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Biomedical subjects

L H Harrison

Publications and source records attributed to L H Harrison.

At least 73 records · Page 4Linked to original sources
PubMed1995

Risk factors for group B streptococcal disease in adults.

OBJECTIVE: To determine risk factors for community-acquired and nosocomial group B streptococcal disease in adults. DESIGN: Case-control study. SETTING: 3 metropolitan areas in the United States with an aggregate population of 6.6 million persons. PATIENTS: 219 nonpregnant adults with invasive group B streptococcal infection identified by a population-based surveillance in 1991 and 1992 and 645 hospital-matched controls. RESULTS: The following conditions were associated with a significantly increased risk for community-acquired group B streptococcal infection after controlling for age in multivariate analysis: cirrhosis (odds ratio, 9.7 [95% CI, 3.5 to 26.9]; P < 0.001), diabetes (odds ratio, 3.0 [CI, 1.9 to 4.7]; P < 0.001), stroke (odds ratio, 3.5 [CI, 1.9 to 6.4]; P < 0.001), breast cancer (odds ratio, 4.0 [CI, 1.6 to 9.8]; P = 0.002), decubitus ulcer (odd ratio, 4.0 [CI, 1.6 to 9.8]; P = 0.002), and neurogenic bladder (odds ratio, 4.6 [CI, 1.4 to 15.1]; P = 0.01). Sixty-three percent of community case-patients had at least one of these conditions. Nosocomial infection (48 cases [22%]) was independently associated with the placement of a central venous line (odds ratio, 30.9 [CI, 5.2 to 184.1]; P < 0.001), diabetes, congestive heart failure, and seizure disorder. CONCLUSIONS: Several chronic conditions were independently associated with group B streptococcal disease, and most case-patients had at least one of these conditions. If group B streptococcal vaccines being developed for prevention of neonatal disease are protective in adults, a vaccination strategy targeting those at highest risk has the potential to substantially reduce the burden of invasive group B streptococcal infection in adults.

Adult↗
PubMed1995

Relapsing invasive group B streptococcal infection in adults.

OBJECTIVE: To study recurrent group B streptococcal infection in adults. DESIGN: Patients with more than one reported group B streptococcal infection were identified through active surveillance for this infection. Sterile-site group B streptococcal isolates were evaluated for serotype and molecular subtyping using restriction endonuclease analysis of chromosomal DNA (REAC). SETTING: All acute-care hospitals in Maryland. PATIENTS: Nonpregnant residents of Maryland 18 years of age or older. RESULTS: 22 adults had at least two group B streptococcal episodes that were separated by 2 to 95 weeks (mean, 24 weeks). Of 395 patients with invasive group B streptococcal infection who survived the first episode and were followed for at least 1 year, 17 (4.3% [95% CI, 2.6% to 6.9%]) had more than one episode. Several patients were found to have endocarditis or osteomyelitis during the second episode. Group B streptococcal isolates from both episodes were obtained from 18 of 22 patients. Of the 18 isolate pairs, 13 (72% [CI, 46% to 90%]) had identical REAC patterns; the probability that at least 13 matches would be found by chance alone was less than 0.000001. Among patients with recurrent infection caused by the same strain, the interval between episodes was shorter (mean, 14 weeks) than that among patients with recurrent infection caused by another strain (mean, 43 weeks; P = 0.05). CONCLUSIONS: Recurrent group B streptococcal infection is common among adults and in most cases appears to be caused by relapse. The optimal management of adults with a first episode of group B streptococcal infection needs to be further defined to minimize the likelihood of recurrent disease.

Adolescent↗
PubMed1995

Maternal reporting of acute respiratory infection in Egypt.

BACKGROUND: Acute respiratory infection (ARI) is a major cause of childhood morbidity and mortality in developing countries. Community surveys are used to determine the proportion of children with ARI for whom care is sought by questioning mothers about the signs and symptoms of illness episodes. The validity of this approach has been studied infrequently. METHODS: We evaluated maternal reporting of signs and symptoms 2 and 4 weeks after diagnosis among 271 Egyptian children < 5 years old. Children with ARI were evaluated by physical examination, chest radiography, and pulse oximetry, and were alternately assigned for a maternal interview about the episode 14 or 28 days later. RESULTS: For radiographically-defined acute lower respiratory infection (ALRI), the sensitivity of several symptoms for combined open- and close-ended questions was relatively high: nahagan (deep or rapid breathing) (80%), nafas sarie (fast breathing) (66%), and kharfasha (coarse breath sounds) (63%). The specificity of these terms was 50-68%. The specificity was inversely related to the follow-up time. No term provided both a sensitivity and specificity of > 50% at day 28 across the radiographically, clinically- and pulse oximetry-based definitions of ALRI. Spontaneously mentioned karshet nafas (difficult or rapid breathing) at 14 days had a specificity and sensitivity for radiographic ALRI of 87% and 41%, respectively, suggesting that this term is a good choice for community surveys. CONCLUSIONS: Maternal reporting of ARI symptoms is non-specific 2 and 4 weeks after diagnosis but may be useful for monitoring trends in the proportion of children with pneumonia who receive medical care. To maximize specificity, ARI programmes should generally use a recall period of 2 weeks.

