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Biomedical subjects

H B Houser

Publications and source records attributed to H B Houser.

At least 19 recordsLinked to original sources

Randomized treatment of patients with typhoid fever by using ceftriaxone or chloramphenicol.

Sixty-three patients with Salmonella typhi infections were randomly assigned to receive either ceftriaxone iv in single daily doses of 75 mg/kg for children and 3-4 g for adults for seven days or to receive 60 mg of chloramphenicol/kg a day orally or iv in four divided doses until defervescence and then 40 mg/kg a day to complete 14 d. In the ceftriaxone group, one death occurred, and two of seven patients still febrile 11 d after starting treatment were given chloramphenicol. In the chloramphenicol group, one death and one gastrointestinal perforation occurred. The probability of remaining febrile was similar for both groups during the first seven days but was significantly greater for patients receiving ceftriaxone during the 14-d period. Patients in the chloramphenicol group were more likely to be bacteremic on day 3. These results suggest that a seven-day course of once-daily ceftriaxone shows promise as an alternative to 14 d of chloramphenicol for treating typhoid fever.

Adolescent

Morbidity in schistosomiasis japonica in relation to intensity of infection. A study of two rural brigades in Anhui Province, China.

Schistosomiasis japonica remains endemic in several provinces south of the Yangtze River in China because of relatively sparse populations of human beings and dense populations of snails. We studied two brigades in a rural commune in Gui-chi County, Anhui Province, to determine the prevalence, intensity, and morbidity associated with this infection before concerted control efforts were instituted. Quantitative fecal examinations, histories, and physical examinations relevant to schistosomiasis japonica were performed in 96 per cent of the available population 2 to 65 years of age. The prevalence was 26.3 per cent in Brigade A (778 persons) and 14.4 per cent in Brigade B (1532 persons). Clinical symptoms and signs were compared among uninfected persons and persons at three levels of infection as determined by fecal egg output. Some increased weakness was seen only at the heaviest levels of infection; abdominal pain was not an important symptom. Hepatomegaly was somewhat more frequent in moderate and heavy infections, but splenomegaly was rare and unrelated to intensity of infection. Neither stool consistency nor occult blood was related to the presence or intensity of infection. Approximately 50 per cent of the population had been treated for schistosomiasis japonica, 25 per cent repeatedly.

Adolescent

Effect of targeted mass treatment on intensity of infection and morbidity in schistosomiasis mansoni. 3-year follow-up of a community in Machakos, Kenya.

The effect of targeted mass treatment, a new strategy for cost-effective control of schistosomiasis mansoni based on administering single-dose chemotherapeutic agents to individuals with disease manifestations (hepatosplenomegaly) or heavy infections, was evaluated in an endemic area in Kenya. Two years after treatment of subjects with hepatosplenomegaly, the mean liver midsternal-line measurement decreased from 6 x 5 +/- 0 x 6 to 2 x 9 +/- 0 x 5 cm and the mean faecal egg count dropped significantly from its pretreatment level of 1090 +/- 290/g to 88 +/- 31/g. Targeted chemotherapy was then administered to a group of 122 subjects with faecal egg counts greater than or equal to 400/g. A similar maintained decrease in egg counts after chemotherapy was demonstrated in this group; mean egg count after one year was 115 +/- 17/g compared with 1250 +/- 232/g before treatment. The yearly rate of acquisition of heavy infection in this community was low (7%) and did not differ significantly in the uninfected, lightly infected, or heavily infected (and treated) groups.

Adolescent

Hycanthone dose-response in Schistosoma mansoni infection in Kenya.

The recommended doses of the drugs now used to cure schistosomiasis mansoni may be associated with toxic side-effects. Since Schistosoma mansoni does not multiply in the human host and the disease seems to be closely associated with the intensity of infection, it may not be necessary to use 100% lethal antischistosomal doses, particularly in endemic areas. A dose-response to the antischistosomal drug, hycanthone was established for three different doses in 169 patients with heavy S. mansoni infections in the Machakos district of Kenya. The highest dose used (1.5 mg/kg or half the recommended package-insert dose) resulted in a 96% decrease in egg output (equivalent ot death of the worms); 0.75 mg/kg in an 85% decrease; and 0.375 mg/kg in an 11% decrease one month after treatment. In contrast to the vomiting common with the package-insert dose (3.0 mg/kg), there were no side-effects with any of the lower doses.

Adolescent

Quantification of infection with Schistosoma haematobium in relation to epidemiology and selective population chemotherapy. I. Minimal number of daily egg counts in urine necessary to establish intensity of infection.

