Biomedical subjects

C A Kozinetz

Publications and source records attributed to C A Kozinetz.

At least 37 records · Page 2Linked to original sources

PubMed1997

Factors influencing survival in children with chronic interstitial lung disease.

To investigate factors influencing survival in children with chronic interstitial lung disease (ILD), we extracted specific clinical information from a data base of 99 children with ILD who met entry criteria for our study. The effects of a weight below the fifth percentile for the patient's age, crackles, clubbing, family history of ILD, symptom duration, and severity-of-illness score on survival were examined with univariate and multivariate statistical analyses. There were 15 recorded deaths in the group, with a probability that a patient would survive to 24 mo, 48 mo, and 60 mo after onset of symptoms of 83%, 72%, and 64%, respectively. Of the clinical features, only increasing severity-of-illness score was significantly associated with a higher probability of decreased survival. Children with ILD have decreased survival probabilities that can be predicted with a severity-of-illness score.

Age Factors↗

PubMed1997

Assessing parental utilization of the poison center: an emergency center-based survey.

The purpose of this study was to identify and characterize caretakers who fail to utilize the poison center for unintentional poisonings involving children. We interviewed 210 caretakers of children evaluated for unintentional poisoning in the emergency center of an urban, university-based teaching hospital to determine (1) whether demographic differences exist between those caretakers who contacted a poison center prior to the emergency center visit and those who did not and (2) whether differences exist in prevalence of poison prevention knowledge and behaviors between the two groups. Ninety-six (46%) of caretakers did not contact the poison center prior to the emergency center visit. Significant differences were found between the two groups for the following caretaker variables: race/ethnicity, language preference, age, level of education, country in which schooling occurred, and type of insurance coverage for the child. When logistic regression was used to control for confounding, the two variables associated with failure to use the poison center were black race and schooled outside the United States (primarily in Mexico). Poison center callers reported a higher prevalence of poison prevention knowledge and behaviors than noncallers. Educational interventions should be targeted to the groups of caretakers identified who do not use the poison center.

Adult↗

PubMed1997

Rett syndrome: an analysis using Sartwell's incubation period model.

Evidence suggests that Rett syndrome is a genetic disorder; however, an etiologic genetic model has yet to be identified. The purpose of this study was to apply a statistical model, Sartwell's incubation period model, to estimate the incubation period of Rett syndrome and postulate further on the etiology of Rett syndrome. Sartwell's model was used to test the hypothesis that the age of onset of developmental regression distributions approximate a logarithmic normal model and thus the etiologic factors of Rett syndrome occur in utero or prior to conception. Data from three case-series of Rett syndrome from different geographic regions were used for the analyses. Curves resulting from the analyses demonstrated a good approximation to the logarithmic normal distribution, indicating a good fit of the data to Sartwell's model. In conclusion, the incubation period of Rett syndrome fits the logarithmic normal model, which is consistent with the theory that a major causal factor for Rett syndrome most likely occurs in utero or prior to conception, eg, a defective gene.

Age of Onset↗

PubMed1997

Effectiveness of a poison center: impact on medical facility visits.

To estimate the effectiveness of a poison center by determining the number of potential medical facility visits for childhood poisonings which are prevented, and to determine how callers learned about the poison center in order to help guide future public educational efforts, a cross-sectional telephone survey was done. A systematic sample of caretakers of children < 6-y-of-age living in Harris County, TX, and who called the poison center about a poisoning incident between February 1993 and January 1994, was taken. One hundred sixty-six/197 eligible caretakers (84%) completed the survey. Of the 166 caretakers, only 5 (3%) were referred by the poison center to a medical facility for treatment, although 6 (3.6%) actually sought medical attention. The remaining 160 (96.4%) were successfully managed at home. The majority of these (74%) required no intervention and the remaining 26% required only minimal treatment, including ipecac, dilution, irrigation or observation. Of the 160 caretakers managed at home, 69 (43%) would have sought medical attention for the child at a health care facility if the poison center did not exist, and of those 81% would have gone to an emergency center or hospital for evaluation. Callers learned about the poison center most often from family/ friends, doctors, Mr Yuk stickers, television, previous use, or pharmacists. Poison centers decrease health care costs by preventing unnecessary medical facility visits for minor childhood poisonings which can be successfully managed at home. Methods effective in educating the public about poison centers should be continued and other methods explored to increase poison centers' use.

Adolescent↗

PubMed1996

Leukocyte esterase dipstick as a rapid screening test for vaginitis and cervicitis.