Acute Disease↗
PubMed1994

A cluster of invasive pneumococcal disease in young children in child care.

OBJECTIVE: To investigate a cluster of invasive pneumococcal disease in children 8 to 26 months of age, using standard microbiological procedures and ribosomal DNA gene-restriction patterns to characterize the outbreak strain. DESIGN: Outbreak investigation. SETTING: A family child-care home with six children in Baltimore, Md. RESULTS: During an 8-day period, three of the six children in the family child-care home had febrile illnesses with pneumococcal bacteremia, and a fourth had purulent pneumococcal conjunctivitis. Type 12F Streptococcus pneumoniae was isolated from the four ill children and from the nasopharynges of the two healthy children. Ribotyping revealed all outbreak isolates had an identical ribotype pattern. Administration of rifampin to the children did not eradicate carriage of the organism. CONCLUSIONS: Our data demonstrate that child care provides an opportunity for outbreak of invasive pneumococcal disease in young children. This observation suggests a need for increased alertness for clusters of pneumococcal disease in young children in child-care facilities and underscores the necessity for a pneumococcal vaccine that is effective in infants and young children.

Bacteremia↗
PubMed1994

Coinfection with human T-cell lymphotropic virus type I and HIV in Brazil. Impact on markers of HIV disease progression.

OBJECTIVES: To study the effect of human T-cell lymph-tropic virus type I (HTLV-I) on markers of human immunodeficiency virus (HIV) disease progression. DESIGN: A retrospective, nested case-control study. SETTING: A university hospital outpatient HIV clinic in Rio de Janeiro, Brazil. PARTICIPANTS: Human immunodeficiency virus-seropositive adults participating in a prospective HIV cohort study. MAIN OUTCOME MEASURES: The HIV clinical stage, CD4+ lymphocyte counts, and other laboratory parameters in 27 individuals infected with HIV and HTLV-I (coinfection) and 99 age-matched, HIV-seropositive, HTLV-seronegative controls (single infection). RESULTS: Variables independently associated with coinfection included higher CD4+ lymphocyte count (odds ratio [OR], 2.3; 95% confidence limits [CL], 1.3, 4.1), higher CD4+ percentage (OR, 2.0; 95% CL, 1.3, 3.2), beta 2-microglobulin level of 254 nmol/L or more (OR, 6.8; 95% CL, 1.3, 35.4), World Health Organization stages 3 and 4 (OR, 4.4; 95% CL, 1.1, 18.0), and reporting a parenteral risk factor (OR, 7.4; 95% CL, 1.4, 38.9). When stratified by p24 antigenemia, coinfection was associated with an estimated 82% higher CD4+ lymphocyte count (P < .05). CONCLUSION: Coinfection was associated with higher CD4+ lymphocyte counts, more advanced clinical disease, and higher beta 2-microglobulin levels than HIV infection alone. The higher mean CD4+ lymphocyte count does not appear to offer immunologic benefit. Caution should be exercised when using CD4+ lymphocytes as a surrogate marker in studies of HIV infection in populations where HTLV-I is prevalent. Further studies are needed to address whether current CD4+ lymphocyte values for the initiation of antiretroviral therapy and chemoprophylaxis against opportunistic infections in HIV infection are appropriate in coinfection.

Adult↗
PubMed1994

Aberrant right subclavian artery aneurysm: an analysis of surgical options.

During evaluation of a man for claudication, abnormal chest roentgenographic results were found. Computed tomography documented a 6.5-cm aneurysm of an aberrant retroesophageal right subclavian artery. Interruption of the right subclavian artery with an end-to-side subclavian-carotid anastomosis was performed via a right supraclavicular incision, followed immediately by left transthoracic interruption of the origin of the right subclavian artery using a heparin-bonded shunt. This approach avoids previously reported embolic complications while preserving brachial blood flow and providing safe access to the aorta.

Aged↗
PubMed1994

Serotypes of Streptococcus pneumoniae causing meningitis in southern India. Use of new direct latex agglutination antigen detection tests in cerebrospinal fluid.

