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Biomedical subjects

U B Schaad

Publications and source records attributed to U B Schaad.

At least 73 records · Page 4Linked to original sources
PubMed1993

Multicentre evaluation of azithromycin in comparison with co-amoxiclav for the treatment of acute otitis media in children.

A total of 389 children (age 0.6-10.2 years) with typical signs and symptoms of acute otitis media were randomized (1:1) to treatment with either azithromycin or co-amoxiclav. The dosage schedule for azithromycin was 10 mg/kg/day, in a single daily dose, administered for three days. Co-amoxiclav was given at a dose of 13.3 mg/kg (amoxycillin equivalent) tid for ten days. Patients were evaluated 4-6 days and 12-16 days after the start of therapy. A satisfactory clinical response was reported for 93.2% of the 192 evaluable azithromycin-treated patients (144 cured, 35 improved), and for 97.3% of the 189 evaluable co-amoxiclav-treated patients (148 cured, 36 improved). Six (3.0%) relapses occurred in the azithromycin group, and four (2.1%) in the co-amoxiclav treatment group, respectively. Side-effects were recorded in a significantly fewer number of the azithromycin patients (23 of 197; 11.7%) compared with the co-amoxiclav patients (43 of 192; 22.4%, P < 0.02). Adverse events were mainly gastrointestinal in nature, with diarrhoea the most frequent complaint (32 cases with co-amoxiclav; five with azithromycin; P < 0.001). One patient from each group discontinued therapy because of treatment-related adverse events. Laboratory analyses (mainly haematological in nature) showed abnormalities in six of 100 azithromycin patients and ten of 101 co-amoxiclav patients. It was concluded that three-day, single-dose azithromycin and ten-day tid co-amoxiclav therapy have comparable clinical efficacy in paediatric patients with acute otitis media; however, there was a lower incidence of side effects in the azithromycin group.

Acute Disease↗
PubMed1993

Novel Campylobacter-like organism resembling Helicobacter fennelliae isolated from a boy with gastroenteritis and from dogs.

We isolated a Campylobacter-like organism resembling Helicobacter fennelliae from a 5 1/2-year-old boy with gastroenteritis. Similar strains had been found previously in fecal specimens from healthy and diarrheic dogs. These isolates could be differentiated from H. fennelliae by a lack of catalase and arylsulfatase activities. This group of organisms seems to be homogeneous by a nonradioactive dot blot DNA hybridization assay.

Animals↗
PubMed1993

Use of the quinolones in paediatrics.

For many years, quinolone-induced cartilage toxicity observed in experiments involving immature animals has represented an indisputable contraindication for the use of these promising antimicrobials in prepubertal patients. Clinical, magnetic resonance imaging and histopathological monitoring of patients receiving ciprofloxacin at the University of Berne, together with published data, suggest that the quinolones do not cause arthropathy in humans. Conditions that potentially qualify for quinolone use (especially ciprofloxacin) in children include oral antipseudomonal (or antistaphylococcal) therapy for pulmonary exacerbations in cystic fibrosis, and complicated urinary tract, skeletal, aural and shunt infections. In addition to these rarer indications, there is an urgent need for the quinolones in developing countries for children with endemic and epidemic shigellosis and invasive salmonellosis. At present, these compounds are not approved for paediatric use and therefore must be administered as part of a controlled study or on a compassionate use basis in individual patients.

Anti-Infective Agents↗
PubMed1992

[Assessment of the nephrotoxicity of amikacin in patients with cystic fibrosis].

Cystic fibrosis patients are at risk for nephrotoxic effects of aminoglycosides. Fifteen cystic fibrosis patients were admitted to hospital with 18 acute exacerbations of pulmonary symptoms associated with the isolation of Pseudomonas aeruginosa from sputum. They were treated intravenously with amikacin and ceftazidime for 14 days. Urinary excretion of N-acetyl-beta-D-glucosaminidase and alpha 1-microglobulin, two markers of tubular damage, and of albumin, a marker of glomerular permeability, was studied before and during treatment. Urinary activity of N-acetyl-beta-D-glucosaminidase and excretion of alpha 1-microglobulin was normal before amikacin treatment in approximately two thirds of patients and pathologically increased at the end of the study in 95%. Urinary albumin excretion was always normal before amikacin treatment and failed to increase consistently during treatment. The pattern of urinary protein excretion observed in the study before and during treatment with amikacin indicates a selective tubular toxicity.

