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Biomedical subjects

M E Weisse

Publications and source records attributed to M E Weisse.

At least 19 recordsLinked to original sources
PubMed2001

The fourth disease, 1900-2000.

Measles and scarlet fever were differentiated from one another in the 17th century. Rubella was accepted as the third distinct paediatric exanthem in 1881. Nil Filatow in 1885 and Clement Dukes in 1894 described two distinct forms of rubella, and in 1900 Dukes proposed that one of these forms of rubella was a separate entity which he called the fourth disease. For the past five decades, fourth disease has been considered a non-entity, perhaps a mild form of scarlet fever, but certainly not a distinct disease. In 1979 Keith Powell resurrected the idea of the fourth disease and argued that it was caused by exotoxin-producing Staphylococcus aureus. We present additional arguments for the existence of fourth disease, as well as information to link the disease to S. aureus.

Child↗
PubMed2001

Restructuring an academic pediatric inpatient service using concepts developed by hospitalists.

In an effort to increase continuity of inpatient care by attending physicians, decrease use of hospital resources, and improve medical education without compromising quality of care, an inpatient pediatric ward service was restructured by using concepts developed by hospitalists. This reorganization reduced the number of yearly inpatient attendings, added a consistent 14-day call schedule, and eliminated attending outpatient responsibilities during their ward service. The restructured ward service attending acted as the attending of record for all general and specialty patients, excluding hematology/oncology, with the subspecialists fulfilling a consultant role. To evaluate the impact of this restructuring, a baseline year of the traditional ward service (TWS) was compared with a subsequent year of the restructured ward service (RWS). Our goal was to evaluate the impact of this new system on average costs of hospitalization, length of stay, resource utilization, inpatient mortality, and 7- and 31-day readmission rates. Hospital costs per patient were lower by 13% (p=0.018) in the restructured system. Average lengths of stay in an observation bed were significantly lower on the RWS (p=0.007), but there was no significant difference in admission length of stay. There was decreased resource utilization for laboratory and radiology tests (p<0.01) on the restructured service. Readmission rates were not significantly changed, and satisfaction among attendings, housestaff, students, and patients was uniformly high in both groups. A reorganized academic pediatric medical service, which allows specific attendings to focus on inpatient care and teaching, can decrease hospital resource utilization without compromising the quality of patient care or medical education.

Child↗
PubMed1998

Prospective randomized double blind placebo-controlled evaluation of azithromycin for treatment of cat-scratch disease.

OBJECTIVE: To determine the efficacy of azithromycin in the treatment of patients with typical cat-scratch disease. DESIGN: Prospective, randomized, double blind, placebo-controlled clinical trial. SETTING: Large military medical center and its referring clinics. PATIENTS: Active duty military members and their dependents with laboratory-confirmed, clinically typical cat-scratch disease. INTERVENTION: Study participants assigned by randomization to treatment with oral azithromycin or placebo for 5 days. OUTCOME MEASURES: Lymph node volume was calculated using three dimensional ultrasonography at entry and at weekly intervals. The ultrasonographer was blinded to the treatment groups. Endpoint evaluations were predetermined as time in days to 80% resolution of the initial total lymph node volume. RESULTS: Demographic and clinical data showed that the azithromycin and placebo treatment groups were comparable at entry although the placebo group tended to be older. Eighty percent decrease of initial lymph node volume was documented in 7 of 14 azithromycin-treated patients compared with 1 of 15 placebo-treated controls during the first 30 days of observation (P = 0.026). After 30 days there was no significant difference in rate or degree of resolution between the two groups. CONCLUSIONS: Treatment of patients with typical cat-scratch disease with oral azithromycin for five days affords significant clinical benefit as measured by total decrease in lymph node volume within the first month of treatment.

Adolescent↗
PubMed1995

Botulism.

Explore the source record for details and available documents.

Botulinum Toxins↗
PubMed1994

Decline of erythromycin resistance of group A beta-hemolytic streptococci in Japan. Comparison with worldwide reports.

