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Biomedical subjects

A Iravani

Publications and source records attributed to A Iravani.

49 records · Page 3Linked to original sources
PubMed1981

Hypertension in a pediatric and adolescent population following kidney transplantation.

The post-renal transplant courses of 53 children and adolescents were evaluated for the prevalence and the etiology of hypertension. The blood pressures were averaged over specific time periods following transplantation and converted to percentile ranks according to standards for age. The number of antihypertensives employed to control blood pressure was assessed. Factors such as sex, obesity, race, donor source, antigen match, steroid administration, rejection, recurrent glomerulonephritis, pre-transplant nephrectomy, renal function and proteinuria were assessed as to their importance in producing hypertension or normotension in the post-transplant period. The average blood pressure was well within acceptable range shortly after transplantation. The patients requiring antihypertensives to control blood pressure dropped by two years post transplant. Chronic rejection was by far the most important factor influencing average blood pressure and the need to employ antihypertensives. Alternate-day prednisone and good graft function were important in establishing the normotensive state.

Adolescent↗
PubMed1980

Treatment of Bartter's syndrome with indomethacin.

Two patients with Bartter's syndrome were treated with indomethacin (2 mg/kg/day). The administration of the drug resulted in weight gain; a decrease in the rate of urinary excretion of sodium and inorganic phosphate suggesting an increase in proximal tubular reabsorption; an increase in serum potassium concentration, with a transient decrease in the rate of urinary potassium excretion in one patient; and a decrease in plasma renin activity and in the rate of urinary aldosterone excretion. Since indomethacin has been shown to inhibit prostaglandin synthetase, these observations support the hypothesis that prostaglandin excess is a basic pathogenic mechanism in Bartter's syndrome.

Adolescent↗
PubMed1980

Urinary tract infection caused by Staphylococcus saprophyticus.

This study was designed to determine whether Staphylococcus saprophyticus was an important cause of urinary tract infection (UTI), as has been reported by European, but not by American, investigators, S. saprophyticus was the second most common cause of UTI in young (mean age, 20 years), sexually active female outpatients without known preexisting kidney disease or preceding manipulation of the urinary tract. Most cases presented as acute cystitis, but frank pyelonephritis and UTI in pregnant females were observed. The organism was rarely found as a contaminant in urine cultures. When present in the mucocutaneous flora of the anal-urogenital area, the organism was significantly associated with UTI by the same organism. These results show that S. saprophyticus should be accepted as an important urinary tract pathogen of young female patients in the United States. A simple adequate laboratory identification may be based on resistance to novobiocin (disk diffusion test), absence of hemolysis and coagulase, and intense pigment production (65% of strains yellow, 35% white).

Adolescent↗
PubMed1980

Urinary tract infections in children: effect of short course antibiotic therapy on recurrence rate in children with previous infections.

Eighty-five girls, ages 3-16, with a past history of recurrent urinary tract infections were treated for 10 days with either trimethoprim/sulfamethoxazole, ampicillin or cephalexin. Patients with normal roentgenograms as well as those with reflux and cortical scarring were included. In the 12 weeks following completion of treatment, a significantly lower recurrence rate was noted in children who received trimethoprim/sulfamethoxazole. There was no difference in the recurrence rate whether or not radiographic abnormalities were present. No serious side effects were noted with any drug regimen.

Adolescent↗
PubMed1980

Clinical significance of the presence of cryoglobulins in patients with glomerulopathies not associated with systemic disease.

Serial serum samples from 102 children with glomerulopathies not associated with systemic diseases and from 23 normal controls were examined for the presence of cryoglobulins. Sera from controls, from patients with glomerulopathies thought to be mediated by immune complexes, and from those with non-immunologically mediated glomerulopathies demonstrated similar incidence of cryoglobulins. There was no correlation between cryoglobulin concentration or composition and the glomerular immunohistologic findings. Furthermore, persistence of cryoglobulinemia could not be correlated with progression of renal disease. Although cryoglobulins may contain immune complexes, determination of serum cryoglobulin concentration appears to be of little value in the diagnosis of immune complex mediated renal disease, nor in the assessment of disease activity or monitoring therapy in patients with glomerulopathies unassociated with systemic disease.

Cryoglobulins↗
PubMedDate not supplied

Comparison of ciprofloxacin (7 days) and trimethoprim-sulfamethoxazole (14 days) for acute uncomplicated pyelonephritis pyelonephritis in women: a randomized trial.