Acetylglucosaminidase↗
PubMed1992

Epidemiology of vertically transmitted HIV-1 infection in Switzerland: results of a nationwide prospective study. Swiss Neonatal HIV Study Group.

A nationwide study involving 286 children of human immunodeficiency virus (HIV)-infected mothers living in Switzerland has been performed with the participation of all paediatricians interested in HIV infection in the country. Of these children 201 could be followed up prospectively from birth up to a median age of 22 months. Prevalence of HIV infection in Swiss parturients was estimated at 0.1% and apparently remained stable from 1986 to 1989. Vertical transmission rate was estimated at 14%-20%. Variables of maternal or perinatal history were not associated with transmission rate. Transmission to pairs of siblings of the same mothers was discordant in 33% (6 of 18), with always the elder sibling being infected. Postneonatal mortality in infants of HIV-infected mothers followed up from birth was increased 15-fold over the general population with a very high incidence (2 in 100) of sudden infant death apparently unrelated to HIV infection.

Child↗
PubMed1992

Occurrence and phenotypic properties of verotoxin producing Escherichia coli in sporadic cases of gastroenteritis.

Five verotoxin producing Escherichia coli strains were detected in 405 patients with infectious gastroenteritis and 3 such strains were detected in 11 patients with the hemolytic uremic syndrome in Switzerland. Production of verotoxin 2 was associated with the latter three strains. Four strains reacted with the probe for the virulence plasmid of Escherichia coli O157:H7, and six reacted with a recently described probe for the eae gene of enteropathogenic Escherichia coli. None of the strains was of serotype O157:H7. The methods available at present for detecting toxins or toxin genes will reliably detect all such verotoxin producing strains.

Adult↗
PubMed1992

Affinity constants of naturally acquired and vaccine-induced anti-Pseudomonas aeruginosa antibodies in healthy adults and cystic fibrosis patients.

Naturally acquired anti-Pseudomonas aeruginosa antibody fails to afford protection against repeated P. aeruginosa bronchopulmonary exacerbations in cystic fibrosis (CF) patients. In an effort to explain this phenomenon, the titer and affinity constants of serum anti-lipopolysaccharide (LPS) IgG were determined in five study groups: healthy adults before and after immunization with a polyvalent LPS-based vaccine, healthy noncolonized CF patients before and after immunization, nonimmunized CF patients with significantly elevated anti-LPS antibody titers without documented colonization, recently colonized CF patients before and after immunization, and nonimmunized CF patients chronically colonized with P. aeruginosa. Immunization elicited a significant rise in total anti-LPS immunoglobulin levels and affinity constants in both healthy adults and CF patients. Although chronically colonized patients had elevated levels of total anti-LPS antibody, these antibodies possessed affinities at least 100-fold less than those of vaccine-induced antibodies.

Antibodies, Bacterial↗
PubMed1992

Linkage analysis in properdin deficiency families: refined location in proximal Xp.

Properdin is a component of the alternative activation pathway of the complement system. Deficiency or dysfunction of the protein is inherited in an X-linked recessive manner. Affected males have an increased risk of developing meningococcal disease. Six multi-generation families with different types of properdin deficiency were analyzed using microsatellite and other polymorphisms on the X chromosome. Based on multipoint data, it was found that the disease gene maps close to DXS255 (Zmax = 13.3 at theta max = 0.00) and DXS426 (Zmax = 12.9 at theta max = 0.00) on the Xp-arm near the centromere. There was no indication of genetic heterogeneity among the six families analyzed. Thus it is now possible to perform accurate DNA-based determination of the inheritance of the mutation in affected families.

Chromosome Mapping↗
PubMed1992

[Group A streptococci 1992--a challenge for general practice, hospital and research].

Group A streptococci continue to frequently cause a wide array of infectious diseases. Prompt and reliable diagnosis of such patients and their adequate management are often complex and require substantial degree of both knowledge and suspicion. Modern aspects concerning acute streptococcal pharyngitis, invasive infections, and rheumatic fever represent important challenges for medical doctors working in private praxis, hospital and research. Major achievements in better understanding streptococcal infection include the complex pathogenicity of M-proteins, the perplexing results of uncritically performed throat cultures, the questionable therapeutic dominance of penicillin, and the prospect for active immunization. These changes certainly imply relevant adaption in managing group A streptococcal infections.

