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Biomedical subjects

C M Kunin

Publications and source records attributed to C M Kunin.

At least 91 records · Page 5Linked to original sources
PubMed1981

Duration of treatment of urinary tract infections.

This review was stimulated by the current interest in use of single-dose therapy for uncomplicated "lower tract" infection in females and the potential benefit of long-term prophylaxis for patients with recurrent infections. Duration of therapy is only a tactic. It is dependent on understanding the natural history of urinary tract infections in relation to risk factors and the predictable response to treatment. Based on the pertinent literature, a series of elements are presented that define the current consensus concerning the definition, natural history and risk of renal damage from urinary tract infection. These are then considered in relation to the current diagnostic measures and procedures to localize infection. Single-dose therapy combined with bacteriologic monitoring appears to be a useful method to localize infection. Although it defines individuals who may require more prolonged treatment, it has not yet been shown to predict risk of renal damage or identify a subpopulation requiring further study. The major predictors of renal injury are anatomic and neurologic lesions that alter urine flow and host factors that decrease resistance to infection. These are currently better defined by individual patient characteristics and clinical observation than by localization studies. Long-term low-dose prophylaxis has been shown to be an effective means of management of highly recurrent episodes of infection. It does not, however, appear to prevent recurrences, after therapy has been discontinued, even after periods of prophylaxis as long as six months. Treatment should be based on reasonable expectancy of reduction in morbidity and/or renal damage.

Adult↗
PubMed1981

Methods for determining the frequency of sexual intercourse and activities of daily living in young women.

To determine whether the frequency of sexual intercourse and other activities of daily living could be reliably measured in a population of women with or without prior urinary tract infections, a prospective pilot, case-control study was undertaken in a family practice clinic. Intensive self-recording of daily activities for one week was consistent with data collected for five more weeks spaced one month apart. Frequency of sexual activity was significantly higher on weekends. Control and bacteriuric subjects reported episodes of sexual intercourse about twice as frequently during the week of intensive recording than during the rest of the month when recording was only once a day. Although individual variation between weeks was minimal, considerable variation was observed among subjects. Voiding patterns were similar in both groups except for significantly higher rates prior to intercourse for controls. It is estimated that a sample size of at last 67-79 pairs will be required to ascertain whether there is a significant differences in frequency of sexual intercourse between cases and controls.

Activities of Daily Living↗
PubMed1980

Periurethral bacterial flora in women. Prolonged intermittent colonization with Escherichia coli.

To determine whether the periurethral flora of women with recurrent urinary infections differ from that of women without infection, a prospective study was conducted of matched premenopausal women. Daily or alternate-day urine cultures in patients and control subjects were obtained for six months to one year, as were daily records of sexual intercourse. Periurethral colonization with the same organism preceded 29 of 31 and six of seven episodes of significant bacteriuria in patients and control subjects, respectively. Prolonged periods of intermittent colonization with the same Escherichia coli serotype were observed in both patients and control subjects. Proportion of days of colonization of E coli or other Gram-negative bacteria was not significantly different between cases and controls and was not influenced by rates of sexual intercourse. Spontaneous cure occurred despite continued sexual intercourse.

Adult↗
PubMed1980

Urinary tract infections.

The urinary catheter is a fact of medical life. It is a valuable instrument when used for proper indications and when aseptic management is enforced. When improperly used, it is the major source of serious gram-negative infection in hospitalized patients. Male patients who require long-term drainage should be first tried on condom catheter drainage if there is no obstruction to flow or significant residual urine. Condom drainage, however, may lead to severe maceration of the penis if daily changing and cleansing is not done. Indwelling urethral catheters must be attached to a good system of closed drainage whether or not infection is present. Continuous bladder irrigation with neomycin-polymyxin solutions is a useful adjunct once closed drainage is established and working well. Suprapubic catheters are of special value for long-term use because they do not obstruct or irritate the urethra. The development of percutaneous methods of suprapubic drainage should improve and increase the use of this method.

Catheters, Indwelling↗
PubMed1979

Natural history of bacteriuria in schoolgirls. A long-term case-control study.