STUDY OBJECTIVE: To assess the ability of vaginal and cervical leukocyte esterase (LE) dipstick to detect vaginitis and cervicitis. DESIGN: A prospective, cross-sectional study to assess the ability of the LE dipstick of vaginal secretions to detect trichomonads, candida, and bacterial vaginosis and the LE dipstick of vaginal and cervical secretions to detect gonococcal and chlamydia infection and polymorphonuclear cells (PMNs). SETTING: An inner-city shelter facility clinic. PARTICIPANTS: 183 sexually active, nonmenstruating females aged 13-21 years (Mean = 17.7, SD = 1.98 years): 47% black, 40% white, and 11% Hispanic. OUTCOME MEASURES: Sensitivity (SN), specificity (SP), positive and negative predictive values (PVP, PVN), with 95% confidence intervals, of vaginal and cervical LE dipstick > or = trace in detecting vaginal and cervical infections. RESULTS: A positive vaginal LE had a moderately high SN and PVN but poor SP and PVP in detecting trichomonas and candida vaginitis and bacterial vaginosis. A positive vaginal and cervical LE had a high SN and PVN but poor SP and PVP in detecting gonorrhea and chlamydia infection. A positive cervical LE had a moderate SN and low SP in detecting PMNs on Gram stain. CONCLUSIONS: The LE dipstick of vaginal and cervical secretions was only a moderately good screening test for vaginal infection but a good screening test for cervical infection.

Adolescent↗

PubMed1995

Population-based registries using multidisciplinary reporters: a method for the study of pediatric neurologic disorders.

Few registries are available for evaluating population differences for rare, newly, or ill-defined pediatric neurologic disorders. The purpose of this article is to present standard methodologies for establishing a population-based registry and evaluating the completeness of a registry's case ascertainment. The Texas Rett Syndrome Registry (TRSR) is used as a model. The combination of health care and education resources has identified approx. 89-100% of the Rett syndrome cases in Texas. Cases reported by non-physician sources, although older on average (10.7 vs 7.7 years of age), did not differ by other demographic characteristics from those reported by physicians. Non-physician health and education professionals participated with the TRSR at a significantly higher rate than physicians, 89 and 37% (p < 0.05), respectively. Capture-recapture techniques, both two-sample and log-linear modeling, were used to quantitatively evaluate case ascertainment. Standardized national and international population-based registries could be the basis of an initiative to identify the etiology and perhaps preventive measures for pediatric neurologic disorders.

Child↗

PubMed1995

Excess intrauterine fetal demise associated with maternal human immunodeficiency virus infection.

A prospective study of transplacental transmission of human immunodeficiency virus (HIV) showed an increased rate of spontaneous fetal demise in HIV-seropositive mothers: 14 losses in 124 pregnancies. HIV was detected in placental and fetal tissues in 7 of 14 by in situ hybridization. The proportion of fetal infection far exceeded the transmission rate of 13% in liveborn babies. No association was seen between fetal transmission and a maternal history of drug abuse or coinfections; mothers with AIDS more often had fetal loss associated with HIV transmission than did asymptomatic mothers. In affected fetuses, HIV was detected in many tissues and was associated with thymic pathology. This suggests that maternal HIV infection increases the risk for pregnancy loss associated with HIV transmission. The possibility that HIV may be fetotoxic, that thymic dysfunction may interfere with pregnancy progression, or that the intrauterine milieu in HIV-seropositive pregnancies may be unfavorable (or a combination of factors) should be considered.

Adolescent↗

PubMed1995

Using administrative data to identify elementary schools at increased risk for student absences.

The ability to use administrative databases to identify elementary schools at risk for high percentages of school absence may prove useful in targeting elementary schools to receive absence reduction interventions. This report demonstrates an analysis method using existing administrative data for generating relative risks. Taking advantage of administrative databases can save resources and assist efforts in developing ways to reduce elementary school absence.

Absenteeism↗

PubMed1995

Sensitivity of immune complex-dissociated p24 antigen testing for early detection of human immunodeficiency virus in infants.