Adult↗
PubMed1991

Safety and immunogenicity of Pseudomonas aeruginosa conjugate A vaccine in cystic fibrosis.

To assess the safety and immunogenicity of a Pseudomonas aeruginosa octavalent O-polysaccharide-toxin A conjugate vaccine, 22 patients (mean age 7 years) with cystic fibrosis who had no history of colonisation with P aeruginosa were immunised with the vaccine. Adverse reactions were mild and self-limiting. IgG antibody concentrations to all vaccine antigens were significantly raised after vaccination and remained so for 12 months. Immunisation produced opsonic and toxin A neutralising antibodies. A booster dose given at 12 months led to an anamnestic response. There was no significant change in clinical status after vaccination. Further work to assess efficacy in patients with cystic fibrosis can now be considered since our findings support the safety and immunogenicity of the vaccine.

ADP Ribose Transferases↗
PubMed1991

[Bacterial meningitis: pathophysiology and therapy 1991].

The new concepts of pathogenesis and pathophysiology of purulent meningitis are discussed and evaluated in logical sequence. Possible therapeutic down-modulation of the initial burst of inflammatory responses, especially with steroids (dexamethasone), is critically analyzed. Prompt and adequate antibiotic therapy remains the essential measure in the management of patients with bacterial meningitis. The individual aspects of antimicrobial therapy are described and specific recommendations are made.

Anti-Bacterial Agents↗
PubMed1991

[Aseptic meningitis in pediatrics].

We analyzed the 259 pediatric patients (69% males, 31% females) treated for aseptic meningitis at the Department of Pediatrics (Inselspital), University of Berne, Switzerland, during the 10-year period from 1978 to 1987. 79% were in- and 21% outpatients. The main study purpose was the evaluation of clinical presentation, diagnostic workup, course and prognosis of this disease entity. The clinical characteristics (fever, meningitic signs, headache, nausea and vomiting, and usually normal consciousness) were not discriminative for differential diagnosis. On the other hand, pleocytosis in cerebrospinal fluid averaged 406 x 10(6) cells/l (57% mononuclear cells) at first lumbar puncture, and 6 to 12 hours later showed both slight decrease of total cell count and clear shift to mononuclear cells (71%). The course of the disease was always short and benign. Complications, usually of a neurologic nature, occurred in only 10% and all were mild and reversible. Nevertheless, follow-up interview by phone identified 21% of patients with transient post-meningitic disorders, especially prolonged episodes of stress-induced headache. However, except for one case of chronic hydrocephalus, there were no severe or persistent sequelae. Neither complications nor sequelae correlated with patient age or laboratory findings. Our results confirm that aseptic meningitis in children is relatively benign, and underline the importance of rest and relaxation during convalescence. Rapid, reliable and cheap viral diagnostic tests in the cerebrospinal fluid could simplify the management of the individual patient with regard to repeated lumbar punctures (in 36%), surveillance in the hospital (in 79%), and antibiotic therapy (in 25%).

Adolescent↗
PubMed1991

[Pneumothorax in cystic fibrosis].

Longer life expectancy for patients with cystic fibrosis (CF) has resulted in an increased incidence of pneumothorax (PT), which occurs in advanced stages of CF. This study is based on 276 patients with CF followed up between 1974 and 1989 at the Department of Pediatrics, University of Berne, Switzerland. 23 children or adolescents (10 boys and 13 girls) experienced 51 events of PT, 18 of which were tension pneumothoraces. The average age at first episode was 15.6 years. The long-term success rates of the four different therapeutic modalities used were 24% for observation, 9% for pleural suction drainage only, 75% for quinacrine sclerosis and 90% for open thoracotomy. Sclerosis was associated with fewer complications and shorter hospital stays than thoracotomy. We therefore conclude that, following initial evacuation of the PT using a chest tube, quinacrine sclerosis should be considered as primary prophylaxis for recurrent PT. Only in 3 of the 23 patients did the course of the basic disease deteriorate substantially following PT, and there was no death related to the PT episodes.

Adolescent↗