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Biomedical subjects

W R Lange

Publications and source records attributed to W R Lange.

At least 37 records · Page 2Linked to original sources
PubMed1992

Dengue fever: a resurgent risk for the international traveler.

The incidence of dengue fever, an acute febrile illness transmitted by the Aedes aegypti mosquito, is on the rise. High fever, severe headache, skin rash and a variety of constitutional symptoms are hallmarks of classic dengue fever. Dengue hemorrhagic fever, a severe manifestation associated with secondary infection, most often occurs in children. Treatment of classic dengue fever is supportive, whereas urgent rehydration therapy is often required in more severe forms. Community-based and personal strategies for avoiding the mosquito vector represent the best methods of prevention, although vaccine development programs are under way.

Aedes↗
PubMed1991

Can protracted relapsing fever resemble Lyme disease?

We report the case of a Protestant missionary who contracted tick-borne relapsing fever in 1979 while serving in the Sudan. Despite tetracycline treatment, his acute illness ran a protracted course, with migratory polyarthralgias lasting approximately 10 months. Symptoms recurred in 1984 and have persisted. At regular intervals, the patient has experienced recurrent episodes of fever, generalized fatigue, bilateral upper and lower extremity muscle weakness, and asymetric large joint polyarthralgia. Indirect fluorescent antibody testing of sera demonstrated titers of 1:16 for B. burgdorferi and 1:64 for B. hermsii, and immunoblotting confirmed past exposure to relapsing fever, but not Lyme disease. It is hypothesized that this individual's chronic symptoms have been related to relapsing fever, and that in certain situations or in select individuals, relapsing fever can be capable of producing a chronic clinical picture analogous to Lyme disease.

Adult↗
PubMed1991

Travel in eastern Europe. Guidelines for patients.

Some patients need medical preparation and physician counseling before traveling to eastern European countries. In addition to baseline immunizations, a measles booster, a polio booster, typhoid vaccination, and immune globulin prophylaxis against hepatitis A may be indicated. Advice should also be given regarding air pollution, contaminated food and water, civil unrest, motor vehicle mishaps, and each country's policy on HIV screening. Because the level of healthcare may be poor, contact with American or British embassies or consulates is recommended in an emergency.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Assessment of risk for HIV-1 infection for missionaries in sub-Saharan Africa.

North American mission boards (N = 82) with programs in sub-Saharan Africa were surveyed to identify practices affecting risk of human immunodeficiency virus type 1 (HIV-1) infection among international staff. Thirty-four percent of participating boards thought risk for HIV-1 infection in missionaries in Africa was greater than it was for the general US population, and 53% considered it greater for overseas medical staff serving in the region than for domestic health care workers. Nevertheless, only 24% of boards had formal AIDS education programs for overseas health care workers, and 19% for nonmedical personnel going abroad. Medical care provision and acquisition were considered high-risk activities; 42% of boards with a known policy acknowledged that disposable injection equipment was routinely reused, 68% indicated that immunizations were provided abroad, and 60% admitted that inoculations were administered by indigenous health care workers. The most frequently cited specific suggestion for decreasing the risk of HIV-1 infection overseas was the implementation of a walking blood bank program. We conclude that current practices and logistic constraints make HIV-1 transmission possible. Risk reduction strategies include more comprehensive health education programs, greater adherence to universal precautions, less dependence on the indigenous Third World health care system, and implementation of innovative programs for health care delivery.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Amyl nitrite alters human in vitro immune function.

Effects on the human immune system of volatile nitrite inhalation were studied in 18 male volunteers. While nitrite inhalation decreased the absolute number of CD3+ T lymphocytes during the period of inhalation, cell numbers returned to pre-treatment levels within one week after cessation of the drug. Nitrite inhalation did not alter the percentage of CD3+, CD4+, CD8+ or CD19+ lymphocytes. Natural killer (NK) cell activity against K562 target cells was depressed by nitrite administration but returned to pre-inhalation or greater levels after nitrite discontinuation. Cell proliferation following cell activation by PHA, ConA and PWM was unaffected by amyl nitrite inhalation. We conclude that in humans inhalation of volatile nitrites causes cycles of modest immunosuppression, particularly in NK activity, followed by gradual recovery when the drug is not inhaled for several days.