The utility of a new latex agglutination (LA) test to directly determine serotypes of Streptococcus pneumoniae in cerebrospinal fluid (CSF) was assessed in prospective evaluation at a referral hospital in southern India. Samples from 18 ill patients with Gram-positive organisms in CSF were tested. The presence of C polysaccharide or specific serotype antigen (types 1, 3, 4, 5, 6, 12, 14, 18, 19, and 23) of S. pneumoniae was detected by slide LA test. Pneumococcal antigen was detected in 17 (94%) of 18 CSF specimens; in 14 (78%) the serotype was determined directly. Serotypes 1, 5, 6, 19, 23, 7, 10, 34, and 38 were found in these patients. A quellung test of the cultured isolates confirmed the serotypes. Information regarding the serotype distribution of pneumococci in varied geographic locations is important for the design and evaluation of pneumococcal vaccines. The slide LA tests seemed useful in detecting S. pneumoniae antigens and in determining the serotype, and have promise in simplifying the gathering of serotype data.

Adult↗
PubMed1994

Postlicensure effectiveness of the Haemophilus influenzae type b polysaccharide-Neisseria meningitidis outer-membrane protein complex conjugate vaccine among Navajo children.

The incidence of invasive Haemophilus influenzae type b (Hib) infection was decreased significantly among Navajo children since the licensure of Hib conjugate vaccines, even though two lots of Hib (polyribosylribitol phosphate)-meningococcal B outer-membrane protein conjugate vaccine (PRP-OMP) widely used among the Navajo were later found to be of low immunogenicity. We measured the effectiveness of all Hib conjugate vaccines combined, PRP-OMP alone, and the PRP-OMP lots with lower-than-expected immunogenicity among Navajo infants and children. This was a matched case-control study using active, laboratory-based surveillance for the ascertainment of Navajo children 2 1/2 to 59 months of age with invasive Hib infection; 45 patients with infection and 180 control subjects were enrolled. The effectiveness of one, two, and three doses, respectively, of all Hib conjugate vaccines combined was 96% (95% confidence interval (CI) 65%, 99%), 99% (95% CI, 69%, 100%), and 99% (95% CI - 57%, 100%). The effectiveness of one or more doses of PRP-OMP was 95% (95% CI, 66%, 99%). The effectiveness of a single dose of the lots of lower-than-expected immunogenicity was 89% (95% CI, -8%, 99%). The Hib conjugate vaccine coverage increased from 49% during 1991 to 94% during 1992; no control subjects younger than 18 months of age were enrolled during 1993. The occurrence of invasive Hib infections in this population after licensure of Hib conjugate vaccines was the result of gradual vaccine uptake, not poor vaccine effectiveness. The use of PRP-OMP has been highly effective despite concerns about the immunogenicity of several lots.

Bacterial Outer Membrane Proteins↗
PubMed1993

Caretaker recognition of respiratory signs in children: correlation with physical examination findings, x-ray diagnosis and pulse oximetry.

Caretaker recognition of clinical utility of respiratory signs and symptoms in the prediction of pneumonia was examined in a prospective study of infants and children in four cities in Egypt. In all 688 children aged 2 months-5 years presenting with a history and/or physical examination findings of cough and difficult or fast breathing were recruited from out-patient health facilities. The validity of caretaker terms was determined using paediatrician observation of standard respiratory signs and symptoms, x-ray diagnosis and pulse oximetry as standards. The sensitivity of 'nahagan' (Egyptian Arabic for fast breathing) for identifying elevated respiratory rate was 78% +/- 4, and was slightly higher for < 12 month olds (85% +/- 5) versus children aged 1-5 years (74% +/- 5). 'Sedro tale nazel', which describes the chest as moving up and down, was a sensitive (86% +/- 3) and specific (60% +/- 4) indicator of chest indrawing. 'Tazyeek' (wheeze) had a sensitivity of 75% +/- 3 and specificity of 66% +/- 4 when compared to paediatrician assessment of wheezing during physical examination. Although not specific, the caretaker terms, 'nahagan' or 'nafas seria' (fast breathing) and 'sedro tale nazel' (chest indrawing), either spontaneously or after asking, were sensitive (> 71%) indicators of radiologic pneumonia and oxygen desaturation, and therefore can be used to prompt timely health seeking behaviour in these settings.

Caregivers↗
PubMed1993

An instrument to assess acute respiratory infection case management in Egypt.

