METHOD FOR THE PRODUCTION OF A PURIFIED DRY Q FEVER VACCINE.
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Journal Article↗
Biomedical subjects
S Berman
Publications and source records attributed to S Berman.
Influence of maternal-fetal medicine subspecialization on the frequency of trial of labor in term pregnancies with breech presentation.
OBJECTIVE: To investigate the role of subspecialization in maternal-fetal medicine (MFM) on the frequency of a trial of labor in term pregnancies with breech presentation. METHODS: We conducted a retrospective study of 332 singleton pregnancies > or =37 weeks with nonfootling breech presentation that delivered over a 6-year period (1994-1998) at a university-based, tertiary care hospital. Patients were divided into two groups based on whether the delivery was attended by an MFM or non-MFM obstetrician-gynecologist. Demographic and clinical data were compared between groups and outcome variables included whether the patient had an attempt at vaginal delivery, cesarean delivery after a labor attempt, or vaginal breech delivery. RESULTS: The frequency of labor attempt (OR 1.4, 95% CI 0.9-2.3), vaginal breech success rate (OR 0.6, 95% CI 0.3-1.5), and overall cesarean rates (OR 0.9, 95% CI 0.5-1.7) were similar between groups. Using discriminant function analysis, only nulliparity (R2 = 1.6%, F = 6.0, P = 0.005) and birthweight (R2 = 2.0% F = 6.4, P = 0.01) were associated with trial of vaginal delivery. CONCLUSIONS: Subspecialization in MFM had no impact on the frequency of trial of labor in the term pregnancy with a breech presentation.
Adult↗
Freeze-drying various attenuated strains of Pasteurella pestis.
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Culture Media↗
Assessment of sexual function, interest and activity in depressed men.
Sexual function, interest, and activity were assessed in drug-free outpatient depressed men (n = 26) and in age-matched healthy control men (n = 20) by means of the Derogatis Sexual Functioning Inventory (DSFI), a retrospective sexual function questionnaire (SFQ), and a prospective daily sexual function log. Good test-retest reliability over 1 month was demonstrated for the DSFI and the SFQ in depressives and controls. Compared to healthy controls, depressed men reported significantly lower sexual interest and satisfaction, but no less sexual activity, on both retrospective questionnaires and prospective daily logs. Depressed men also showed significantly more negative body image and less 'manly' sexual role function as measured by the DSFI. Significant partial correlations (controlling for the effects of anxiety) were found between severity of depression and sexual interest, satisfaction, and role.
Adult↗
Prenatal alcohol consumption. Self versus collateral report.
The reservations expressed about the accuracy of patient self-reports of drinking may be heightened when obtaining information about prenatal alcohol consumption, which may be subject to fears of social or medical disapproval. Thus, clinicians may seek collateral reports to confirm patients' reports during this critical time. The purpose of this study is to compare the self and collateral reports of antepartum alcohol consumption by 247 pregnant women, obtained shortly after the initiation of prenatal care, and again after delivery. Collateral reports of subjects were exceeded by the subjects' self-reports of alcohol consumption before pregnancy and in the antepartum.
Adult↗
Epidemiology of acute respiratory infections in children of developing countries.
Acute respiratory infections cause four and a half million deaths among children every year, the overwhelming majority occurring in developing countries. Pneumonia unassociated with measles causes 70% of these deaths; post-measles pneumonia, 15%; pertussis, 10%; and bronchiolitis and croup syndromes, 5%. Both bacterial and viral pathogens are responsible for these deaths. The most important bacterial agents are Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus. The data on bacterial etiology of pneumonia during the first 3 months of life are limited, and almost no information on the role of chlamydia and pertussis in this age period is available. The distribution of viral pathogens in developing countries can be summarized as follows: respiratory syncytial virus, 15%-20%; parainfluenza viruses, 7%-10%; and influenza A and B viruses and adenovirus, 2%-4%. Mixed viral and bacterial infections occur frequently. Risk factors that increase the incidence and severity of lower respiratory infection in developing countries include large family size, lateness in the birth order, crowding, low birth weight, malnutrition, vitamin A deficiency, lack of breast feeding, pollution, and young age. Effective interventions for prevention and medical case management are urgently needed to save the lives of many children predisposed to severe disease.
Acute Disease↗
Selective primary health care: strategies for control of disease in the developing world. XXI. Acute respiratory infections.