Adult↗
PubMed1990

Safety and side-effects of buprenorphine in the clinical management of heroin addiction.

Sublingual buprenorphine (8 mg) was administered to heroin-dependent addicts daily for 18 days and continued from day 19-day 36 either daily or on alternate days. Final data are reported on 18 subjects. The number of self-reported symptoms reviewed as potential adverse drug reactions ranged from 1 to 88 per participant. None was considered to be related definitely to the study medication, and there were no reporting differences between the two dosing regimens. Forty-five reactions were considered probably related to buprenorphine: sedation/drowsiness (three reports) and constipation (42 reports). It was concluded that these were anticipated drug effects rather than adverse reactions. Although some participants showed increases in serum aminotransferase levels, those increases could not be directly attributed to buprenorphine. We conclude that buprenorphine was well tolerated, but further study is needed in this population to delineate the possible attributable risk of the drug to hepatic dysfunction in this population.

Administration, Sublingual↗
PubMed1990

High incidence of viral hepatitis among American missionaries in Africa.

Protestant missionaries (n = 360) serving in sub-Saharan Africa between 1967-1984 were studied to determine the risk of hepatitis A virus (HAV) and hepatitis B virus (HBV) infection. Personnel were serologically screened for antibody to both the hepatitis A virus (anti-HAV) and the surface antigen to the hepatitis B virus (anti-HBs) prior to departure, periodically during service abroad, and upon completion of their African tour. Rates of seroconversion were used as measures of the incidence of infection. Prior to service, 16% of the staff had anti-HAV and 3% had anti-HBs; post-service rates were 42% and 26%, respectively. Over 90% of the staff with greater than 20 years of service were seropositive for anti-HAV. For both viruses, the infection rate was highest during the first 1-2 years of service, when 28% of those susceptible to HAV and 11% of those susceptible to HBV became infected. Over the next decade, the median annual attack rate was 5.4% for HAV and 4.2% for HBV. Differences in the missionary HBV infection rate among the various African nations served tended to reflect differences in the magnitude of chronic HBV carriage among indigenous population groups. We conclude that missionaries to sub-Saharan Africa are at enhanced risk of both HAV and HBV infection, and that all should receive passive immunization with immune globulin and active immunization with hepatitis B vaccine.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Puffer fish poisoning.

Regarded by many as a delicacy, puffer fish can be the source of lethal food poisoning in humans. The syndrome is caused by tetrodotoxin, one of the most potent poisons known. Intoxication produces a constellation of symptoms, with paresthesias and generalized muscle weakness being common complaints. Treatment is symptomatic and often needs to be aggressive. Life support may be required. In some series, the mortality rate has approached 60 percent.

Animals↗
PubMed1990

The association of hepatitis delta virus and hepatitis B virus in parenteral drug abusers. 1971 to 1972 and 1986 to 1987.

From 1971 to 1972 (N = 105) and 1986 to 1987 (N = 160), parenteral drug abusers seropositive for hepatitis B virus (HBV) markers were screened for antibodies to the hepatitis delta virus (anti-HD). In both time frames anti-HD was independently associated with the hepatitis B surface antigen. It was observed that 31% of those positive for hepatitis B surface antigen from the early sample and 20% of those from the latter sample had detectable anti-HD, as opposed to 10% and 7%, respectively, of those negative for hepatitis B surface antigen. Anti-HD seropositivity was unrelated to gender and ethnicity, and in the 1971 and 1972 nationwide sample, its presence was unrelated to geographic location. The probability of manifesting anti-HD increased with the more HBV markers detected, particularly the number of different HBV antibody markers. We conclude that anti-HD was wide-spread in parenteral drug abusers at least as early as 1971, and that its expression was associated with hepatitis B surface antigen and the intensity of the immune response to HBV as evidenced by the number of different circulating HBV antibodies.