CONTEXT: The optimal antimicrobial regimen and treatment duration for acute uncomplicated pyelonephritis are unknown. OBJECTIVE: To compare the efficacy and safety of a 7-day ciprofloxacin regimen and a 14-day trimethoprim-sulfamethoxazole regimen for the treatment of acute pyelonephritis in women. DESIGN: Randomized, double-blind comparative trial conducted from October 1994 through January 1997. SETTING: Twenty-five outpatient centers in the United States. PATIENTS: Of 378 enrolled premenopausal women aged at least 18 years with clinical diagnosis of acute uncomplicated pyelonephritis, 255 were included in the analysis. Other individuals were excluded for no baseline causative organism, inadequate receipt of study drug, loss to follow-up, no appropriate cultures, and other reasons. INTERVENTIONS: Patients were randomized to oral ciprofloxacin, 500 mg twice per day for 7 days (with or without an initial 400-mg intravenous dose) followed by placebo for 7 days (n = 128 included in analysis) vs trimethoprim-sulfamethoxazole, 160/800 mg twice per day for 14 days (with or without intravenous ceftriaxone, 1 g) (n = 127 included in the analysis). MAIN OUTCOME MEASURE: Continued bacteriologic and clinical cure, such that alternative antimicrobial drugs were not required, among evaluable patients through the 4- to 11-day posttherapy visit, compared by treatment group. RESULTS: At 4 to 11 days posttherapy, bacteriologic cure rates were 99% (112 of 113) for the ciprofloxacin regimen and 89% (90 of 101) for the trimethoprim-sulfamethoxazole regimen (95% confidence interval [CI] for difference, 0.04-0.16; P = .004). Clinical cure rates were 96% (109 of 113) for the ciprofloxacin regimen and 83% (92 of 111) for the trimethoprim-sulfamethoxazole regimen (95% CI, 0.06-0.22; P = .002). Escherichia coli, which caused more than 90% of infections, was more frequently resistant to trimethoprim-sulfamethoxazole (18%) than to ciprofloxacin (0%; P<.001). Among trimethoprim-sulfamethoxazole-treated patients, drug resistance was associated with greater bacteriologic and clinical failure rates (P<.001 for both). Drug-related adverse events occurred in 24% of 191 ciprofloxacin-treated patients and in 33% of 187 trimethoprim-sulfamethoxazole-treated patients, respectively (95% CI, -0.001 to 0.2). CONCLUSIONS: In our study of outpatient treatment of acute uncomplicated pyelonephritis in women, a 7-day ciprofloxacin regimen was associated with greater bacteriologic and clinical cure rates than a 14-day trimethoprim-sulfamethoxazole regimen, especially in patients infected with trimethoprim-sulfamethoxazole-resistant strains.

Acute Disease↗
PubMedDate not supplied

Bacampicillin vs. amoxicillin for treatment of acute infections of the urinary tract.

Orally administered bacampicillin (400 mg twice daily for 10 days) was as effective as orally administered amoxicillin (250 mg thrice daily for 10 days) for the treatment of acute, uncomplicated infections of the urinary tract in young women. A satisfactory clinical response was produced by bacampicillin in 71 (98.6%) of 72 patients and by amoxicillin in 73 (98.6%) of 74 patients. A satisfactory bacteriologic response was produced by bacampicillin in 69 (95.8%) of 72 patients and by amoxicillin in 72 (97.3%) of 74 patients. In a subset of the patients, bacampicillin and amoxicillin were equally effective in the treatment of infections of the upper and lower urinary tract, as determined by the fluorescent antibody-coated bacterial test of localization. Both bacampicillin and amoxicillin were well tolerated. Allergic skin reactions occurred in two (2.7%) of 74 patients receiving amoxicillin but in none of the patients receiving bacampicillin. Mild diarrhea occurred in two (2.8%) of 72 patients receiving bacampicillin and in two (2.7%) of 74 patients receiving amoxicillin. Bacampicillin administered twice daily may offer several advantages over drugs given three times a day (e.g., amoxicillin) or four times a day (e.g., ampicillin). These advantages might include lower cost, better compliance with treatment regimen, and fewer allergic episodes and adverse reactions.

