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Harms G.,Institute of Tropical Medicine | Scherbaum H.,Paul Lechler Hospital and Clinic for Tropical Diseases | Reiter-Owona I.,University of Bonn | Stich A.,Mission Medical, Inc. | Richter J.,Heinrich Heine University Düsseldorf
International Journal of Dermatology | Year: 2011

Background Cutaneous leishmaniasis (CL), a parasitic disease which represents a public health problem, particularly in Central and South America, has become a leading condition in travelers who return from tropical countries with skin disorders. Cutaneous leishmaniasis caused by Leishmania (Viannia) braziliensis, the most common causative agent, requires systemic treatment because it is potentially able to disseminate and to cause mucosal or mucocutaneous disease. Although several drugs are available for the systemic treatment of leishmaniases, a definitive treatment regimen for infection caused by species of the Viannia subgenus has yet to be established in many countries, including Germany. Methods We analyzed treatment outcomes in 23 returnees from Central and South America who were diagnosed with L.(V.)braziliensis CL by polymerase chain reaction. Results Complete cure within onemonth following treatment was observed in 18 patients (78%). Cure was achieved with liposomal amphotericin B in 11 of 13 patients, miltefosine in five of eight patients, and meglumine antimoniate in two (of two) patients. Of the five patients (22%) who failed to respond to initial therapy, four were cured with meglumine antimoniate and one with liposomal amphotericin B. Conclusions In this outcome evaluation of treatment of imported L.(V.)braziliensis infections, liposomal amphotericin B, miltefosine, and meglumine antimoniate proved to be effective. Conventional meglumine antimoniate showed high efficacy as a first-line treatment and cured lesions that failed to respond to the other two drugs. A multi-country study using standardized treatment protocols is needed to establish a definitive regimen. © 2011 The International Society of Dermatology.


Hiwat H.,Mission Medical, Inc. | Issaly J.,Institute Pasteur Of La Guyane | Gaborit P.,Institute Pasteur Of La Guyane | Somai A.,Mission Medical, Inc. | And 4 more authors.
Transactions of the Royal Society of Tropical Medicine and Hygiene | Year: 2010

The border area between Suriname and French Guiana is considered the most affected malaria area in South America. A one-year cooperative malaria vector study was performed by the two countries, between March 2004 and February 2005, in four villages. Anopheles darlingi proved to be the most abundant anopheline species. Human biting rates differed between villages. The differential effect of high rainfall on mosquito densities in the villages suggests variation in breeding sites. Overall parity rates were low, with means varying from 0.31 to 0.56 per study site. Of the 2045 A. darlingi mosquitoes collected, 13 were found to be infected with Plasmodium: ten P. falciparum, two P. malariae and one mixed P. malariae/P. vivax. The overall annual entomological inoculation rates in the villages ranged from 8.7 to 66.4. There was an apparent lack of relationship between number of malaria cases and periods of high mosquito density. The tendency of Anopheles darlingi to bite during sleeping hours provides opportunity for malaria control using impregnated bed nets, a strategy just introduced in Suriname that may also find its way into French Guiana. © 2009 Royal Society of Tropical Medicine and Hygiene.


Reed D.C.,University of California at Los Angeles | Shah K.H.,Mission Medical, Inc. | Hubschman J.-P.,University of California at Los Angeles
Seminars in Ophthalmology | Year: 2013

Introduction: Coccidioides immitis endophthalmitis usually results in enucleation, and there is evidence that vitrectomized eyes are more likely to become enucleated. Methods: A 55-year-old man presented to us with steroid-resistant granulomatous uveitis and was eventually diagnosed with C. immitis endophthalmitis. He was treated with an aggressive medical and surgical approach, receiving a total of 16 intravitreal antifungal injections and three vitrectomies, as well as lensectomy and penetrating keratoplasty. Results: At 13 months after presentation, the patient's eye was free of inflammation, and his best corrected visual acuity was 20/25. Discussion: This is the first reported case of culture-proven C. immitis endophthalmitis with a favorable final outcome. We propose that the good outcome may have been due to our aggressive therapeutic approach. © 2013 Informa Healthcare USA, Inc.


