RESUMO
The mechanism of resistance was investigated in 39 macrolide-resistant clinical isolates of Streptococcus pneumoniae isolated from January 1997 to July 1999 in Santiago, Chile. Our results showed that 22 (56.5%) were macrolide-resistant, clindamycin-susceptible isolates (M phenotype) and 17 (43.5%) were macrolide and clindamycin resistant (MLS(B) phenotype). mefE gene was detected in all M phenotype, while ermB gene was detected in all MLS(B)-phenotype strains. Serotype 14 was the most frequent serotype among M-phenotype strains, and serotypes 19 and 23F were the most frequent serotypes in MLS(B) strains. These results demonstrate that both phenotypes of macrolide-resistant S. pneumoniae are found in Santiago, Chile, with the M phenotype predominating.
Assuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana , Eritromicina/farmacologia , Proteínas de Membrana , Streptococcus pneumoniae/efeitos dos fármacos , Adulto , Proteínas de Bactérias/genética , Criança , Chile , Clindamicina/farmacologia , Farmacorresistência Bacteriana/genética , Humanos , Metiltransferases/genética , Testes de Sensibilidade Microbiana , Fenótipo , Sorotipagem , Streptococcus pneumoniae/classificação , Streptococcus pneumoniae/genéticaRESUMO
The reliability and validity of the application of legal criteria for commitment were investigated as part of a larger study. Evaluations of 411 patients by 96 different clinicians showed good interrater reliability for assessment of dangerousness and committability. A strong relationship between ratings of committability and ratings of dangerousness suggests that clinicians were conforming to the logic of the commitment law. Discrepant cases involved patients who desired voluntary admission or whose commitment was completed elsewhere. Results suggest fair application of commitment standards but that two issues of statutory interpretation confused participating clinicians.
Assuntos
Internação Compulsória de Doente Mental/legislação & jurisprudência , Transtornos Mentais/diagnóstico , Pessoas Mentalmente Doentes , Comportamento Perigoso , Tomada de Decisões , Serviços de Emergência Psiquiátrica , Psiquiatria Legal , Hospitalização , Humanos , Transtornos Mentais/classificação , Transtornos Mentais/psicologia , Estados UnidosRESUMO
At the time of discharge from their index hospitalizations, 52 schizophrenic patients initially admitted for acute psychotic episodes were assessed on an Insight and Treatment Attitudes Questionnaire. When these patients were followed up 2 1/2 to 3 1/2 years later, adequate information on their clinical courses and outcomes was available in 46 cases. A global assessment of aftercare environment was made in each case, reflecting the degree to which individuals other than the patient were helpfully invested in maintaining the patient in treatment, whether these individuals were in the patient's living or treatment situations. Five factual outcome variables were also assessed: a) compliance with treatment 30 days after discharge; b) long-term compliance; c) whether or not patients were readmitted; d) readmissions per year; and e) percent of time spent in the hospital. As expected, aftercare environment was significantly related to outcome (p = .039). The overall relationship between insight and the outcome variables closely approached statistical significance (p = .053). Patients with more insight were significantly less likely to be readmitted over the course of follow-up. There was a trend for patients with more insight to be compliant with treatment 30 days after discharge. No significant interaction between aftercare environment and insight was found, suggesting that insight may influence outcome independently of aftercare environment.
Assuntos
Conscientização , Cognição , Hospitalização , Avaliação de Processos e Resultados em Cuidados de Saúde , Esquizofrenia/terapia , Psicologia do Esquizofrênico , Adolescente , Adulto , Assistência ao Convalescente , Assistência Ambulatorial , Atitude Frente a Saúde , Feminino , Seguimentos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Readmissão do Paciente , Estudos Prospectivos , Esquizofrenia/diagnóstico , Apoio SocialRESUMO
The relationship between insight and acute psychopathology was explored in a group of 52 acutely psychotic, schizophrenic patients. A measure of insight, reflecting patients' recognition of their illness and need for care, was validated against ratings from a semi-structured interview and against assessments of patients' compliance with medication. Contrary to expectations, degree of insight was not consistently related to the severity of acute psychopathology, as measured on two structured scales. Nor did changes in insight during hospitalization vary consistently with changes in acute psychopathology. These data suggest that very little of the deficiency in insight seen in schizophrenic patients is explainable on the basis of acute psychopathological features. The mechanism that accounts for impairment in insight in schizophrenia may be relatively resistant to treatment with neuroleptic medication.
Assuntos
Conscientização , Cognição , Esquizofrenia/diagnóstico , Psicologia do Esquizofrênico , Doença Aguda , Adolescente , Adulto , Antipsicóticos/uso terapêutico , Atitude Frente a Saúde , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Escalas de Graduação Psiquiátrica , Esquizofrenia/tratamento farmacológicoRESUMO
The susceptibility of 310 mainly clinically isolated Gram-negative nonfermenters to aztreonam, carumonam, ciprofloxacin, ofloxacin and fleroxacin was determined by agar dilution. All 3 quinolones were very active, with MIC90 ranges (micrograms/ml) against all organisms ranging between 0.25 and 8 for ciprofloxacin, and 0.25 and 16.0 for ofloxacin and fleroxacin, respectively. Aztreonam and carumonam showed less activity than the quinolones on a weight-for-weight basis, with MIC90 values ranging from 4 to 32 for both drugs; only Pseudomonas aeruginosa and Acinetobacter calcoaceticus biotypes haemolyticus and alcaligenes were uniformly susceptible to both monobactams. The broad-spectrum activity of the 3 quinolones suggests potential use in therapy of infections caused by nonfermenters; monobactams should be reserved for infections caused by P. aeruginosa and possibly Acinetobacter spp.