Several investigators have suggested that early diagnosis of human immunodeficiency virus (HIV) infection in infants could be accomplished with a modified, more-sensitive, acid-dissociated p24 antigen enzyme-linked immunosorbent assay (ELISA) technique (p24 antigen immune complex dissociation [ICD]). We compared detection of HIV infection by HIV culture, PCR, and p24 antigen ICD assays in 46 infants by using samples collected independently. The detection sensitivity of the p24 antigen ICD assay was 0% with cord blood samples (2 HIV-positive infants), 38% with plasma samples from infants under 3 months of age (8 HIV-positive infants), and 58% overall (12 HIV-positive infants). By contrast, the sensitivities of HIV culture and PCR were 50% for cord blood samples, 75% for plasma samples from infants under 3 months of age, and 83% overall. These results indicate that the p24 antigen ICD does not offer the sensitivity necessary for this assay to be used as an indicator of HIV infection in infants.

Antigen-Antibody Complex↗

PubMed1995

Characteristics of children surviving to 5 years of age or older with vertically acquired HIV infection.

The objective of this study was to examine characteristics of long-term survivors (aged 5 years or older) of vertical human immunodeficiency virus (HIV) infection. A retrospective cohort study design was employed. Forty-eight (68%) of 71 children who were born before 1990 and evaluated in our center survived to at least 5 years of age; 41 (58%) children remain alive (median age, 7.3 years). Only one (11%) of nine children with initial acquired immunodeficiency syndrome (AIDS)-defining conditions in the first year of life survived to age 5, whereas 47 (76%) of 62 children who did not have AIDS by age 1 year were alive at 5 years of age (p = .0003). Seventeen (43%) of 40 children with AIDS-defining conditions before age 5, and all 31 children without such conditions, survived to age 5 years (p = .000001). All eight children with lymphoid interstitial pneumonitis/pulmonary lymphoid hyperplasia (LIP/PLH) as their sole AIDS-defining condition survived to age 5. All 24 children who had neither an AIDS-defining condition nor severe immunosuppression by 5 years of age, and 24 (51%) of 47 children who had either or both of these findings, survived to age 5 years (p = .00008). To date, only 16 (39%) of 41 surviving children older than 5 years of age have had an AIDS-defining condition. However, true nonprogression of HIV disease (no clinical signs or symptoms; no evidence of immunosuppression) was unusual, occurring in only two (5%) of the same 41 children. In our center, most children with vertical HIV infection survive to at least 5 years of age, but the prognosis is not as good for those who experience an AIDS-defining condition or severe immunosuppression in the first 5 years of life.

Acquired Immunodeficiency Syndrome↗

PubMed1995

Early detection of HIV in infants: aspects of design and analysis for diagnostic test studies.

OBJECTIVE: To review investigations on the early detection of HIV infection in infants to determine adherence to traditional methods of study design and analysis for evaluating new laboratory tests. DATA SOURCES: A National Library of Medicine (MEDLINE) search was conducted to identify such investigations through 1993. Cited references in identified manuscripts were also considered. The search was restricted to investigations of human subjects and those published in the English language. STUDY SELECTION: Final inclusion criteria included (1) report of the age and human immunodeficiency virus (HIV) infection status of the subjects at the time of the diagnostic testing, and (2) presentation of data allowing confirmation of presented analyses and additional analyses. DATA EXTRACTION: Criteria for judging the investigations included (1) whether the criteria used to determine the positive and negative test results were defined; (2) whether the necessary sample size for the study was calculated; (3) whether the patients studied were representative of the patients to whom the test would be applied; (4) whether a gold standard evaluation was performed; (5) whether the outcomes included in the analyses were independent; (6) whether the test characteristics were properly analyzed; and, (7) whether confidence intervals were presented. DATA SYNTHESIS: An informative presentation of a diagnostic test should include as a minimum the seven criteria listed above. Only 21 of 36 (58%) of the studies incorporated at least three of the criteria. CONCLUSIONS: There is a wide variation in the manner in which investigations of diagnostic tests are conducted and the results reported. Increased awareness and use of standard study designs and analyses will allow the application of metanalyses. Such analyses will help guide the direction taken for finding and establishing early diagnostic procedures for HIV infection at birth or during infancy.

AIDS Serodiagnosis↗

PubMed1995

Antenatal steroids are associated with less need for blood pressure support in extremely premature infants.

