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Biomedical subjects

D Craven

Publications and source records attributed to D Craven.

13 recordsLinked to original sources
PubMed2001

Ipratropium bromide plus nebulized albuterol for the treatment of hospitalized children with acute asthma.

OBJECTIVE: To determine whether the addition of repeated doses of nebulized ipratropium bromide (IB) to a standardized inpatient asthma care algorithm (ACA) for children with status asthmaticus improves clinical outcome. STUDY DESIGN: Children with acute asthma (N = 210) age 1 to 18 years admitted to the ACA were assigned to the intervention or placebo group in randomized double-blind fashion. Both groups received nebulized albuterol, systemic corticosteroids, and oxygen according to the ACA. The intervention group received 250 microg IB combined with 2.5 mg albuterol by jet nebulization in a dosing schedule determined by the ACA phase. The placebo group received isotonic saline solution substituted for IB. Progression through each ACA phase occurred based on assessments of oxygenation, air exchange, wheezing, accessory muscle use, and respiratory rate performed at prescribed intervals. RESULTS: No significant differences were observed between treatment groups in hospital length of stay (P =.46), asthma carepath progression (P =.37), requirement for additional therapy, or adverse effects. Children >6 years (N = 70) treated with IB had shorter mean hospital length of stay (P =.03) and more rapid mean asthma carepath progression (P =.02) than children in the placebo group. However, after adjustment was done for baseline group differences, the observed benefit of IB therapy in older children no longer reached statistical significance. CONCLUSION: The routine addition of repeated doses of nebulized IB to a standardized regimen of systemic corticosteroids and frequently administered beta-2 agonists confers no significant enhancement of clinical outcome for the treatment of hospitalized children with status asthmaticus.

Acute Disease↗
PubMed1998

Low yield of bacterial stool culture in children with nosocomial diarrhea.

OBJECTIVE: To determine whether bacterial stool cultures (BSC) are useful in initial evaluation of children with symptoms of nosocomial diarrhea. To answer this question we performed a retrospective record review to determine the yield of BSC in children who developed diarrhea after the third hospital day (HD-3). METHODS: The hospital computer record keeping system was utilized to compile the result of BSC collected from children and adolescents ages 0 to 20 years between January 1, 1988, and October 31, 1996. All specimens were analyzed for Salmonella, Shigella, Yersinia and Campylobacter. We reviewed hospital charts of all children who developed a positive BSC beyond HD-3 to determine the time of onset of diarrhea and clinical circumstances. RESULTS: A total of 11 516 BSCs were submitted from 9262 children during the 8 1/2-year period. Five hundred sixty-eight (6.6%) of 9262 children had at least 1 positive BSC. Two thousand five hundred seventy-two children had the first BSC submitted after HD-3 and 13 (0.5%) of these children had a positive result. Chart review of these 13 children demonstrated that 6 had onset of diarrhea during the first 3 hospital days. Therefore only 7 children met our criteria for having nosocomially acquired diarrhea caused by a bacterial pathogen. Children whose first BSC was submitted after HD-3 accounted for 3767 (46%) of the total 8126 inpatient BSCs and in excess of $21000 annually in patient billing charges. CONCLUSION: In the absence of a known exposure the isolation of a bacterial pathogen from the stool of children with onset of diarrhea beyond HD-3 is a rare event. Under most circumstances BSC should not be part of the initial evaluation of children with symptoms of nosocomial diarrhea.

Adolescent↗
PubMed1997

Cerebral infarction in patients with AIDS.

PURPOSE: To establish the frequency, distribution, and pathogenesis of cerebral infarction as confirmed with MR imaging in a cohort of patients with acquired immunodeficiency syndrome (AIDS). METHODS: We reviewed all (71) abnormal cranial MR studies obtained at our institution in human immunodeficiency virus (HIV)-positive patients over a 2-year period and recorded the number and distribution of ischemic lesions, any associated abnormalities, and the MR angiographic findings, where available. Patients' charts were studied for relevant clinical data, biochemical and culture results, and potential etiologic factors. RESULTS: Twenty-two infarcts were seen in 13 of the 71 patients. Of these 22, the basal ganglia area was affected in 15, the middle cerebral artery territory in two, and the vertebrobasilar territory in five. Five patients had concomitant evidence of infection, six others used cocaine or were intravenous drug abusers. MR angiography was performed in eight patients; two of these had multiple lesions consistent with vasculitis, two had isolated lesions that corresponded with their parenchymal infarct, and four had normal findings. CONCLUSIONS: The frequency of infarction was 18%, higher than previously reported. The pathogenesis of infarction was multifactorial. Underlying infectious causes were identified in 39% of patients. Two patients had an idiopathic vasculitis.

AIDS Dementia Complex↗
PubMed1995

A randomized trial of three antipneumocystis agents in patients with advanced human immunodeficiency virus infection. NIAID AIDS Clinical Trials Group.

