become a problem of epidemic proportions; however, patients believe antibiotics can treat any infection (National Committee for Quality Assurance [NCQA], 2011). Judicious prescribing practices are known to decrease antimicrobial resistance in the community (Centers for Disease Control [CDC], 2012).Purpose:Primary care providers (PCPs) are in a position to change current prescribing practices and patient beliefs regarding antimicrobials. This project focused on a PCP-facilitated educational intervention.Design/Methods:A quasi-experimental chart review performed over 3 months. PCPs were educated on CDC treatment guidelines for acute bronchitis, sinusitis, pharyngitis, and the educational pamphlet. The PCPs provided a brief educational session with the pamphlet to patients presenting with upper respiratory infections (URIs).Sample:A convenience sample of patients 18–64 years old presenting with URI symptoms; data were collected on antibiotic prescriptions, patient demographics, comorbid diagnoses, and discharge diagnosis.Results:Antibiotic prescribing rates for patient’s pre- to postintervention decreased significantly from 77.9% to 61.6% (1,N= 163) = 0.02,p< .05. Improved adherence to guidelines from pre- to postintervention for bronchitis was demonstrated yet no statistically significant improvement for pharyngitis and sinusitis.Conclusion:A PCP-facilitated educational intervention demonstrated an effective method to reduce antibiotic prescriptions for URIs in primary care.

scholarly journals Evidence-based primary care approach to treating people with COVID-19 infection to prevent life-threatening complications: A review of the evidence for practical application in a clinical setting

2021 ◽  
Vol 5 (1) ◽  
pp. 009-014
Author(s):  
Sharon Thomas A
Keyword(s):  
Primary Care ◽  
At Risk ◽  
Treatment Guidelines ◽  
Primary Care Providers ◽  
Evidence Based ◽  
Cytokine Storm ◽  
Care Providers ◽  
Vitamin D Levels ◽  
Cytokine Levels ◽  
Standard Practices

The NIH has published treatment guidelines for treating COVID-19 patients in the hospital. However, as of this writing, there are no established protocols for treating COVID-19 positive patients in primary care. Accordingly, this investigator has taken on the task of reviewing the medical literature to be able to propose evidence-based protocols for treating COVID-19 positive patients in primary care. The CDC is advising people to do nothing when they find out they are positive for COVID-19 unless they have symptoms. The evidence from the literature irrefutably shows COVID-19 infection evokes a massive and deadly hyperinflammatory response called the “Cytokine storm” and that Cytokine levels in the blood have a predictive value in identifying an impending Cytokine storm. With such data primary care providers can effectively lower Cytokine levels and prevent critical illness and death. Accordingly, this paper presents identification of the problem of not having standard practices in primary care for people who are positive for COVID-19 and not knowing who is at risk. Moreover, the evidence shows that knowing vitamin D levels and correcting deficiencies can go a long way in reducing Cytokine levels. Additionally, the literature review presents evidence that undeniably shows the stark possibility that many of the COVID-19 related deaths can be prevented by identifying who is at risk for the Cytokine storm and other complications and providing early treatment even before symptoms appear.

Assembly of VP26 in herpes simplex virus-1 capsid implicated by 3-D structure of recombinant capsid

1995 ◽  
Vol 53 ◽  
pp. 840-841
Author(s):  
Z. Hong Zhou ◽  
Jing He ◽  
Joanita Jakana ◽  
J. D. Tatman ◽  
Frazer J. Rixon ◽  
...  
Keyword(s):  
Herpes Simplex Virus ◽  
Herpes Simplex ◽  
3D Structure ◽  
Structure Study ◽  
Herpes Simplex Virus 1 ◽  
Shell Proteins ◽  
Life Threatening ◽  
Infected Cells ◽  
Simplex Virus ◽  
Hsv 1

Herpes simplex virus-1 (HSV-1) is a ubiquitous virus which is implicated in diseases ranging from self-curing cold sores to life-threatening infections. The 2500 Å diameter herpes virion is composed of a glycoprotein spike containing, lipid envelope, enclosing a protein layer (the tegument) in which is embedded the capsid (which contains the dsDNA genome). The B-, and A- and C-capsids, representing different morphogenetic stages in HSV-1 infected cells, are composed of 7, and 5 structural proteins respectively. The three capsid types are organized in similar T=16 icosahedral shells with 12 pentons, 150 hexons, and 320 connecting triplexes. Our previous 3D structure study at 26 Å revealed domain features of all these structural components and suggested probable locations for the outer shell proteins, VP5, VP26, VP19c and VP23. VP5 makes up most of both pentons and hexons. VP26 appeared to bind to the VP5 subunit in hexon but not to that in penton.

The Perspective of Older Men With Depression on Suicide and Its Prevention in Primary Care

Crisis ◽  
2018 ◽  
Vol 39 (5) ◽  
pp. 397-405 ◽  
Author(s):  
Steven Vannoy ◽  
Mijung Park ◽  
Meredith R. Maroney ◽  
Jürgen Unützer ◽  
Ester Carolina Apesoa-Varano ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Socioeconomic Status ◽  
Thematic Analysis ◽  
Older Men ◽  
Primary Care Providers ◽  
Depression Treatment ◽  
Care Providers ◽  
Low Socioeconomic ◽  
Self Image ◽  
The Impact

Abstract. Background: Suicide rates in older men are higher than in the general population, yet their utilization of mental health services is lower. Aims: This study aimed to describe: (a) what primary care providers (PCPs) can do to prevent late-life suicide, and (b) older men's attitudes toward discussing suicide with a PCP. Method: Thematic analysis of interviews focused on depression and suicide with 77 depressed, low-socioeconomic status, older men of Mexican origin, or US-born non-Hispanic whites recruited from primary care. Results: Several themes inhibiting suicide emerged: it is a problematic solution, due to religious prohibition, conflicts with self-image, the impact on others; and, lack of means/capacity. Three approaches to preventing suicide emerged: talking with them about depression, talking about the impact of their suicide on others, and encouraging them to be active. The vast majority, 98%, were open to such conversations. An unexpected theme spontaneously arose: "What prevents men from acting on suicidal thoughts?" Conclusion: Suicide is rarely discussed in primary care encounters in the context of depression treatment. Our study suggests that older men are likely to be open to discussing suicide with their PCP. We have identified several pragmatic approaches to assist clinicians in reducing older men's distress and preventing suicide.

Sign in / Sign up

Export Citation Format

Share Document