OBJECTIVE: To determine if antenatal steroids decrease the amount of blood pressure support required by extremely premature infants between 23 and 27 weeks' gestation. DESIGN: Retrospective cohort study. SETTING: Texas Children's Hospital neonatal intensive care unit from January 1986 to December 1991. PARTICIPANTS: Two hundred forty premature infants between 23 and 27 weeks' gestation who survived at least 48 hours. MAIN OUTCOME MEASURES: The amount of blood pressure support received in the form of dopamine and colloid. Secondary analysis investigated differences in mortality, respiratory support requirements, the incidence of intraventricular hemorrhage, necrotizing enterocolitis, infection, retinopathy of prematurity requiring surgery, and the length of hospitalization. RESULTS: During the first 48 hours of life, premature newborns exposed to antenatal corticosteroids were less likely to receive dopamine for blood pressure support (47% vs 67%), and if they did, the amount of dopamine expressed as a dopamine score was less than that received by those infants not exposed to antenatal corticosteroids (281 +/- 240 vs 407 +/- 281). Those exposed to antenatal corticosteroids also had a lower mortality rate (8% vs 24%) and lower respiratory support requirements. The incidence of grade 3 or 4 intraventricular hemorrhage was 8% in infants exposed to antenatal corticosteroids and 17% in infants not exposed. No difference was found in the incidence of necrotizing enterocolitis, infection, or retinopathy of prematurity requiring surgery, or length of hospitalization. CONCLUSION: Receipt of antenatal corticosteroids is associated with less need for blood pressure support during the first 48 hours after birth in premature infants between 23 and 27 weeks' gestation.

Adrenal Cortex Hormones↗

PubMed1994

Diagnostic tests for occult bacteremia: temperature response to acetaminophen versus WBC count.

A cohort of 484 febrile children were examined to (1) assess the utility of temperature response to acetaminophen as a diagnostic test for occult bacteremia (OB) and (2) compare it with the white blood cell (WBC) count. For a period of 18 months, the records of all febrile children seen in the emergency department were reviewed. Testing a response to acetaminophen of a < or = 0.8 degrees C decrease in temperature, the sensitivity, specificity, and positive and negative predictive values were 47%, 74%, 12%, and 95%, respectively. When compared with a WBC count > or = 15,000/microL, the corresponding values were 76%, 65%, 15%, and 97%. Receiveroperator characteristic curves were constructed to compare temperature responses with WBC values. The difference was not significant (P > 0.05). The conclusion reached was that temperature response to acetaminophen has predictive values that are similar to the WBC count, and it may provide useful information. However, neither test is impressive, and the clinician cannot reliably predict which febrile children are at risk.

Acetaminophen↗

PubMed1994

Endotracheal colonization with Candida enhances risk of systemic candidiasis in very low birth weight neonates.

OBJECTIVE: To determine whether growth of Candida from an endotracheal aspirate identifies a population of very low birth weight (VLBW; < or = 1500 gm) neonates at increased risk of systemic candidiasis. DESIGN: Prospective evaluation with weekly cultures of endotracheal and rectal specimens to determine colonization status. SUBJECTS: One hundred sixteen VLBW neonates (mean birth weight, 975 +/- 23 gm, estimated gestational age, 27.6 +/- 0.2 weeks) with endotracheal tubes in place who were admitted to a level III nursery between Jan. 8 and Dec. 2, 1992. RESULTS: Of the 116 subjects, 39 infants were colonized with Candida (34%). Thirteen neonates had growth of Candida in one or more cultures of endotracheal specimens. Eleven of these could be examined, and in five systemic disease developed (disease in 5/11 vs 2/26; relative risk = 5.9; 95% confidence interval, 1.34 to 26). Eight infants were colonized with Candida in the first week of life. Seven of these could be examined, and in five systemic candidiasis developed (disease in 5/7 vs 2/30; RR = 9.3; 95% confidence interval, 2.3 to 38.0). CONCLUSIONS: Colonization with Candida occurs frequently in VLBW infants. Progression from colonization to systemic infection is more common in the smallest neonates. Detection of colonization in the first week of life or the growth of Candida from an endotracheal aspirate identifies a group of VLBW neonates with an endotracheal tube in place whose risk of systemic candidiasis is increased. A prospective trial of intervention in this high-risk population is warranted.

Analysis of Variance↗

PubMed1994

A comparative study of human immunodeficiency virus culture, polymerase chain reaction and anti-human immunodeficiency virus immunoglobulin A antibody detection in the diagnosis during early infancy of vertically acquired human immunodeficiency virus infection.

