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Biomedical subjects

J Grunberg

Publications and source records attributed to J Grunberg.

At least 19 recordsLinked to original sources
PubMed1999

One dose ceftriaxone vs. ten days of amoxicillin/clavulanate therapy for acute otitis media: clinical efficacy and change in nasopharyngeal flora.

OBJECTIVE: To compare the efficacy and the safety of a single intramuscular dose of ceftriaxone, 50 mg/kg, vs. a 10-day course of amoxicillin/clavulanate (amox/clav) therapy, 80 mg/kg/day of amoxicillin: 10 mg/kg/day of clavulanate in three divided doses, in children with acute otitis media (AOM) and to evaluate the changes in nasopharyngeal flora after treatment. METHODS: In a prospective, comparative, open randomized, multicenter trial, children were scheduled to return for visits on Days 12 to 14 (main end point) and Days 28 to 42 after the beginning of treatment for AOM. A nasopharyngeal swab for bacterial culture was obtained before the treatment and at Days 12 to 14. RESULTS: Between February, 1995, and May, 1996, 513 children with a mean age of 14.2 +/- 6.7 months were enrolled. All the patients were evaluable for the safety and intent-to-treat analyses and 463 for the per protocol efficacy. At Days 12 to 14 clinical success was obtained in 186 of the 235 children (79%) given ceftriaxone and in 188 of the 228 children (82.5%) treated with amox/clav. Among the patients with clinical success on Days 12 to 14, the success was maintained at Days 28 to 42 for 108 of 183 (59%) patients in the ceftriaxone group and 103 of 187 (55%) patients in the amox/clav group. Before the antibiotic treatment the percentages of children carrying Streptococcus pneumoniae (59.1%), Haemophilus influenzae (39.4%), Moraxella catarrhalis (55.7%) and the rate of penicillin-resistant S. pneumoniae (52.2%) were comparable between the 2 groups. At Days 12 to 14 the carriage of S. pneumoniae and M. catarrhalis was significantly different between the patients treated with ceftriaxone, 43.9 and 42.2, respectively, and the patients treated with amox/clav, 17.4 and 11.1%, respectively. Among the children carrying S. pneumoniae at Days 12 to 14, the percentage of penicillin-resistant strains reached 63.4% in the ceftriaxone treatment group and 83.0% in the amox/clav treatment group, (P = 0.02). Adverse events (mainly diarrhea) related to the study medication were reported more frequently (P < 0.0001) in the amox/clav treatment group. CONCLUSIONS: In an area with a high rate of penicillin-resistant S. pneumoniae, a single dose of ceftriaxone is as efficient as a 10-day course of amox/clav in the treatment of AOM in young children. There was for the two regimens an increased rate of penicillin-resistant strains among the pneumococci carried, whereas the chance for a child to carry a penicillin resistant S. pneumoniae did not increase after treatment.

Acute Disease↗
PubMed1998

Alzheimer's disease associated presenilin-1 holoprotein and its 18-20 kDa C-terminal fragment are death substrates for proteases of the caspase family.

Mutations in the presenilin (PS) genes are linked to early onset familial Alzheimer's disease (FAD). PS-1 proteins are proteolytically processed by an unknown protease leading to the formation of two stable fragments of approximately 30 and approximately 20 kDa [Thinakaran, G., et al. (1996) Neuron 17, 181-190]. In addition to the conventional fragments, alternative cleavage products were observed as well. Here we characterize an alternative proteolytic pathway of PS-1 which involves proteases of the caspase superfamily. Caspase mediated cleavage occurs between aspartate 345 and serine 346 C-terminal to the conventional cleavage determined previously [Podlisny, M., et al., (1997) Neurobiol. Dis. 3, 325-337]. Full-length PS-1 can serve as a substrate for caspase-like proteases, as demonstrated by the generation of the alternative C-terminal fragment in cells expressing PS-1 containing the Deltaexon 10 deletion which is known to accumulate as a full-length molecule [Thinakaran, G., et al. (1996)]. By inhibition of de novo protein synthesis in untransfected cells we demonstrate that the conventional C-terminal fragment of PS-1 is a substrate for caspase-like proteases as well. Therefore full-length and the conventional C-terminal fragment of PS-1 can serve as potential death substrates. Due to the fact that very little full-length PS-1 is expressed in vivo, the much more abundant C-terminal fragment and not the full-length precursor is the major in vivo substrate for the alternative cleavage of PS-1 by proteases of the caspase superfamily.

Alzheimer Disease↗
PubMed1994

Paediatric nephrology in countries with limited resources.

This paper summarises a symposium concerned with the provision of care for children with kidney disease in developing countries. Better organisation of services is required to prevent waste of resources, with the emphasis on team work between professionals, shared care with local health care personnel remote from the paediatric nephrology unit and good communications. Families need to be educated and provided with appropriate information so that they can care for their child at home. Technology should be simple and robust and the staff using it should be fully trained to maintain it in use. Therapies should be definitive where possible, because long-term supervision of treatment is often difficult. Effective but inexpensive medications should be used where possible. Twinning of developing and richer countries is valuable to transfer technology, help with training and assist in care through the development of personal contacts.