Acute respiratory infections represent an important cause of mortality in developing countries, especially among malnourished infants. The microbial etiologies are numerous and complex. Since vaccines effective against the likely major pathogens in the youngest children are not available, the acute respiratory infection control programs designed by the World Health Organization are based on simple schemes to classify illness according to severity and to treat bacterial infections early, thus preventing severe complications. These programs require careful planning to anticipate and circumvent local problems, and their efficacy should be monitored with care. In addition, research is needed in many areas: definition of the spectrum of organisms involved and the pathogenesis of severe infection; delineation of markers that will accurately identify patients needing antibiotics or hospitalization; performance of controlled trials of intervention strategies that will unequivocally identify effective methods; design and production of new, simple, and inexpensive diagnostic tools; and development of vaccines that will be effective in the target populations.
Adolescent↗
Is reimbursement for childhood immunizations adequate? evidence from two rural areas in colorado.
OBJECTIVE: To assess adequacy of reimbursement for childhood vaccinations in two rural regions in Colorado, the authors measured medical practice costs of providing childhood vaccinations and compared them with reimbursement. METHODS: A "time-motion" method was used to measure labor costs of providing vaccinations in 13 private and public practices. Practices reported non-labor costs. The authors determined reimbursement by record review. RESULTS: The average vaccine delivery cost per dose (excluding vaccine cost) ranged from $4.69 for community health centers to $5.60 for private practices. Average reimbursement exceeded average delivery costs for all vaccines and contributed to overhead in private practices. Average reimbursement was less than total cost (vaccine-delivery costs + overhead) in private practices for most vaccines in one region with significant managed care penetration. Reimbursement to public providers was less than the average vaccine delivery costs. CONCLUSIONS: Current reimbursement may not be adequate to induce private practices to provide childhood vaccinations, particularly in areas with substantial managed care penetration.
Child↗
A controlled trial of cefaclor versus amoxicillin for treatment of acute otitis media in early infancy.
Optimal antimicrobial therapy of acute otitis media with effusion in early infancy is controversial. We studied the efficacy of cefaclor and amoxicillin in the treatment of 40 nonconsecutive infants less than 3 months of age in a double blind comparative trial. Infants were randomly assigned to receive either oral amoxicillin or cefaclor in a dosage of 40 mg/kg/day divided into 3 doses for 10 days. Clinical responses and adverse drug effects were evaluated at 48 to 72 hours, 5 to 7 days, 2 weeks and 3 weeks. Pathogenic bacteria isolated from ear aspirates in 24 cases included Streptococcus pneumoniae (14), Haemophilus influenzae type b (5), H. influenzae nontypeable (3), Staphylococcus aureus (4), Branhamella sp. (2), and Streptococcus pyogenes (1). Nonpathogenic bacteria isolated in 14 cases included Streptococcus epidermidis, diphtheroids and Streptococcus viridans. Two aspirates were sterile. A satisfactory clinical response was achieved in 15 of 21 cases (71%) treated with amoxicillin and 14 of 19 cases (74%) treated with cefaclor. We conclude that amoxicillin and cefaclor are comparable in efficacy for the therapy of acute otitis media with effusion in early infancy.
Acute Disease↗
Cerebral activation in patients with irritable bowel syndrome and control subjects during rectosigmoid stimulation.
OBJECTIVE: Patients with irritable bowel syndrome (IBS) show evidence of altered perceptual responses to visceral stimuli, consistent with altered processing of visceral afferent information by the brain. In the current study, brain responses to anticipated and delivered rectal balloon distension were assessed. METHODS: Changes in regional cerebral blood flow were measured using H2(15)O-water positron emission tomography in 12 nonconstipated IBS patients and 12 healthy control subjects. Regional cerebral blood flow responses to moderate rectal distension (45 mm Hg) and anticipated but undelivered distension were assessed before and after a series of repetitive noxious (60-mm Hg) sigmoid distensions. RESULTS: Brain regions activated by actual and simulated distensions were similar in both groups. Compared with control subjects, patients with IBS showed lateralized activation of right prefrontal cortex; reduced activation of perigenual cortex, temporal lobe, and brain stem; but enhanced activation of rostral anterior cingulate and posterior cingulate cortices. CONCLUSIONS: IBS patients show altered brain responses to rectal stimuli, regardless of whether these stimuli are actually delivered or simply anticipated. These alterations are consistent with reported alterations in autonomic and perceptual responses and may be related to altered central noradrenergic modulation.
