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Biomedical subjects

D E Snider

Publications and source records attributed to D E Snider.

At least 55 records · Page 3Linked to original sources
PubMed1989

Tuberculosis and acquired immunodeficiency syndrome--Florida.

Florida reported 1858 cases of the acquired immunodeficiency syndrome (AIDS) and 8455 cases of tuberculosis from January 1, 1981, through October 31, 1986. Of the patients with AIDS, 159 (8.6%) also had tuberculosis, and 154 (1.8%) of the patients with tuberculosis also had AIDS. Among patients with both diagnoses, tuberculosis was diagnosed before AIDS by more than 1 month in 50%, was diagnosed within 1 month before or 1 month after the diagnosis of AIDS in 30%, and was diagnosed more than 1 month after the AIDS diagnosis in 20%. Compared with patients with AIDS only, patients with both diagnoses were also more likely to be Haitian, black (other than Haitian), or Hispanic. Compared with patients with tuberculosis only, patients with both diagnoses were more likely to be younger, male, Haitian, black (other than Haitian), and Hispanic, have extrapulmonary tuberculosis and negative tuberculin skin tests, and have noncavitary chest roentgenograms. These data suggest that patients with AIDS may have an increased risk of tuberculosis and that patients with both diagnoses differ in important demographic and clinical characteristics from patients with AIDS only or tuberculosis only.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Recurrent tuberculosis: why do patients develop disease again? A United States Public Health Service cooperative survey.

In October 1983, a retrospective survey was initiated to determine if patients reported to the Centers for Disease Control as having recurrent tuberculosis truly had recurrent disease and, if so, why they had developed tuberculosis again. Twenty-three health jurisdictions provided information on 800 patients diagnosed as having recurrent tuberculosis during 1981 and 1982. We found that 199 (25 per cent) of the cases did not meet the criteria for recurrent disease. Of the remaining 601 recurrent cases, 20 per cent had no chemotherapy prescribed for their previous episodes of tuberculosis, 20 per cent were prescribed inadequate or inappropriate therapy, and 33 per cent were not compliant with their prescribed therapy regimens. Patients who, during their original episode of tuberculosis, received the major portion of their medical care from physicians in private practice were more compliant than those treated by other health care providers. However, those same patients were more likely to have received inappropriate therapy than patients treated by other providers. Better patient and physician education, closer monitoring, and greater use of preventive therapy and directly observed therapy are necessary to resolve these problems.

Adolescent↗
PubMed1988

Tuberculosis control among homeless populations.

The prevalence of tuberculosis infection and disease among homeless persons is high. Several recent outbreaks have been reported in shelters for the homeless. To address this problem, the Centers for Disease Control, Atlanta, convened a group of consultants who made the following recommendations: (1) Tuberculosis should be suspected and sputum samples should be collected from any homeless individual with a productive cough. (2) Diagnosed or suspected tuberculosis in a homeless individual should be immediately reported to the health department. (3) Therapy should be fully supervised by a responsible person, and an intensive multidrug, six-month regimen should be utilized whenever possible. (4) A contact investigation should be conducted around each infectious case, and preventive therapy should be prescribed for high-risk infected individuals. (5) Shelter staff should receive a tuberculin skin test when they start work and every six to 12 months thereafter. (6) Skin test reactors should be considered for preventive therapy according to current guidelines. (7) Installation of ultraviolet lights to reduce transmission should be considered in some situations.

Ill-Housed Persons↗
PubMed1987

The epidemiology of nontuberculous mycobacterial diseases in the United States. Results from a national survey.

During the 2-yr period 1981-83, demographic, clinical, and laboratory information was collected for 5,469 patients from whom nontuberculous mycobacteria (NTM) had been isolated. Among the potential NTM pathogens, isolates of Mycobacterium avium complex were most frequent, followed by M. kansasii, M. fortuitum, M. scrofulaceum, and M. chelonae. Almost 90% of the isolates were obtained from respiratory specimens. Prevalence rates for NTM disease, as calculated by a diagnostic algorithm, were highest for M. avium complex (1.3/10(5)), M. fortuitum-M. chelonae (0.2/10(5)). The data suggest a changing epidemiologic picture of NTM disease due perhaps to the decreasing incidence of tuberculosis, the increasing prevalence of chronic lung disease, and increased culturing of diagnostic specimens, as well as possibly a change in the ecology of these organisms.

Adolescent↗
PubMed1986

Preventive therapy with isoniazid. Cost-effectiveness of different durations of therapy.

Daily administration of isoniazid for one year to persons infected with Mycobacterium tuberculosis is effective in considerably reducing the risk of disease. From a practical viewpoint, this approach to prevention is less than ideal because it results in considerable costs as health care providers monitor for possible hepatotoxic effects and because it is difficult to maintain compliance for 12 months. The efficacy and toxicity of isoniazid preventive therapy regimens of 12, 24, and 52 weeks' duration were recently assessed in a study conducted in Eastern Europe. We used data from this study to conduct a cost-effectiveness analysis of the three alternative regimens. The results indicate that over a wide range of assumptions, a regimen of 24 weeks' duration is more cost-effective than either the 12- or 52-week regimen. Using base case estimates, the cost per case prevented for the 24-week regimen was $7,112, compared with $16,024 for the 52-week regimen. Among a cohort of 1,000 persons treated, each additional case prevented by the 52-week regimen would cost $80,807. Thus, a shorter course of isoniazid preventive therapy is relatively cost-effective compared with current policy.

Chemical and Drug Induced Liver Injury↗
PubMed1986

Short-course tuberculosis chemotherapy studies conducted in Poland during the past decade.

During the past decade, six short-course (6-month) chemotherapy regimens were studied in which drugs were given daily and intermittently. Four regimens containing isoniazid, rifampin, and ethambutol caused little toxicity but yielded relapse rates (8-21%) which were unacceptably high. The safety of giving rifampin (450 or 600 mg) twice weekly was confirmed, however, and there was evidence that daily therapy during the 4-month continuation phase was no more effective than twice weekly isoniazid and rifampin. Once weekly therapy during the continuation phase was clearly inadequate. The use of four drugs (isoniazid, rifampin, pyrazinamide, and streptomycin) given daily during the initial 2 months of therapy followed by 4 months of twice weekly isoniazid and rifampin resulted in a nearly 100% cure rate. However, this regimen was not well tolerated by patients. Deleting streptomycin improved the tolerability of the regimen but appears to have slightly increased the frequency of treatment failure and relapse. A suggested model for choosing treatment regimens is presented.

Adolescent↗