OBJECTIVE: To determine the current prevalence of erythromycin resistance and penicillin tolerance of group A beta-hemolytic streptococci (GABHS) in Japan. RESEARCH DESIGN: One hundred four isolates of GABHS from the civilian community in Tokyo and 101 isolates from the military population at the US Air Force Base in Yokota, Japan, were tested for erythromycin susceptibility and penicillin susceptibility and tolerance. SETTING: US Army Medical Center. RESULTS: Of the Japanese civilian isolates, two were moderately susceptible and none were resistant to erythromycin; of the military isolates, none were moderately susceptible and one was resistant, for an overall resistance rate of 0.49%. All isolates were exquisitely susceptible to penicillin, and no evidence of penicillin tolerance was found. CONCLUSIONS: Comparison with similar studies world-wide shows that erythromycin susceptibility of GABHS in Japan is now among the lowest in the world, while just over a decade ago it was the highest. These observations mandate constant monitoring of erythromycin resistance of GABHS wherever this drug is used to treat patients with infections due to this organism.

Drug Resistance, Microbial↗
PubMed1993

Antimicrobial treatment of occult bacteremia: a multicenter cooperative study.

This prospective multicenter study was conducted to define more clearly clinical and laboratory criteria that predict a strong probability of occult bacteremia and to evaluate the effect of empiric broad spectrum antimicrobial treatment of these children. Children 3 to 36 months old with fever > or = 40 degrees C (104 degrees F) or, > or = 39.5 degrees C (103 degrees F) with white blood cells (WBC) > or = 15 x 10(9)/liter, and no focus of infection had blood cultures obtained and were randomized to treatment with oral amoxicillin/potassium clavulanate or intramuscular ceftriaxone. Sixty of 519 (11.6%) study patients had positive blood cultures: Streptococcus pneumoniae, 51; Haemophilus influenzae b, 6; Neisseria meningitidis, 2; and Group B Streptococcus, 1. Subgroups of high risk were identified as fever > or = 39.5 degrees C and WBC > or = 15 x 10(9)/liter, 55 of 331 or 16.6% positive with increasing incidence of positive culture with increasing increments of degrees of leukocytosis to WBC > or = 30 x 10(9)/liter where 9 of 21 or 42.9% were positive. Subgroups of significantly lower risk were identified as fever > or = 39.5 degrees C and WBC < 15 x 10(9)/liter, 5 of 182 or 2.7% positive and those with WBC < 10 x 10(9)/liter, 0 of 99 or 0.0% positive. Children with positive cultures who received ceftriaxone were nearly all afebrile after 24 hours whereas a significant number who received amoxicillin/potassium clavulanate remained febrile. In the 459 culture-negative children more amoxicillin/potassium clavulanate-treated children developed diarrhea and had less improvement in clinical scores after 24 hours than ceftriaxone-treated children.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1991

Antigenuria after immunization with Haemophilus influenzae oligosaccharide CRM197 conjugate (HbOC) vaccine.

We tested the urine of 30 infants 6 weeks to 7 months of age after they received standard 10-micrograms (0.5-ml) doses of HbOC (HibTITER) Haemophilus influenzae b (Hib) conjugate vaccine for the presence of Hib antigenuria using a commercially available latex particle agglutination assay (Directigen). Urines were collected within 1 hour, from 1 to 3 hours, at 24 hours and at 3, 6 and 9 days after vaccine administration and reactions were quantitated from 0 to 3+. In contrast to previous studies in older children which showed little or no antigenuria following HbOC vaccination, our study shows that in infants intense Hib antigenuria is evident within 2 to 3 hours and persists 3 days after vaccine administration and that less intense antigenuria may be detected in some infants for several days. With efficacious vaccines now being used in 2- to 6-month-old infants, invasive Hib disease may soon be limited to infants of this age just before their seroconversion. It should be recognized that antigenuria occurs for several days after vaccination with Hib conjugate vaccines and that it could be erroneously interpreted as evidence of invasive Hib infection.

Antigens, Bacterial↗