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One of the harsh lessons of the "unforgiving" outbreak of severe acute respiratory syndrome (SARS) in Toronto was the infectious risk of the undiagnosed patient. While much has been made of the respiratory protection issues and fit-testing of N95 respirators, almost three-quarters of the health care workers infected in the 2003 Toronto outbreak were treating patients who had not been diagnosed with the emerging infection, said Allison McGeer, MD, infectious disease consultant at Mount Sinai Hospital in Toronto.
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The emergence of extensively drug-resistant tuberculosis (XDR-TB) has joined with the aftershocks of SARS and the threat of pandemic flu to put respiratory protection issues for health care workers back on the front burner.
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Tuberculosis has been reduced to record lows in the United States since the major hospital outbreaks in the 1980s and '90s, but there is growing concern that deadly strains of extensively drug-resistant (XDR) TB may arise at a point of U.S. disinterest and waning funding, the very trough of the so-called "U-shaped curve of concern" that historically precedes TB resurgence.
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When a day care worker reported to employee health at Dartmouth-Hitchcock Medical Center in Lebanon, NH, with a severe, spasmatic cough that had lasted more than two weeks, an employee health nurse immediately thought of pertussis.
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If extensively drug-resistant tuberculosis (XDR-TB) emerges to become an infection control threat in the nation's hospitals, the lessons learned from past outbreaks will prove invaluable.
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A review of evaluable multidrug-resistant tuberculosis (MDR-TB) cases that occurred in the United States from 1993 to 2006 found that 49 (3%) met the definition for extensively drug-resistant XDR-TB cases. Of those, 17 (35%) were reported during 2000-2006, the Centers for Disease Control and Prevention reports.
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Even though multidrug-resistant (MDR) and extensively drug resistant (XDR) TB are at extremely low levels in the United States, the cost of a single infection is staggering, Julie Gerberding, MD, MPH, director for the Centers for Disease Control and Prevention recently told Congress.
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Risk factors for atrial fibrillation (AF) most prominently include age, hypertension, diabetes, valvular disease, and heart failure.