Adolescent↗
PubMed1989

The effects of 9-ene-tetrahydrocannabinol on hormone release and immune function.

We investigated effects of 9-ene-tetrahydrocannabinol (THC) on endocrine and immunological function. Seventeen male volunteers entered into a double blind, randomized study to receive oral THC (10 mg t.i.d. for 3 days and on the morning of the fourth day) or placebo, after at least 2 weeks of abstinence. Plasma prolactin, ACTH, cortisol, luteinizing hormone and testosterone were not altered during or after THC, compared with baseline concentrations. Tests of lymphocyte function showed no differences compared to baseline between THC and placebo groups. As the relatively low dosing regimen of THC (10 mg t.i.d.) resulted in no alterations, another group of 6 men were administered higher doses of THC by inhalation (18 mg/marijuana cigarette) following the same dosing regimen. No endocrine or immunological alterations were observed. When the subjects were grouped according to their history of THC use prior to admission, heavy THC users had lower prolactin concentrations than light users. No differences were observed in concentrations of other hormones or in tests of immune function.

Adult↗
PubMed1989

Mycobacterium tuberculosis infection in foreign born adoptees.

Korean adoptees placed by Associated Catholic Charities of Baltimore between January, 1985, and December, 1988 (N = 873), underwent surveillance for tuberculosis (TB). Overall tuberculin reactivity or active TB was documented in nine placements. Two children had active disease; both were skin test-negative and one died of tuberculous meningitis. The median age of the seven asymptomatic tuberculin reactors, none of whom had received Bacillus Calmette-Guérin vaccination, was 1 year. This reactivity rate is approximately 50 times greater than that of age-matched United States-born children. We conclude that high risk pediatric groups for TB, in addition to refugees, displaced persons and black and Hispanic minorities, include children involved in international adoption. Total reliance cannot be placed on screening tuberculin skin tests, and TB must be included in the differential diagnosis of high risk children presenting with recurrent pneumonia, fever of unknown origin, failure to thrive and altered mental status.

Adoption↗
PubMed1989

Are missionaries at risk for AIDS? Evaluation for HIV antibodies in 3,207 protestant missionaries.

Serum specimens (n = 6,045) obtained from 3,207 Protestant missionaries serving in 57 countries, including 28 African nations, between 1967 and 1984 were assayed for antibodies to the human immunodeficiency virus (HIV) by enzyme-linked immunosorbent assay (ELISA) screening and Western blot confirmatory testing. Seventy sera (1.2%) from 51 missionaries (1.6%) were ELISA positive; however, on Western blot confirmatory testing none was diagnostic of HIV infection. Twenty-two (43%) of the Western blot tests were read as indeterminate, with band p17 occurring with the greatest frequency (57%), followed by p24 (23%), either alone or in combination. The significance of these equivocal results is unclear, but they do not appear to be a consequence of exposure to either HIV or the related retrovirus HTLV-I. Based on this seroprevalence survey, we conclude that missionary staff and their families were not at high risk of HIV infection between 1967 and 1984, even when serving in regions of high HIV endemicity.

Adult↗
PubMed1989

Substance abuse and international travel.

Travel for both business and pleasure can be a risk factor for substance abuse problems, for clinical deterioration in those with chemical dependence, and for relapse when an addiction has been in remission. Sedatives, opioids and alcohol can complicate many of the physiologic adjustments mandated by modern jet travel, such as adaptation to different altitudes, climates, and time zones. Additionally, substances of abuse can result in a deterioration of many clinical conditions during travel, and they can precipitate other medical problems while underway, including motion sickness, heat-related illness and diarrheal disease. Drugs and alcohol are crucial factors in both serious accidents and legal difficulties while traveling. Finally, involvement with drugs as well as close and intimate liaison with drug abusers and their consorts has associated with it a high degree of risk for exposure to serious infectious diseases worldwide.

Humans↗