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Biomedical subjects

J R Starke

Publications and source records attributed to J R Starke.

At least 19 recordsLinked to original sources
PubMed1992

Tuberculosis and pregnancy.

After decades of decline, tuberculosis case rates are again increasing in the United States. The increases have been most dramatic among minority young adults of childbearing age. The availability of adequate chemotherapy means that the outcome for both mother and child in pregnancy complicated by tuberculosis should be good. Complete case finding and screening of high-risk adults is essential to bring tuberculosis under control again.

Female↗
PubMed1992

Current chemotherapy for tuberculosis in children.

Antituberculosis medications are extremely well tolerated by children and have proved to be very successful. The newer regimens of intensive short-course chemotherapy for tuberculosis have several advantages over traditional two-drug regimens, including faster sterilization and bactericidal action, shorter duration over which patient noncompliance can occur, less expenditure of resources for monitoring treatment, lower failure and relapse rates, and broader coverage for possible drug-resistant M. tuberculosis. The currently recommended regimen for pulmonary and most extrapulmonary forms of tuberculosis in children is 6 months of isoniazid and rifampin supplemented during the first 2 months by pyrazinamide. Treatment during the first 1 to 2 months should, if possible, be daily but the last 4 to 5 months of therapy can be either daily or twice weekly under direct observation of a health-care professional. For patients in whom social or other constraints prevent reliable self-administration of daily treatment in the initial phase, medications may be given twice weekly from the beginning under close observation. For these situations, a total duration of treatment of 6 to 9 months is reasonable. Non-life-threatening forms of extrapulmonary tuberculosis can be treated in the same manner as pulmonary tuberculosis. Although tuberculous meningitis probably will respond to these regimens, the relative lack of data at present leads most experts to recommend total durations of between 6 and 12 months for this form of tuberculosis. The major limitation to controlling tuberculosis in the United States is noncompliance or nonadherence to medications by patients. The physician and other health-care providers must devote a great deal of their time and energy to ensuring adherence with medications and take whatever steps are necessary to make sure that the child with tuberculosis is adequately treated.

Adrenal Cortex Hormones↗
PubMed1991

Vaccine-preventable respiratory infections in childhood.

In the past decade, immunization rates among preschool-age children in the United States have decreased to levels lower than those in many developing countries. As a result, epidemics of vaccine-preventable diseases have occurred, especially in urban areas. Six of the infections prevented by immunization--those caused by Bordetella pertussis, Streptococcus pneumoniae, Haemophilus influenzae type B, Corynebacterium diphtheriae, measles virus, and influenza virus--frequently cause respiratory tract disease. Pneumonia in children may have subtle presentations and require special considerations depending on the age and condition of the child and the current rate of disease in the community. In addition to the epidemics occurring throughout the country, the growing number of immunocompromised children has also influenced diagnostic, treatment, and prevention considerations. These patients include children with cancer, organ transplants, congenital immune disorders, sickle cell disease, human immunodeficiency virus infection, as well as other disorders that lead to increased risk of infection. The current recommendations for routine and special childhood immunizations are reviewed in this article.

Bacterial Vaccines↗
PubMed1989

Tuberculosis in the pediatric population of Houston, Texas.

From September 1984 to December 1987, the children's tuberculosis clinic in Houston, TX, cared for 110 children with active tuberculosis. The median age was 24 months. Approximately one half of the cases were in Hispanic children, but one third were in black children. Only 11% were foreign-born. Diagnosis resulted from case contact investigation in 50% of cases, routine tuberculin screening in 6%, and evaluation of an ill child in 44%. Intrathoracic disease alone was present in 77% of cases, and extrathoracic disease in 23%, including involvement of the cervical and supraclavicular lymph nodes, meninges, brain, liver, and skin. Gastric aspirates yielded Mycobacterium tuberculosis from 39% of the children with pulmonary disease. Of six children infected with drug-resistant tuberculosis, two became critically ill before referral because the probability of resistance was not recognized by the referring physician. Presently, 94% of patients have successfully completed therapy, which has been shortened from 12 to 18 months to 6 to 9 months. However, 39% were noncompliant with treatment and required twice-weekly supervised therapy to complete treatment. Tuberculosis remains a serious cause of morbidity in children; specific expertise in obtaining cultures, selecting drugs, and assuring compliance is crucial for adequate results.

Adolescent↗
PubMed1989

Prevention of tuberculosis.