Adult↗
Chlamydial pneumonia of infancy in siblings.
We describe two brothers born 16 months apart who were hospitalized with culture-proved chlamydial pneumonia of infancy due to the same immunotype of Chlamydia trachomatis. Presumably the mother had either been chronically infected or had been reinfected. Chlamydial pneumonia of infancy is a preventable disease if genital infection in pregnant women is diagnosed and treated. However, if pregnant women at high risk are not screened for C. trachomatis, multiple offspring may acquire the infection and develop serious perinatal chlamydial disease.
Chlamydia Infections↗
Chromosomal translocation (1:13) in a case of alveolar rhabdomyosarcoma.
PURPOSE: To describe a patient with a variant translocation (1;13)(p36;q14) in an alveolar rhabdomyosarcoma and compare the clinical course with four other cases. PATIENTS AND METHODS: A 10-year-old girl presented with multiple masses involving the thigh, abdomen, chest wall, and scalp with pleural effusion and edema of the lower extremities. RESULTS: A bone marrow biopsy, aspirate, and biopsy of the thigh mass all showed tumor invasion. Histopathology and cytogenetics of the thigh mass revealed an alveolar rhabdomyosarcoma with a t(1;13)(p36q14) variant. There was no response to aggressive therapy and the patient died within 3 weeks of admission. CONCLUSION: Variant t(1;13)(p36;q14) has now been described in 5 cases of rhabdomyosarcoma, and may define a subset of patients with extensive disease at diagnosis unresponsive to current therapeutic modalities.
Child↗
How much does a regional immunization registry increase documented immunization rates at primary care sites in rural colorado?
OBJECTIVE: To determine increases in immunization up-to-date (UTD) rates at a rural pediatric practice with the sequential addition of records from other sites in a 2-county region. DESIGN/METHODS: UTD rates for children aged 3 months to 35 months (n = 876) were determined for the index practice and then recalculated after sequential addition of records from 1) the other private practice in the region, 2) 7 public primary care sites, and 3) 2 public health clinics in the region. RESULTS: Adding records from all sites increased documented UTD rates in the index practice from 49% to 64% at 3 months (N = 33, P = 0.025), 50% to 68% at 5 months (N = 38, P = 0.008), 28% to 45% at 7 months (N = 113, P <.01), 29% to 54% at 12 months (N = 200, P <.001), 11% to 35% at 19 months (N = 124, P <.001), and 10% to 33% at 24 months (N = 368, P <.001). CONCLUSIONS: Regional registries will be valuable tools for immunization delivery if there is an ongoing commitment to effective collection of current and historical immunization data.
Child, Preschool↗
[Acute coronary syndromes without ST segment elevation. Why should we take an interventionist approach?].
The incidence of unstable angina and non-Q-wave myocardial infarction has increased dramatically. Risk of death and infarction is greatest in the first 6-8 weeks after admission. Risk stratification should be performed in patients with acute coronary syndromes at the earliest opportunity. The VANQWISH trial and TIMI-III B suggested that most patients do not benefit from routine, early invasive management. In the FRISC II trial, the rates of death/myocardial infarction at 6 months were 9.4% in patients treated with an early invasive strategy vs 12.1% with a more conservative approach. The previously reported superiority of the invasive strategy was also confirmed by the TACTICS-TIMI 18. The trial's primary composite end point at 6 months was significantly reduced in the invasive group: 15.9% vs 19.4% of the conservative group. The early invasive strategy was more beneficial the higher the patient's risk. We do not know whether we have reached the limits in terms of improving outcome with available strategies. What we do know is that all patients discharged following an acute coronary syndromes need to be treated aggressively in order to neutralize vulnerable atherosclerotic plaques and to manage cardiovascular risk factors.
Acute Disease↗
The psychological implications of intractable asthma in childhood.
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Asthma↗
Relationship between renal mass and atrial natriuretic peptide release. 1. Paradoxical effect of unilateral nephrectomy on serum atrial natriuretic peptide in rats.