Child, Preschool↗
PubMed1993

Follow-up of chronically homeless mentally ill men.

OBJECTIVE: To supply information on the efficacy of on-site day treatment for homeless mentally ill men in shelters, the authors followed up homeless mentally ill men 18 months after placement in community housing. METHOD: The 42 subjects had been evaluated before and 6 months after entering an on-site day treatment program. The authors reinterviewed 34 of these patients again 1 year after the first follow-up to determine housing status, hospitalization, aftercare, criminal justice contacts, income, and employment. RESULTS: By the 18-month follow-up the positive effects of the program at 6 months had deteriorated; 44% of the men had returned to shelters at some point during the follow-up period, and the number of men with criminal justice contacts had increased to a proportion exceeding that before the program. A concurrent diagnosis of substance abuse increased the risk of homelessness during follow-up. CONCLUSIONS: These findings underscore the need for innovative treatment and support services for the homeless mentally ill who have concurrent substance abuse.

Adult↗
PubMed1990

Appropriate training in paediatric nephrology for developing countries: hypothesis and proposals.

Appropriate training in paediatric nephrology is a comprehensive approach designed to develop skills and capabilities to deal with the following basic components of medical care: (1) medical competence for clinical and research activities; (2) interpersonal relationships directed at maintaining patients' freedom and autonomy; and (3) adequate incorporation of technological, financial and managerial aspects of paediatric nephrology services. Inappropriate training causes frequent, dramatic and paradoxical negative feedback in developing countries: shortage of functioning medical equipment, skilled manpower and trained paediatric nephrologists co-exist with unused high-cost medical equipment and loss of skilled health care professionals. Appropriate training, tailored to the needs and resources of developing countries, could be an efficient way to develop high-quality paediatric nephrology care. Efficient training must develop self-reliant, self-sufficient and skilled health care professionals in the local economic, educational, technological and political context. Regional and international co-operation is essential to promote adequate training in paediatric nephrology. Developing countries lack an effective and accurate information communication network for selecting modern technology for paediatric nephrology. The development of this network through international co-operation, is an urgent requirement.

Developing Countries↗
PubMed1990

An evaluation of a mental health program for homeless men.

The authors report the results of a before-and-after evaluation of an on-site mental health day treatment program for homeless men. Thirty-two subjects were interviewed 6 or more months after placement from a crisis shelter to community housing in order to probe housing stability, aftercare treatment compliance, employment, rehospitalization, and criminal justice contacts. In the after phase, living on the street was virtually eliminated, use of shelters decreased sevenfold, aftercare utilization tripled, and contacts with the criminal justice system were halved. Psychiatric hospitalizations and unemployment were higher in the after phase. Findings are discussed in relation to the need to conduct controlled experiments of new psychosocial treatments for the homeless mentally ill.

Adult↗
PubMed1990

Shelterization: how the homeless adapt to shelter living.

Emergency shelters have become the backbone of the service delivery system to the homeless. Particularly in large shelters, crime is a pervasive aspect of life. But despite the dangers of shelter living, many residents do not flee; instead they develop coping strategies that provide them with a feeling of mastery unparalleled on the outside. This adaptation process, which the authors call "shelterization," is characterized by a decrease in interpersonal responsiveness, a neglect of personal hygiene, increasing passivity, and increasing dependency on others. The authors suggest that the shelterization process may be ameliorated by helping homeless persons establish positive social networks and affiliations with social service and mental health providers. They believe onsite psychosocial rehabilitation programs can foster such affiliation by offering a therapeutic alternative to the shelter subculture.

Acculturation↗
PubMed1987

A modified, solid phase radioimmunoassay for the differential diagnosis of acute and convalescent phases of hepatitis A infection.

The commercial assays for diagnosing the presence of hepatitis A antibodies (HAVAB; Abbott Laboratories, North Chicago, IL) or the presence of IgM class anti-hepatitis A virus antibodies (HAVAB-M; Abbott) do not provide precise information as to the timing of the acute infection. IgM class antibodies are detected as late as six months after the acute infection. In this study the authors describe a modified HAVAB test that inactivates the IgM class antibodies. It thus measures the proportion of IgG antibodies out of the total anti-hepatitis A virus antibodies. In a study of 139 patients with impaired liver function, the available and modified tests showed good agreement except for the convalescent phase of hepatitis A. During serial testing for three months after the acute infection, the commercial tests continuously detected IgM class antibodies. The modified test detected predominantly IgG class antibodies from four weeks on. By six weeks, 85% of the patients had predominantly IgG class antibodies. The modified test thus provides information on the timing of recent hepatitis A infection.

Acute Disease↗