Tuberculosis (TB) continues to be a major cause of morbidity and mortality throughout the world. One billion people are infected with the tubercle bacillus, and there are 8 million new cases and 3 million deaths annually. Existing methods of preventing TB are effective, but due to economic and societal constraints, have not been applied throughout the world. Examples of primary prevention include case management and contact investigation, environmental control and vaccination. Secondary prevention is achieved by chemotherapy. The efficiency and use of these various methods will be reviewed, and areas for future study will be discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Modern approach to the diagnosis and treatment of tuberculosis in children.

Tuberculosis in children remains an important infectious disease in the United States, with 1261 cases reported in 1985. The percentage of extrapulmonary manifestations is increasing. Advances in the diagnosis and treatment of tuberculosis in children have lagged behind those in adults owing to diminished familiarity with the disease and difficulty in performing clinical studies in children. Tuberculosis in the United States now occurs mainly in clusters of high-risk people, such as the foreign born, Hispanics, blacks, Native Americans, and the impoverished. In general, the diagnosis of tuberculosis is epidemiologic, supported by the chest roentgenogram, skin test, and, most important, contact tracing. As the rate of drug-resistant tuberculosis increases, greater effort should be made to obtain cultures. New advances, such as DNA probes and serodiagnosis, may improve diagnostic accuracy, especially for extrapulmonary tuberculosis. Noncompliance is the major problem in treating tuberculosis, and greater effort should be directed toward novel treatment approaches in children, such as twice-weekly supervised therapy and shorter, more intense durations of therapy.

Child↗
PubMed1988

Intracranial tuberculoma in children: a new look at an old problem.

Intracranial tuberculoma has become a rare cause of space-occupying intracranial lesions in childhood, but it must still be considered in the differential diagnosis. Tuberculosis remains a significant disease in developing countries and in the United States, and tuberculoma is a well known presentation of childhood tuberculosis. This diagnosis must be considered especially in persons traveling or living in developing countries and in immigrants from third-world areas. We report three cases of tuberculoma in children seen during one year at our institutions to illustrate the need for continued suspicion. We summarize the clinical presentation and current treatment recommendations and review the available literature.

Adolescent↗
PubMed1987

Pharmacokinetics of amphotericin B in infants and children.

The pharmacokinetics of amphotericin B (AmB) have not previously been evaluated in children. Five very small, premature infants and five older children received 0.25-1.0 mg of AmB/kg per 24 hr for Candida infections. Serum concentrations of AmB, measured by bioassay, were used to determine various pharmacokinetic parameters of AmB. A one-compartment model of drug distribution was most consistent with the data. The volume of AmB distributed per kilogram of body weight was smaller and the elimination clearance more rapid than those previously reported for adults. Serum levels were approximately one-half those seen in adults given comparable doses. The mean concentrations of AmB after various doses were as follows: at 0.25 mg/kg, 0.08 microgram/ml; at 0.50 mg/kg, 0.20 microgram/ml; at 0.75 mg/kg, 0.42 microgram/ml; and at 1.0 mg/kg, 0.54 microgram/ml. Interpatient variability was, however, marked, especially among the premature infants. AmB pharmacokinetics are different in infants and children than in adults; these differences may have implications for determining optimal pediatric dosing regimens.

Adolescent↗
PubMed1987

A mouse model of chronic pulmonary infection with Pseudomonas aeruginosa and Pseudomonas cepacia.

A mouse model of chronic pulmonary infection with either Pseudomonas aeruginosa or Pseudomonas cepacia was developed to compare bacteriologic and pathologic features of these infections. Experimental pneumonia was established in Swiss mice by transoral intratracheal inoculation of 10(3)-10(4) colony-forming units of mucoid P. aeruginosa or P. cepacia enmeshed in agarose beads. Unilateral infection with either strain was tolerated without morbidity. By 10 days postinoculation, the mean colony-forming units per infected lung was 3.8 X 10(5) for P. aeruginosa and 1.0 X 10(5) for P. cepacia. Bacterial counts remained stable through 21 days with no significant difference between organisms. Acute and chronic inflammatory histopathologic changes similar to many found in the lungs of cystic fibrosis patients were present in 95% of lung specimens. The changes occurred with both organisms but were more extensive with mucoid P. aeruginosa. This model represents an important tool for study of the contribution of complement, antibody, and adoptive transfer of T cell-mediated immunity to the pathogenesis of chronic pneumonia with Pseudomonas species, and represents the first successful model of chronic pulmonary infection with P. cepacia.

Animals↗