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Biomedical subjects

S D Goodwin

Publications and source records attributed to S D Goodwin.

31 records · Page 2Linked to original sources
PubMed1990

Prospective surveillance of intravenous amphotericin B use patterns.

Information on amphotericin B use patterns and infusion-related adverse events were prospectively collected from 397 hospitalized adults. The methods of initiating amphotericin B varied greatly, with the majority of patients being gradually titrated to a full maintenance dose over 1-5 days. Overall, 71% of patients experienced at least one episode of an infusion-related adverse event (IRAE) during the first week of therapy. Fever and chills were most commonly observed, with peak frequency on days 1-3, followed by a subsequent decline. A wide variety of pretreatment medications were used to minimize IRAE; the most common regimens included some combination of diphenhydramine, acetaminophen, and corticosteroids, with or without heparin. The majority of patients (84.7%) received a test dose, and although none experienced a severe allergic reaction, one patient subsequently had an anaphylactic episode on the third day of amphotericin B therapy. The use of a test dose and the titration process are attempts to avoid the IRAE frequency associated with large initial doses of amphotericin B, but we observed that they provided little or no benefit. In addition, our study suggests that pretreatment regimens are frequently used in conjunction with the test dose. If the intent of the test dose is to identify patients sensitive to amphotericin B, pretreatment drugs may minimize these adverse events and prevent a complete evaluation of response to the test dose.

Acetaminophen↗
PubMed1990

Trimethoprim-sulfamethoxazole anaphylactoid reactions in patients with AIDS: case reports and literature review.

Adverse effects are common in patients with acquired immunodeficiency syndrome (AIDS) who receive trimethoprim-sulfamethoxazole (TMP-SMX). Two patients experienced a rare anaphylactoid syndrome. Within hours of receiving a double-strength TMP-SMX tablet, a 28-year-old human immunodeficiency virus (HIV)-positive man developed fever, hypotension, and bilateral pulmonary infiltrates. Broad-spectrum antimicrobial therapy was begun but discontinued 2 days later when signs and symptoms resolved and specimens for Pneumocystis carinii were negative. A 38-year-old man developed rash, fever, hypotension, hyperbilirubinemia, renal dysfunction, and bilateral pulmonary infiltrates after taking two doses of oral TMP-SMX. Several antimicrobial agents, including parenteral pentamidine, were administered despite lack of evidence for P. carinii or other infection. four case reports of similar reactions in patients with AIDS have been published. Notable differences exist between the syndrome described and anaphylaxis. The TMP-SMX anaphylactoid reactions in patients with AIDS mimic sepsis or opportunistic infection, thus making diagnosis difficult.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Comparison of the safety and efficacy of intravenous ciprofloxacin and intravenous ceftazidime in the treatment of selected infections.

A study was conducted to determine the comparative safety and efficacy of intravenous ciprofloxacin with that of intravenous ceftazidime in the treatment of selected infections. Male and female inpatients 18 years or older had bacterial infections of the blood, skin or skin/structure, intra-abdominal region, lower respiratory tract, or urinary tract (considered complicated) caused by organisms susceptible to both ciprofloxacin and ceftazidime. Patients were randomly assigned to receive either ciprofloxacin 200 mg intravenously every 12 hours or ceftazidime 0.5 to 2 g intravenously every eight to 12 hours. Clinical evaluations were performed daily during therapy and within five to nine days after therapy was complete. For patients with urinary tract infection, urine for culture was obtained during (Day 3 or 4) and after (five to nine days and three to five weeks) therapy. A total of 86 patients were enrolled into the study. Forty-three received ciprofloxacin and 43 received ceftazidime. There were 22 evaluable patients in the ciprofloxacin group with 24 infection sites: skin/skin structure (eight), respiratory tract (nine), blood (two), urinary tract (five). In the ceftazidime group, there were 26 evaluable patients with 29 infection sites: skin/skin structure (15), respiratory tract (nine), blood (three), and urinary tract (two). The mean duration of therapy with ciprofloxacin and ceftazidime was 7.5 days (range, four to 28 days) and 8.4 days (range, three to 25 days), respectively. Bacteriologic eradication of the causative organisms occurred at 17 infection sites (70.8 percent) in the ciprofloxacin-treated patients and 21 infection sites (72.4 percent) in the ceftazidime group. Clinically, resolution or improvement in signs/symptoms was demonstrated in 22 patients (91.7 percent) in the ciprofloxacin group and 26 patients (89.7 percent) in the ceftazidime group. Bacteriologic response (by organism) and overall response were comparable in both groups. All enrolled patients were evaluated for determination of safety. Adverse events considered possibly or probably related to the study drugs were reported in 16 of 43 patients (37.2 percent) in the ciprofloxacin group and four of 43 patients (9.3 percent) in the ceftazidime group. Ciprofloxacin and ceftazidime were equally efficacious in the treatment of selected infections, but ciprofloxacin was associated with a higher incidence of adverse reactions probably or possibly related to drug administration. Further studies with larger sample sizes in selected patient populations will be required to identify differences in efficacy among the two antibiotics.