BACKGROUND: We evaluated the effectiveness of three treatment strategies for the prevention of a first episode of Pneumocystis carinii pneumonia in patients infected with the human immunodeficiency virus (HIV). METHODS: In an open-label trial, 843 patients with HIV infection and fewer than 200 CD4+ cells per cubic millimeter received zidovudine plus one of three randomly assigned prophylactic agents, beginning with trimethoprim-sulfamethoxazole, dapsone, or aerosolized pentamidine and followed by a defined sequence of other drugs to be used in cases of intolerance. RESULTS: The estimated 36-month cumulative risks of P. carinii pneumonia were 18 percent, 17 percent, and 21 percent in the trimethoprim-sulfamethoxazole, dapsone, and aerosolized-pentamidine groups, respectively (P = 0.22). The difference in risk among treatment strategies was negligible in patients entering the study with 100 or more CD4+ lymphocytes per cubic millimeter. In those entering with fewer than 100 CD4+ cells per cubic millimeter, the risk was 33 percent with aerosolized pentamidine, as compared with 19 percent with trimethoprim-sulfamethoxazole and 22 percent with dapsone (P = 0.04). The lowest failure rates occurred in patients receiving trimethoprim-sulfamethoxazole, and failures were more common with 50 mg of dapsone than with 100 mg. Toxoplasmosis developed in less than 3 percent of patients. Of the patients assigned to the two systemic therapies, only 23 percent were receiving their assigned drug and dose when they completed the study. The median survival was approximately 39 months in all three groups, and the mortality attributable to P. carinii pneumonia was only 1 percent. CONCLUSIONS: In patients with advanced HIV infection, the three treatment strategies we examined have similar effectiveness in preventing P. carinii pneumonia. Strategies that start with trimethoprim-sulfamethoxazole or with high-dose dapsone, rather than aerosolized pentamidine, are superior in patients with fewer than 100 CD4+ lymphocytes per cubic millimeter.

AIDS-Related Opportunistic Infections↗
PubMed1991

Identification and comparative sequence analysis of a gene in equine herpesvirus 1 with homology to the herpes simplex virus glycoprotein D gene.

A homologue of the herpes simplex virus (HSV) glycoprotein D gene has been identified in the genome of equine herpesvirus-1 (EHV-1, equine abortion virus). An open reading frame in the middle of the short unique (US) region is capable of encoding a polypeptide of 402 amino acids that has 26% and 20% of its residues matching pseudorabies virus (PRV) gp50 and HSV-1 gD, respectively. Despite this low level of similarity, the positional identity of six cysteine residues and certain motifs, and the location of the EHV-1 gene, clearly define the EHV-1 polypeptide as one of a family of "gD-like" proteins. Two transcripts of 3.3-3.6 kb and 5.4-5.9 kb were identified, consistent with coterminal mRNAs for the EHV-1 gD gene and the adjacent upstream gene, respectively. Partial sequencing of other regions in US also revealed EHV-1 homologues of HSV-1 gE and gI genes, and a possible equivalent gene to PRV gX. By analogy with the ability of HSV-1 gD and PRV gp50 to induce strong anti-viral immune responses, the EHV-1 gD gene product is expected to be an excellent candidate for development as a vaccine antigen.

Amino Acid Sequence↗
PubMed1980

Dissociated renin-aldosterone response to acute sodium depletion in patients with a previous history of pregnancy-associated hypertension.

The effect of sodium depletion on body weight, plasma renin activity (PRA) and plasma aldosterone concentration has been studied in 10 normotensive subjects with a previous history of pregnancy-associated hypertension. The results demonstrate an appropriate increase in PRA but a suppression of plasma aldosterone response to this form of acute sodium depletion. The significance of this dissociated renin-aldosterone response is discussed.

Adolescent↗
PubMed1979

Treatment of premenstrual syndrome by spironolactone.

Spironlactone was given to 28 women in a double blind cross over trial during four menstrual cycles. Hormonal profiles were measured during the first two cycles. Plasma aldosterone was elevated in the premenstrual phase of the cycles but there was no significant difference between symptomatic and asymptomatic groups. The rise in serum progesterone was higher in the symptomatic group during the postovulatory phase. The administration of spironolactone reduced weight and relieved psychological symptoms in more than 80 per cent of the symptomatic group.

Aldosterone↗
PubMed1978

The different molecular weight forms of bovine liver rhodanese.

Sedimentation equilibrium studies show that there are two forms of bovine liver rhodanese in crystalline enzyme preparations of full specific activity. One form dissociates to a species with a limiting molecular weight close to 19,000. The second form is nondissociable under the same experimental conditions. It exhibits a molecular weight of approximately 33,000. These conclusions are augmented by data from polyacrylamide gel electrophoresis and molecular exclusion chromatography. They serve to explain apparent inconsistencies in previous reports on this enzyme.

Animals↗