Adult↗
PubMedDate not supplied

Trimethoprim once daily vs. nitrofurantoin in treatment of acute urinary tract infections in young women, with special reference to periurethral, vaginal, and fecal flora.

College women with acute urinary tract infections were assigned randomly to three groups: 110 received trimethoprim (TMP), 300 mg once a day for seven days (group 1); 104 received TMP, 200 mg once a day for 10 days (group 2); and 108 received nitrofurantoin, 100 mg four times a day for 10 days (group 3). All primary urinary pathogens were sensitive to TMP, and 98.8% were sensitive to nitrofurantoin. A satisfactory clinical response was achieved by the end of therapy in each group. Bacteriologic cures occurred in 100.0% of the TMP groups and 99.0% of the nitrofurantoin group by the end of therapy. By four weeks after therapy, bacteriologic cure rates were 87.0% in group 1, 93.0% in group 2, and 82.0% in group 3. Bacteria responsible for the recurrences remained sensitive to TMP and nitrofurantoin. Patients with positive and negative tests for antibody-coated bacteria had similar responses to therapy. After therapy there was minimal emergence of Enterobacteriaceae resistant to TMP or nitrofurantoin in the fecal and urogenital flora. Both TMP and nitrofurantoin were tolerated well and were effective for treatment of acute urinary tract infections in women.

Adult↗
PubMedDate not supplied

Loracarbef versus cefaclor in the treatment of cystitis and asymptomatic bacteriuria.

In this double-blind study, 333 patients (16 males, 317 females) with cystitis or asymptomatic bacteriuria were randomly assigned to receive 200 mg of loracarbef once daily (n = 164; mean age, 36 years) or 250 mg of cefaclor thrice daily (n = 169; mean age, 37 years) for seven days. Cystitis was diagnosed in 97.8% of the evaluable loracarbef-treated patients and 94.4% of the evaluable cefaclor-treated patients. Clinical and bacteriologic responses were assessed in 92 loracarbef-treated patients and 107 cefaclor-treated patients. At the five- to nine-day posttreatment evaluation, a clinical cure was found in 84.5% of the loracarbef-treated patients and in 79.4% of the cefaclor-treated patients and improvement in 3.3% and 7.5%, respectively. The pathogen was eliminated in 76.1% and 72.9%, respectively; new pathogens were identified in 4.3% and 4.7%, respectively; and the original pathogen was not eliminated or recurred in 19.6% and 21.5%, respectively. Nausea was the most frequently reported adverse event (in 4.5% of all patients). The results indicate that both loracarbef and cefaclor are safe and effective in the treatment of uncomplicated urinary tract infections.

Adolescent↗
PubMedDate not supplied

Cefprozil versus cefaclor in the treatment of acute and uncomplicated urinary tract infections. Cefprozil Multicenter Study Group.

Cefprozil is a new oral cephalosporin with an in vitro spectrum of activity that includes the pathogens most commonly associated with acute and uncomplicated urinary tract infections (UTIs). A multicenter, randomized study was conducted to compare the clinical efficacy and safety of cefprozil, administered once daily, with cefaclor, administered three times a day, for ten days in patients 2 years of age or older who had acute and uncomplicated UTIs. The rate of satisfactory clinical response in evaluable patients was 87% in the cefprozil group and 84% in the cefaclor group. The patient bacteriologic response rates were also similar: 83% for cefprozil and 85% for cefaclor. The overall effective response rate for both cefprozil and cefaclor was 77%. Both drugs were well tolerated, with no difference in the incidence of drug-related adverse events. Because of its efficacy and once-daily dosing regimen, cefprozil may be an alternative to currently available oral antibiotics in the treatment of UTIs.

Acute Disease↗
PubMedDate not supplied

The use of the kidney biopsy to predict allograft loss in a pediatric transplant population.

Forty-seven biopsy specimens of renal allografts from pediatric transplant recipients were evaluated by light microscopy using a 117 item survey of histopathologic changes. The presence and distribution of immunofluorescent staining were also evaluated. Histopathologic findings associated with irreversible allograft rejection were determined using statistical methods and then correlated with one another. The effect on allograft survival when several of these features were present on the same specimen was assessed. Glomerular, arteriolar and small artery changes were associated with irreversible rejection. When several of these histologic findings occurred on the same biopsy specimen the allograft was always lost. Interstitial and tubular changes generally not predictive of rejection and immunofluorescent staining was not associated with graft loss.

Adolescent↗