Adult↗
PubMed1987

Biochemical and behavioral effects of intrahippocampal AF64A in rats.

AF64A (ethylcholine aziridinium, 1 nmole) injected into the dorsal hippocampus of the rat decreased choline acetyltransferase activity there by 20% without greatly affecting adjacent areas. The decrease was maximal by 3 days, and persisted for at least 3 weeks. The acetylcholine concentration at the injection site was decreased by 25-30% from 3 days to 4 weeks. Rats were trained on a continuous reinforcement (CRF) food-reinforced lever press schedule and then injected bilaterally in the dorsal and ventral hippocampus. Subsequent switching to a daily CRF-extinction schedule resulted in increased responding during extinction compared to controls which persisted for at least 13 session. However, injection after switching schedules increased it for only 2 sessions. This indicates that the persistently increased extinction responding is due mainly to impaired learned habituation to a new schedule. Most of the extinction effect of the intrahippocampal AF64A was due to its injection at the dorsal site. Separate rats which were trained on the 8-arm radial maze task (a test of short-term spatial working memory) and injected as above only showed marginally impaired task performance even at higher doses. We conclude that even relatively minor, localized, cholinergic deficits confined to the hippocampus can produce significant learning and memory impairments in situations where intermediate or long term memory formation is required.

Acetylcholine↗
PubMed1984

Temporary use of an eroded bipolar pacemaker system.

Over a 2.5-year period, of 176 bipolar pacemaker procedures, six were complicated by erosion (incidence, 3.4%). One patient was treated whose pacemaker was inserted at another hospital. Time from insertion to presentation ranged from 5 to 23 months. When infection was present, Staphylococcus epidermidis was found to be the offending organism. We have used a staged method for managing this problem. Initially, the bipolar pulse generator was exteriorized and worn suspended around the neck while infection was controlled. A new pacemaker system (catheter and pulse generator) was inserted from the opposite side once infection was controlled. The main advantage of this type of approach is that the old pacing catheter and old bipolar generator can be used as an effective temporary pacing system, while the infection is being controlled thus eliminating the step of inserting a temporary pacing catheter after the eroded generator and catheter have been removed. A temporary pacing catheter is only safe and effective for a few days (perhaps up to a week), and this may not be sufficient time to be sure that infection is locally controlled. In addition, the patient can be ambulatory as the old permanent catheter is not likely to be dislodged easily as compared with a temporary catheter. Follow up ranging from 2 to 23 months has shown this to be an effective method for treating bipolar pacemaker erosion or infection in all instances without further infection or complication.

Aged↗
PubMedDate not supplied

Pneumocystis carinii pneumonia in human immunodeficiency virus-infected infants and children.

Pneumocystis carinii pneumonia (PCP) is the most common opportunistic infection in adults and children infected with the human immunodeficiency virus (HIV). Without prophylaxis, half of all these children will develop PCP at sometime during their illness. The disease is associated with high mortality and a poor prognosis for long-term survival in this patient population. In infants and young children, PCP may be a primary infection, compared with reactivation of a latent infection that is usually the case in older children and adults. Clinical features, radiographic findings and diagnostic strategies are similar in children and adults. Although alternative agents are being investigated, trimethoprimsulfamethoxazole (TMP-SMX) and pentamidine remain the standard therapeutic agents. Insufficient data are available to recommend routine adjunctive corticosteroids in children with acquired immunodeficiency syndrome (AIDS), PCP, and significant respiratory disease. Prophylaxis against PCP occurrence or recurrence is indicated for HIV-infected children and infants under 1 year of age, children with less than 20% T4 helper lymphocytes, those meeting age-related Centers for Disease Control (CDC) guidelines for prophylaxis, and those with a history of suspected or documented PCP. The CDC recommends intermittent TMP-SMX for PCP prophylaxis in children with AIDS.

AIDS-Related Opportunistic Infections↗