The infection status of 91 infants born to mothers with human immunodeficiency virus (HIV) infection was determined. Twenty-eight (31%) infants had confirmed HIV infection and 63 (69%) had seroreverted to HIV and lack evidence of infection. During the first 6 months of life HIV culture had a sensitivity and specificity for diagnosis of HIV infection of 80 and 100%, respectively. False negative HIV cultures were observed in only 7 of 35 specimens, 6 from among the 12 infected infants tested at birth. The sensitivity and specificity of polymerase chain reaction (PCR) detection of HIV were 95 and 93% respectively. A single false negative PCR test result was observed among the 19 tests performed on specimens from HIV-infected infants. False positive PCR test results were observed occasionally throughout the first 6 months of life. Detection of HIV-specific IgA antibody lacked diagnostic sensitivity; positive test results were observed in only 53% of specimens obtained from infected infants. Culture and PCR detection offer excellent sensitivity and specificity for diagnosis of HIV infection during the first 6 months of life; however, false-negative HIV cultures sometimes are observed, particularly during the newborn period, and either false negative or false positive PCR test results may be noted occasionally. For purposes of clinical decision-making, any positive test result should be confirmed with a second HIV culture or PCR test performed on a separate blood specimen.

False Negative Reactions↗

PubMed1993

Sensitivity, specificity and predictive value of physical examination, culture and other laboratory studies in the diagnosis during early infancy of vertically acquired human immunodeficiency virus infection.

The medical records of 142 infants referred for evaluation solely because they were born to human immunodeficiency virus (HIV)-infected mothers (i.e. not because of signs or symptoms suggesting HIV infection), were reviewed. The infection status of 85 of these infants has been determined; 17 (20%) have confirmed HIV infection and 68 have seroreverted to HIV and lack evidence of infection. During the first 6 months of life HIV culture had better sensitivity, specificity, positive predictive value and negative predictive value for diagnosis of HIV infection than did physical examination, serum immunoglobulin determination or HIV p24 antigen determination. Of the 16 HIV-infected infants who were available for evaluation during the first 6 months of life, all had at least one culture from blood positive for HIV. Two of 4 and 10 of 11 infants were culture-positive at birth and during the first 3 months of life, respectively. A positive HIV culture results was the earliest finding of infection in 15 infants; 10 of these infants concomitantly were found to have hyperimmunoglobulinemia (8 cases) and/or an abnormal physical examination (4 cases). One HIV-infected infant developed hyperimmunoglobulinemia G and A at age 3 months without other evidence of HIV infection until age 5 months when a positive HIV culture was noted. All HIV-infected infants had abnormal findings by physical examination, a positive HIV culture, and/or hyperimmunoglobulinemia by 3 months of age. Infants with normal physical examination and laboratory test results at 3 and/or 6 months of age invariably were HIV-uninfected.

Female↗

PubMed1993

Epidemiology of Rett syndrome: a population-based registry.

The Texas Rett Syndrome Registry maintains the largest population-based registry of cases and potential cases of Rett syndrome in the world. The most precise estimate of the prevalence of Rett syndrome of 1 per 22800 (0.44/10000) females aged 2 through 18 years of age was generated from this Registry. In addition, the first prevalence figures for black and Hispanic female cases were estimated. Registry cases are actively ascertained from multiple sources. Registry staff identify presumptive cases from review of information provided to the Registry by the parent or guardian. Preliminary diagnostic evaluation includes standardized review of medical records and videotape of key behaviors. Diagnosis is confirmed at clinical evaluation. The active surveillance system is monitored with the two-source capture-recapture methodology and case ascertainment is projected. The 1990 prevalence estimate of Rett syndrome indicates that the syndrome occurs less frequently than previously estimated. Until a biologic marker for Rett syndrome is identified or a standard definition for an incident case of Rett syndrome is designated, the prevalence of Rett syndrome will remain a major investigative issue of its epidemiology, and the Registry will be an important, systematic mean to gather case material for clinical and laboratory studies providing the foundation for the development of preventive interventions.

Adolescent↗

PubMed1992

The challenge of follow-up for clinical trials of somatic gene therapy.

Although extensive efforts have been made to optimize the safety of vectors for somatic gene transfer and somatic gene therapy, the safety of these agents must ultimately be assessed in clinical trials. A statistically significant assessment of safety will be complicated by the relatively small number of patients who will be enrolled in initial clinical trials, the need for long-term longitudinal follow-up of patients and perhaps their progeny, and the traditionally poor participation in long-term follow-up by many patients. This article reviews the potential risks of retroviral-mediated gene transfer, the statistical power required to assess the true incidence of potential complications, the number of patients who may participate in clinical trials involving retroviral vectors, and the factors that make thorough follow-up and uniform data ascertainment difficult. The role of the FDA in assessing the safety of retroviral vectors and the potential role of registries for patient tracking and data ascertainment are discussed.

Clinical Trials as Topic↗