UNLABELLED: To develop an instrument to measure the quality of acute respiratory infection (ARI) case management among Egyptian children. METHODS: A baseline survey of all health facilities in a single district, using a multi-data source instrument. Data sources included providers, caretakers, patient records and observation of patient care. MAIN RESULTS: Physicians did not count the respiratory rate and check for subcostal retraction. Eighty-seven per cent of children who did not require antibiotics received them. Of five children who required antibiotics, four (80%) were prescribed an oral regimen. Three of these should have been admitted to a hospital but were not. Antibiotics were available at the facilities an estimated 7.9 months per year. Oxygen for inpatient treatment was available in one of two hospitals. CONCLUSIONS: This instrument was useful for comprehensively evaluating facility capability to provide quality case management. Deficiencies were identified but were not unexpected in a baseline survey. The Egypt ARI program has the potential to have a substantial impact on how children with ARI are diagnosed and treated in health facilities.

Acute Disease↗
PubMed1993

The evolving role of thoracoscopy in the diagnosis and treatment of chest disease.

Between April 1, 1988 and April 1, 1993, 88 patients underwent thoracoscopic procedures for diagnosis or treatment or both of diseases which had previously been approached by standard thoracotomy in our practice. Fifty-three (60.2%) were men and 35 (39.8%) women. The median age was 63, range 19 to 88 years. Although the indications for operation generally fell into one of five categories, the ultimate diagnoses established by the procedure spanned a wide array of chest pathology. Morbidity and mortality remained low and length of stay in hospital was favorable in comparison with a subset of patients with malignant pleural disease who underwent thoracotomy for diagnosis. Thoracoscopy, or video-assisted thoracic surgery (VATS), is a procedure which compares favorably with traditional thoracotomy in selected patients and its horizons as a diagnostic and therapeutic tool continue to expand.

Adult↗
PubMed1993

Community health worker competency in managing acute respiratory infections of childhood in Bolivia.

A competency-based training and evaluation method was developed to improve and assess the management of acute respiratory infections (ARI) in young children by community health workers (CHWs) in Bolivia. This method was used to evaluate three groups of Bolivian CHWs, provide them with a one-day refresher course in ARI management, and assess the effects of the course. The results showed the CHWs capable of acquiring the skills needed to effectively manage ARI cases in accordance with the World Health Organization's ARI case management strategy. It was found important, however, that their training emphasize how to count the respirations of children with tachypnea and how to identify chest indrawing. In general, the competency-based methods appeared to be effective in training and evaluating CHWs in the area of ARI case management; it is expected that these methods will prove useful in other community-based health interventions.

Acute Disease↗
PubMed1992

Transurethral laser prostatectomy in the canine model.

A technique for performing transurethral prostatectomy was devised using a Neodymium:Yttrium Aluminum Garnet laser in a canine model. Six dogs underwent transurethral laser prostatectomy following establishment of a perineal urethrostomy. The efficacy of the prostatectomies was judged by retrograde urethrography, transrectal prostate ultrasonography, cystoscopy, and histologic examination. The method of applying laser energy while holding the tip of the fiberoptic light guide 2-3 mm away from the prostate was ineffective; with power ranging from 40 to 70 watts, this technique resulted mainly in coagulation necrosis and removal of only a small amount of tissue. However, placing the tip of the light guide in direct contact with the prostate and using power from 70 to 100 watts produced impressively large prostatectomy defects by tissue vaporization. We conclude that this newly devised technique for transurethral prostatectomy in the canine model can be performed safely and effectively using a Neodymium:Yttrium Aluminum Garnet laser (Neodymium:YAG).

Aluminum Silicates↗
PubMed1992

Comparative efficacy of oral rifampin and topical chloramphenicol in eradicating conjunctival carriage of Haemophilus influenzae biogroup aegyptius. Brazilian Purpuric Fever Study Group.

Persistent conjunctival carriage of the Haemophilus influenzae biogroup aegyptius (Hae) strain (BPF clone) responsible for Brazilian purpuric fever (BPF) has been documented. Topical chloramphenicol is routinely used to treat conjunctivitis in areas affected by BPF in Brazil. Although the BPF clone is susceptible to chloramphenicol, we observed a number of children treated with topical chloramphenicol for conjunctivitis who still developed BPF. During an investigation of an outbreak of BPF in Mato Grosso State, Brazil, we compared oral rifampin (20 mg/kg/day for 4 days) with topical chloramphenicol for eradication of conjunctival carriage of H. influenzae biogroup aegyptius among children with presumed BPF clone conjunctivitis. Conjunctival samples were taken for culture on the day treatment was initiated and a mean of 8 and 21 days later. At 8 days the eradication rates for oral rifampin and topical chloramphenicol were 100 and 44%, respectively (P = 0.003); at 21 days they were 100 and 50% (P = 0.01). Oral rifampin was more effective than topical chloramphenicol for eradication of the BPF clone and may be useful in prevention of BPF.

Administration, Oral↗