The intensity of infection with Schistosoma haematobium (worm burden) can be approximated by quantifying the number of parasite eggs excreted in the urine. A new method of egg counting has been developed in which urine samples are passed through transparent Nuclepore filters (Nuclepore Corp., Pleasanton, Calif.). The method requires no staining, is rapid, and can be performed in the field. It has previously been reported, however, that there is a significant daily fluctuation in output of eggs in the urine of patients with schistosomiasis haematobia. In the present study, daily urine samples were obtained on each of the 10 school days during a 12-day period from 121 schoolchildren in Coast Province, Kenya (total, 10 samples per child). In terms of detecting infection, it was of interest that egg counts of 0 were very rarely recorded for subjects whose mean egg counts were greater than 20/10 ml of urine. When the patients were classified into one of four groups, according to egg count (less than 1, 1--100, 101--400, greater than 400), the proportion correctly classified based on a single urine specimen was 75%; this proportion rose to 78% when the classification was based on two specimens and to 83% with three specimens. Most of the urine specimens that were misclassified belonged in an adjacent group.

Adolescent

Quantification of infection with Schistosoma haematobium in relation to epidemiology and selective population chemotherapy. II. Mass treatment with a single oral dose of metrifonate.

Determination of the efficacy of mass treatment of schistosomiasis is usually based on the rate of cure. However, schistosomes do not multiply in the human host, disease tends to cluster in the small proportion of individuals with heavy infections, and reinfection continually occurs in endemic areas. Thus drastic reduction in worm burdens can be a reasonable goal for mass treatment campaigns. The standard dose and regimen of metrifonate for the treatment of schistosomiasis haematobia is 7.5 mg/kg administered in three doses two weeks apart. This treatment results in a cure rate of approximately 50% and a reduction in egg output of 94.5%. In the present study, 72 infected children with egg counts before treatment that averaged from 0.1 to 2,334/10 ml of urine were treated with a single oral dose of 10 mg of metrifonate/kg: the cure rate was 22%, and the reduction in egg output was 96.5%. No side effects were recorded.

Administration, Oral

Community screening for diabetes by blood glucose measurement. Results of a five-year experience.

The Diabetes Association of greater Cleveland screened 307,000 individuals in the metropolitan area for diabetes with a 75-gm. oral load of carbohydrate. Of these subjects 12,600 (4.1 per cent) had a two-capillary blood glucose level of greater than 139 mg. per cent and were defined as positive. Seventy per cent of the positives were retested, and 65 per cent of these again had two-hour levels greater than 139 mg. per cent. Seventy-one per cent of the original screening values were between 104 and 199 mg. per cent. The rate of positivity on retesting increased with the original screening bracket reaching 90 per cent at an original screening level of 240 mg. per cent or higher. The frequency of positive retests also increased with age irrespective of whether the original screening level was less than or greater than 200 mg. per cent. The implications of this large detection experience for conducting future mass surveys for diabetes are discussed.

Age Factors

Suicide rate of callers to a poison information service.

The authors assessed the frequency of suicide subsequent to calls to a poison information center in a follow-up study. The 8 confirmed suicides out of 2,177 calls yielded a rate of 66.8 per 100,000 population--significantly higher than that for the general population. In addition, 15 possible or probable suicides were identified. The authors note that poison center callers seem to constitute a pool of significantly suicidal persons and reaffirm the premise that poison centers and suicide centers should coordinate their efforts.

Adult

Schistosomiasis mansoni in Yemeni in California: duration of infection, presence of disease, therapeutic management.

Investigations of schistosomiasis mansoni in 218 Yemeni agricultural workers in the San Joaquin Valley of California revealed a prevalence of 56%. In those infected, quantitative egg counts performed by the Kato thick smear method revealed that 57% had light infections (1-100 eggs/g), 27% moderate infections (101-400 eggs/g), and 16% heavy infections (greater than 400 eggs/g; mean--918 eggs/g). The Yemeni had been migrating to the USA for the past 20 years, a period in which the prevalence of schistosomiasis had remained constant in the Yemen. The prevalence of schistosomiasis in those who had been away from Yemen for less than 5 years was 59% with a mean egg output of 236 eggs/g, but in those away for more than 5 years (up to 20 years) it was 32% with a mean egg output of 75% eggs/g. This is in spite of the fact that 75% of the latter had returned to Yemen for short visits. Statistical analysis by the Fisher's exact probability test revealed a significantly lower egg output in those away from Yemen more than 5 years. On the basis of these findings the mean life span of the Yemen strain of Schistosoma mansoni in man was estimated to be between 5 and 10 years. The presence of disease was assessed in this population by traditional medical means without prior knowledge of the status of the infection in the individuals examined. Under these circumstances, there were no differences in symptoms such as weakness, diarrhea and abdominal pain among the uninfected proportion of the population, total infected group and a small subgroup of those most heavily infected. None of the patients had hepatomegaly and only two had splenomegaly--one lightly and the other heavily infected. Because of the toxicity of antischistosomal drugs and the lack of treatment facilities only the 22 most heavily infected (greater than 200 eggs/g) of the 122 individuals with schistosomiasis mansoni were treated with niridazole. In addition the two individuals with splenomegaly were treated with antimony dimercaptosuccinate. Side effects, though common, were not severe. Although follow-up in this migrant population was poor the nine patients examined 3 to 7 months after treatment showed a mean decrease in egg output of 97%.

Adolescent