To define better the natural history of bacteriuria in females, we followed 60 schoolgirls with bacteriuria and 38 matched controls for periods ranging from nine to 18 years. Among the schoolgirls with bacteriuria (greater than or equal to 10(5) organisms per milliliter in two or more consecutive cultures), reflux was repaired in five, nephrectomy was performed in two, and reduced inulin clearance was noted in one subject with atrophic pyelonephritis. Serum creatinine was slightly higher in cases than in controls. Renal scars or caliectasis occurred in 16 cases but in none of the controls. Blood pressure was similar in both groups. Episodes of bacteriuria in cases and controls were, respectively: five or more episodes, 21.7 and 2.6 per cent; and episodes during pregnancy, 63.8 and 26.7 per cent. Seven children of the cases but none of the children of controls showed urinary-tract infections. Bacteriuria among schoolgirls defines a group at great risk of recurrent symptomatic infections and renal scars and at low risk of reduced renal function.

Acute Disease↗
PubMed1979

Oral neomycin dosage schedules for suppression of ammonia production by bowel flora.

To better define a minimal but optimal dose of oral neomycin to suppress ammonia production by bowel flora, several dosage regimens were examined in normal healthy volunteers. Fecal urease activity was quantitatively determined and was used as an indirect measure of intrinsic ammonia production by bowel flora. Large doses of neomycin were found to exert inhibition of fecal urease for many days. There was considerable variation in enzymatic activity among subjects even after adjustments were made for protein content of the stool. Depending on the dose, there was a 1- to 3-day lag in neomycin effect on stool urease activity and several days of continued effect. The most effective regimen of those studied was a loading dose of 6 g of neomycin given in three divided doses on day 1, followed by 1 g twice daily.

Adult↗
PubMed1978

Salicylate-induced enzymuria: comparison with other anti-inflammatory agents.

N-acetyl-beta glucosaminidase (NAG) enzymuria was used as a marker of renal injury in patients with rheumatic disease. An elevated NAG level was particularly common in patients receiving gold or aspirin therapy. The multiplicity of drugs received and the unknown role of underlying disease in these patients led to a study in healthy volunteers. Customary therapeutic doses of aspirin, choline salicylate, ibuprofen, indomethacin and acetaminophen did not produce enzymuria. Large single doses of salicylates equivalent to 6 tablets of aspirin consistently did produce enzymuria. The size of the individual dose in relation to body weight was more important than the total daily dose. NAG enzymuria appears to be a sensitive tool for identifying potentially nephrotoxic drugs.

Acetaminophen↗
PubMed1978

Minocycline-induced loss of potassium from erythrocytes: identification of a family with an augmented response.

The effect of several tetracycline antibiotics of human erythrocytes was examined because of previous findings that these drugs bind to erythrocyte membranes. Minocycline and cetocycline, two highly lipid-soluble analogues, but not tetracycline, induced loss of K+ from red blood cells. Loss of K+ increased linearly with time of incubation, concentration of minocycline, and temperature. The effect of minocycline was inhibited by plasma and calcium. The cells from one volunteer consistently showed an augmented response to minocycline; similar findings for family members of the volunteer suggested a dominant autosomal mode of inheritance. The only abnormality noted in the subject was mild reticulocytosis and a slightly reduced K+ content in his red blood cells. Preliminary studies did not demonstrate alterations in protein composition of his red blood cell membranes, enhanced osmotic fragility, or defects in Ca++-dependent or ouabain-sensitive (Na+-K+)-dependent adenosine triphosphatase activity. The exact site of the minocycline effect remains to be determined.

Adenosine Triphosphatases↗
PubMed1978

Problem of antibiotic usage. Definitions, causes, and proposed solutions.

Standardized surveillance methods are needed in order to obtain valid comparison among institutions concerning use of antimicrobial agents. These include use of data from the hospital pharmacy and review of routine orders for propolyaxis in surgery and for specific infectious diseases. Audits of individual agents should be based on standardized guidelines for use. Attempts to improve the quality of use of antimicrobial agents require understanding of the constraints of medical practice that effect use of drugs to solve problems. These include the practice setting, cost and availability of laboratory support, and patient expectation. Promotion by the pharmaceutical industry capitalizes on the motivation of the physician to help his patient, often in setting in which diagnosis and management are uncertain. Promotion is a continuous process beginning early in medical school and extending to the media and university teaching staffs. The overall solution to inappropriate antibiotic use requires more than educational programs. There should also be a well-structured hospital program regulating pharmaceutical representatives, the formulary, antimicrobial susceptibility tests, justification for high-cost agents, and development of mutually agreed on guidelines for use.

Anti-Bacterial Agents↗