Coats N.P.,Mission Medical, Inc. | Baranyay J.,Baranyay Consulting Services Corporation
Journal of Cardiovascular Nursing | Year: 2012

Pharmacologic stress myocardial perfusion imaging is a noninvasive method for evaluating coronary artery disease in patients unable to exercise sufficiently to achieve a heart rate high enough to facilitate satisfactory imaging. The nuclear cardiology nurse is an invaluable member of the laboratory team that performs these tests. In this specialist role, the nurse must have a thorough knowledge of the different pharmacologic stress agents (dipyridamole, adenosine, regadenoson, and dobutamine) that can be used. This should comprise an understanding of their mechanisms of action, contraindications, drug-drug interactions, adverse effects, and administration protocols. By drawing on this knowledge, the nurse is able to verify that the right agent has been selected for each patient based on his/her medical history. The nurse also can help patients follow pretest instructions (such as withholding caffeine and certain medications) by explaining that the measures are necessary for a safe and successful procedure and that violation may result in test cancellation or postponement. On the day of the stress test, the nurse has an important role in safeguarding the patient as well as providing support and reassurance throughout the different stages of the examination. Responsibilities include explaining the entire procedure to the patients, notably, what they will be asked to do, the effect of the stress agent, the timing of each step, the adverse effects that they may experience, how any adverse events will be managed, and the importance of remaining still during imaging. This central role of the nuclear cardiology nurse in overseeing the practical aspects of the pharmacologic stress test has important implications in terms of optimizing the productivity and efficiency of their noninvasive cardiology laboratory and nuclear medicine department. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Sprague S.M.,Mission Medical, Inc. | Crawford P.W.,Mission Medical, Inc. | Melnick J.Z.,Mission Medical, Inc. | Strugnell S.A.,Mission Medical, Inc. | And 5 more authors.
American Journal of Nephrology | Year: 2016

Background/Aims: Vitamin D insufficiency and secondary hyperparathyroidism (SHPT) are associated with increased morbidity and mortality in chronic kidney disease (CKD) and are poorly addressed by current treatments. The present clinical studies evaluated extended-release (ER) calcifediol, a novel vitamin D prohormone repletion therapy designed to gradually correct low serum total 25-hydroxyvitamin D, improve SHPT control and minimize the induction of CYP24A1 and FGF23. Methods: Two identical multicenter, randomized, double-blind, placebo-controlled studies enrolled subjects from 89 US sites. A total of 429 subjects, balanced between studies, with stage 3 or 4 CKD, SHPT and vitamin D insufficiency were randomized 2:1 to receive oral ER calcifediol (30 or 60 µg) or placebo once daily at bedtime for 26 weeks. Most subjects (354 or 83%) completed dosing, and 298 (69%) entered a subsequent open-label extension study wherein ER calcifediol was administered without interruption for another 26 weeks. Results: ER calcifediol normalized serum total 25-hydroxyvitamin D concentrations (>30 ng/ml) in >95% of per-protocol subjects and reduced plasma intact parathyroid hormone (iPTH) by at least 10% in 72%. The proportion of subjects receiving ER calcifediol who achieved iPTH reductions of ≥30% increased progressively with treatment duration, reaching 22, 40 and 50% at 12, 26 and 52 weeks, respectively. iPTH lowering with ER calcifediol was independent of CKD stage and significantly greater than with placebo. ER calcifediol had inconsequential impact on serum calcium, phosphorus, FGF23 and adverse events. Conclusion: Oral ER calcifediol is safe and effective in treating SHPT and vitamin D insufficiency in CKD. © 2016 S. Karger AG, Basel