Serial serum atrial natriuretic peptide (ANP) determinations were performed in 15 uninephrectomized Charles River rats and in 15 sham-operated control animals during the 60 days following surgery. In a second group of 7 control and 7 uninephrectomized animals, housed in metabolism cages, serum ANP, body weight, 24-hour urine volume, osmolality and sodium excretion were serially measured. In a third group of uninephrectomized and control rats the effect of acute salt loading 24 h, 6 and 60 days after surgery on serum ANP was studied. No significant changes in ANP levels were observed during the 60 days following surgery in control animals. In the uninephrectomized animals a sharp drop in basal ANP levels was evident 24 and 48 h after surgery, but increased levels of serum ANP were seen from day 6 to 28. Thereafter ANP returned to baseline levels for the rest of the study period. Urinary sodium excretion decreased in the nephrectomized animals on days 1 and 2 following surgery. No such change was seen in the control animals during the same period. Body weight, 24-hour urine volume and urine osmolality were not statistically different in the nephrectomized vs. control rats at any time and remained constant in each group throughout the experimental period. Central venous pressure (CVP) did not change significantly in both groups 24 h and 6 days following surgery. CVP rose similarly in both groups immediately following saline loading and returned to preload levels 1 h later.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Relationship between renal mass and atrial natriuretic peptide release. 2. Acute effects of various degrees of renal damage on atrial natriuretic peptide release in rats.
We studied basal serum atrial natriuretic peptide (ANP) levels and the response to acute salt loading in rats with different grades of functional renal mass reduction. The six groups of rats studied included 2 controls, i.e. unoperated (n = 12) and sham-operated (n = 24) groups. Each of the 4 experimental groups (n = 24 in each) underwent one of the following procedures: bilateral nephrectomy; unilateral nephrectomy; bilateral ureteral ligation; unilateral ureteral ligation. Basal ANP was assessed in the intact controls and operated groups 4, 8, 16 and 24 h after surgery. In addition, ANP was determined in the sham-operated controls and in the experimental groups 1 h following acute intravenous saline loading performed 4 h after surgery with central venous pressure monitoring. Basal ANP dropped significantly following bilateral nephrectomy but was not significantly altered after unilateral nephrectomy or the two modalities of ureteral ligation. In all 4 experimental groups ANP failed to rise after saline loading. We conclude that substantial renal damage results in early impairment in ANP secretion suggesting the existence of a renal physiological stimulus controlling ANP release by cardiac atria.
Animals↗
[Intravenous diltiazem in the reversion to sinus rhythm in supraventricular tachyarrhythmias].
UNLABELLED: The safety and therapeutic efficacy (sinus rythm recovery) of intravenous diltiazem vs verapamil in paroxysmal supraventricular tachycardias (PSVT), and diltiazem vs the Sokolow protocol (i.v. digital and oral quinidine) in recent onset atrial fibrillation (AF) were compared. Sixty patients with PSVT were randomized to have a bolus of 0.3 mg/Kg of diltiazem or 75 micrograms/Kg of verapamil. If after 15 minutes the PSVT persisted, a 6 hours i.v. infusion of diltiazem was started (0.0028 mg/Kg/min) or a second dose of verapamil was repeated. In 100 patients with PAF the alternative to diltiazem was i.v. digital plus oral quinidine (400 to 1,200 mg). Ninety per cent of the PSVT and 64% of de AF, recovered sinus rythm with diltiazem. The same results were obtained with verapamil in PSVT. With the Sokolow protocol 90% of the AF recovered sinus rythm. In 83% of AF who did not revert to sinus rythm, diltiazem was effective for slowing the ventricular response. In relation with the drug safety, only 5 patients showed hypotension, without clinical relevance, in the diltiazem group. With verapamil one patient had a transitory ischemic attack after recover sinus rythm. In the Sokolow group 26% had minor gastrointestinal disorders. CONCLUSIONS: In this clinical trial (n = 160): 1) Diltiazem and verapamil were highly and equally effective (90%) in reverting PSVT to sinus rythm. 2) The Sokolow protocol was more effective than diltiazem for reversing PAF to sinus rythm (90% vs 64%, p < 0.01). 3) Diltiazem was effective for slowing the ventricular rate in 83% of the patients with AF who did not revert to sinus rythm. 4) There was a low incidence of side effects with diltiazem and verapamil. 5) Diltiazem is a first choice therapeutic agent in reverting PSVT to sinus rythm and for slowing the ventricular rate in AF.
Adult↗