Bitar R.A.,Mission Medical, Inc. | Bitar R.A.,Pomerado Medical Center
Emerging Infectious Diseases | Year: 2016

Lacking population-specific data, activity of seasonal and pandemic influenza is usually tracked by counting the number of diagnoses and visits to medical facilities above a baseline. This type of data does not address the delivery of services in a specific population. To provide population-specific data, this retrospective study of patients with influenza- like illness, influenza, and pneumonia among members of a Kaiser Permanente health plan in San Diego, California, USA, during October-December 2009 was initiated. Population data included the number of outpatients accessing healthcare; the number of patients diagnosed with pneumonia; antimicrobial therapy administered; number of patients hospitalized with influenza, influenza-like illness, or pneumonia; level of care provided; and number of patients requiring specialized treatments (e.g., oxygen, ventilation, vasopressors). The rate of admissions specific to weeks and predictions of 2 epidemiologic models shows the strengths and weaknesses of those tools. Data collected in this study may improve planning for influenza pandemics. © 2016, Centers for Disease Control and Prevention (CDC). All rights reserved.


Tunstall T.D.,Mission Medical, Inc.
Journal of Diagnostic Medical Sonography | Year: 2010

Knowledge of how to prevent healthcare-associated infections within the sonography department is an important step in providing quality care. Employing scientifically based preventative measures will ensure that the tools we use do not become vectors for the spread of pathogens that cause infections. These avoidable infections have not only an added financial cost to patients and the already burdened healthcare system but also physical and emotional costs to the patients we treat. Specific infection control guidelines for the sonography department are lacking, and the guidelines that are available are often based on proven infection control practiced in similar situations. Within this article are the applicable infection guidelines sonographers can use to provide safe quality care. © 2010 The Author(s).


Grant
Agency: Department of Health and Human Services | Branch: | Program: SBIR | Phase: Phase I | Award Amount: 200.00K | Year: 2012

DESCRIPTION (provided by applicant): Radiofrequency ablation (RFA) is widely and increasingly utilized in cases where surgery is not possible as a minimally invasive treatment for cancer. Despite rapid adoption of this technique due to its proven success in treating smaller tumors, however, clinicians have been unable to consistently achieve the desired goal of complete and/or predictable ablation for many larger tumors. Manufacturers of RFA systems have tried to address this limitation, inter alia, by developing RF generators with ever increasing power. However, as the power of RF ablation systems has increased over the years, the incidence of skin burns at the grounding pad sites has increased as well. The current incidence of grounding-pad skin burns ranges from 1-3.2 % for severe skin burns (2nd or 3rd degree), with mild skin burns ranging between 5-33 %. The statistics on file with the legal department at 3M Healthcare indicate that the mean expected (or anticipated) rate of severe burns associated withthe use of all types of grounding pads is 1% and that this translates to ~5000 instances per year in the United States. It is estimated that 10% of the patients that suffer from serious burns every year are contacted by medical malpractice attorneys andencouraged to begin the process of litigation. As a result, records indicate that approximately 200 Million (MM) have been unnecessarily drained from the critical healthcare sector and forcibly transferred to the more wasteful litigation sector over the last 10 years. Given the ever-increasing rate of RFA adoption as well as RFA power-usage, it is projected that this loss will double to 400 MM over the next decade. The solution, then, lies in the innovative development of a vastly more efficient type of grounding pad that can safely and efficiently reduce the potential for skin-burns in a manner that is simple enough such that it does not require expensive changes to the capital equipment that is currently in use. We have developed prototypes of such a hyper-efficient yet inexpensive smart grounding pad. The smart-pad is a simple combination of a conventional grounding pad and a special layer of a novel Polymeric Electro-Thermal Switch (PETS) material. The PETS layer in the smart-pad automatically regulates current densities such that the temperature at the skin can never exceed a pre-set threshold, thereby significantly reducing the probability of acute as well as latent skin-burns. It also vastly increases the area-usage efficiency of the pad by automatically diverting the incoming current away from the hotter regions and towards the regions that tend to stay cooler by virtue of its intrinsic properties. In this Phase-I SBIR/STTR project, we will demonstrate proof of application of this novel smart-padby focusing on two core issues: (a) In vivo validation of the smart-pad performance in a porcine model, and, (b) Development of smart-pads with varying threshold-temperatures so as to determine the actual and optimum safety factor in in vivo use. The former confirms that the technology correctly translates from the simple bench model to the more complex and more realistic animal model. The latter ensures that the technology has an optimum safety-factor that is still large to allow safe function in a reliable manner when in widespread use. In the long run, the success of this project will reduce the potential for skin- burns, thereby containing the runaway skin-burn related litigation costs that currently burden the healthcare system. PUBLIC HEALTHRELEVANCE: The overall goal of this SBIR project is to develop a novel smart grounding pad in order to lower the potential for skin- burns that is associated with the ever- increasing wattage being used in the RFA of cancer. The proposed smart grounding pad will lower the wasteful leakage of funds from the healthcare sector by reducing the potential for the type of burn- related litigation that currently bleeds the industry. This implies that the smar pad could increase patient safety while simultaneously lowering healthcare costs in the RFA of cancer.


PubMed | Mission Medical, Inc.
Type: Journal Article | Journal: Transactions of the Royal Society of Tropical Medicine and Hygiene | Year: 2010

The border area between Suriname and French Guiana is considered the most affected malaria area in South America. A one-year cooperative malaria vector study was performed by the two countries, between March 2004 and February 2005, in four villages. Anopheles darlingi proved to be the most abundant anopheline species. Human biting rates differed between villages. The differential effect of high rainfall on mosquito densities in the villages suggests variation in breeding sites. Overall parity rates were low, with means varying from 0.31 to 0.56 per study site. Of the 2045 A. darlingi mosquitoes collected, 13 were found to be infected with Plasmodium: ten P. falciparum, two P. malariae and one mixed P. malariae/P. vivax. The overall annual entomological inoculation rates in the villages ranged from 8.7 to 66.4. There was an apparent lack of relationship between number of malaria cases and periods of high mosquito density. The tendency of Anopheles darlingi to bite during sleeping hours provides opportunity for malaria control using impregnated bed nets, a strategy just introduced in Suriname that may also find its way into French Guiana.


PubMed | Mission Medical, Inc.
Type: Journal Article | Journal: The Journal of cardiovascular nursing | Year: 2012

Pharmacologic stress myocardial perfusion imaging is a noninvasive method for evaluating coronary artery disease in patients unable to exercise sufficiently to achieve a heart rate high enough to facilitate satisfactory imaging. The nuclear cardiology nurse is an invaluable member of the laboratory team that performs these tests. In this specialist role, the nurse must have a thorough knowledge of the different pharmacologic stress agents (dipyridamole, adenosine, regadenoson, and dobutamine) that can be used. This should comprise an understanding of their mechanisms of action, contraindications, drug-drug interactions, adverse effects, and administration protocols. By drawing on this knowledge, the nurse is able to verify that the right agent has been selected for each patient based on his/her medical history. The nurse also can help patients follow pretest instructions (such as withholding caffeine and certain medications) by explaining that the measures are necessary for a safe and successful procedure and that violation may result in test cancellation or postponement. On the day of the stress test, the nurse has an important role in safeguarding the patient as well as providing support and reassurance throughout the different stages of the examination. Responsibilities include explaining the entire procedure to the patients, notably, what they will be asked to do, the effect of the stress agent, the timing of each step, the adverse effects that they may experience, how any adverse events will be managed, and the importance of remaining still during imaging. This central role of the nuclear cardiology nurse in overseeing the practical aspects of the pharmacologic stress test has important implications in terms of optimizing the productivity and efficiency of their noninvasive cardiology laboratory and nuclear medicine department.

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