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Biomedical subjects

D E Snider

Publications and source records attributed to D E Snider.

At least 109 records · Page 6Linked to original sources
PubMed1980

Treatment of tuberculosis during pregnancy.

The pregnant woman with tuberculosis who requires treatment presents a therapeutic dilemma; therefore, we reviewed all available literature on pregnant women treated with isoniazid (INH), ethambutol (EMB), rifampin (RMP), or streptomycin (SM) and report here on the relative safety of these drugs and whether the risk of teratogenesis justifies abortion on medical grounds. Other than the ototoxicity of SM, none of these drugs in normal dosages are proved teratogens to human fetuses. We recommend the use of INH in combination with EMB for a pregnant woman with tuberculosis, if the disease is not extensive. If a third drug is warranted, then RMP could be added. Because of its ototoxicity, SM should not be used, unless RMP is contraindicated or proves unsatisfactory. Routine therapeutic abortion is not medically indicated for a pregnant woman who is taking first-line antituberculosis drugs.

Abnormalities, Drug-Induced↗
PubMed1980

Rifampin-isoniazid therapy of alcoholic and nonalcoholic tuberculous patients in a U.S. Public Health Service Cooperative Therapy Trial.

A history of alcoholism is often regarded as a relative contraindication to the use of isoniazid and rifampin in patients with tuberculosis. To test the validity of this assumption the outcome of 6 months of rifampin-isoniazid therapy was analyzed for the first 531 eligible patients enrolled in a U.S. Public Health Service Cooperative Trial of Short-Course Chemotherapy of Pulmonary Tuberculosis. In this study, data were available to classify a patient as an alcoholic in the following 2 ways: (1) patient's statement that he was a moderate, heavy, or excessive user of alcohol, or (2) patient's score of 6 or more on a Brief Michigan Alcoholism Screening Test (MAST). Based on their statements, 58% of the patients were classified as alcoholic, whereas only 17.9% were thus classified by their MAST scores. Although alcoholics had more abnormal concentrations of aspartate aminotransferase (AST) before and during therapy, there was no significant difference between the alcoholics and non-alcoholics in the incidence of adverse reactions, including hepatotoxic reactions, including hepatotoxic reactions, attributed to the drugs. We concluded that in the absence of clinically significant and persistent pretreatment abnormalities of hepatic function tests, rifampin and isoniazid are not contraindicated in patients categorized as alcoholic by our 2 commonly used methods.

Alcoholism↗
PubMed1980

Short-course (6 month) cooperative tuberculosis study in Poland: results 18 months after completion of treatment.

This study compared the efficacy and toxicity of 4 drug regimens containing rifampin, isoniazid, and ethambutol administered both daily and intermittently for a total duration of 6 months (26 wk). There were 411 patients with newly diagnosed, previously untreated, pulmonary tuberculosis admitted to the study. All patients received isoniazid, rifampin, and ethambutol daily in a hospital for the first 8 wk of treatment. One group continued to receive these 3 drugs daily as outpatients for an additional 18 wk; a second group received the same drugs twice weekly, and a third group received the 3 drugs once weekly during the 18-wk "continuation phase." A fourth group of patients received 2 drugs, isoniazid and rifampin, twice weekly during the continuation phase. Drug toxicity was not a major problem; drugs were permanently discontinued in only 1% of the patients. All 4 regimens were highly effective in achieving sputum negativity. By the fifty month, 100% of the patients had become culture negative. However, the relapse rate was found to be relatively high for all regimens (range, 7 to 20%). Patients with extensive disease, large cavities, heavy growth on pretreatment cultures, slow sputum conversion, persistent cavities, heavy use of alcohol, and concomitant diseases were more likely to relapse. In order to achieve relapse rates acceptable in developed countries, regimens containing rifampin and isoniazid must either be given for longer than 6 months or strengthened by the addition of supplemental drugs during the initial phase.

Adolescent↗
PubMed1979

The booster phenomenon in serial tuberculin testing.

To determine the frequency, magnitude, and causes of the booster phenomenon in tuberculin testing, a total of 1,478 employees from 10 hospitals throughout the United States received sequential intradermal tests using PPD-T. In addition, approximately 70 per cent were initially tested with PPD-G. Boosting was found in all age groups tested, but increased with age. It occurred as soon as one week after an initial tuberculin test, but rarely before that time. The boosted reactions were apparently caused either by remote tuberculous infection or recent or remote sensitization by one or more of the nontuberculous mycobacteria. In areas endemic for nontuberculous mycobacteria, they are the most likely cause of the sensitivity that may be boosted. On the basis of these findings, it is recommended that when repeated tuberculin testing is required as part of a hospital control program, a second identical tuberculin test be given one week after the first. When subsequent tests are given, this should permit separation of boosted reactions from reactions caused by new infections. Persons who do not boost when giben repeat tests at one week, but whose tuberuclin reactions change to positive after one year, should be considered to have newly acquired tuberculous infection and managed accordingly.

Adult↗
PubMed1979

Isoniazid prophylaxis among Alaskan Eskimos: a final report of the bethel isoniazid studies.

As a result of numerous trials, isoniazid prophylaxis was shown to be effective in preventing tuberculosis in many different populations and under a variety of conditions. However, the duration of the protective effect has been of some concern. In a previous report, the protective effect of isoniazid prophylaxis among Alaskan Eskimos was shown to persist through the fifteenth year after its administration. In this final report, the protective effect is shown to persist for more than 19 years. The magnitude of the effect is related to the amount of isoniazid taken. The results of the study are consistent with the hypothesis that the decrease in risk of tuberculosis produced by isoniazid preventive therapy is lifelong.

Alaska↗
PubMed1979

U.S. Public Health Service Cooperative trial of three rifampin-isoniazid regimens in treatment of pulmonary tuberculosis.

A total of 822 patients with newly diagnosed pulmonary tuberculosis were assigned randomly to one of 3 daily rifampin-isoniazid (RIF-INH) regimens: 450, 600, or 750 mg of RIF in combination with 300 mg of INH. After an initial 20 weeks of therapy with RIF-INH, patients recieved 300 mg of INH and 15 mg of ethambutol (EMB) per kg of body weight for either 12 or 18 months after their sputum cultures became negative. The rate of bacteriologic conversion of sputum among the 3 RIF-INH regimens was compared for 552 patients who completed the 20 weeks of RIF-INH therapy. Apporximately 60 per cent of these patients also completed their assigned INH-EMB therapy and were examined for relapse for at least one year after therapy was stopped. There was no significant difference in the rate of sputum conversion or rate of relapse between the group of patients who received 600 mg of RIF and those who received 750 mg of RIF. However, the 450-mg RIF regimen was significantly less effective than the other 2 regimens, as manifested by a lower rate of sputum conversion and a higher rate of treatment failures. Further analysis showed that RIF dosages of less than 9 mg per kg of body weight per day may be inadequate for treatment of pulmonary tuberculosis. The acceptability of these regimens was high, and the incidence of adverse reactions requiring discontinuation of RIF-INH therapy was quite low (3.3 per cent). A large proportion of patients (44 per cent) developed increased concentrations of transaminase during therapy with RIF-INH. These abnormalities were usually transient and, in most cases, of no clinical significance. In the relapse analysis, 12 months of chemotherapy after sputum conversion was shown to be as effective as 18 months of therapy after conversion of these RIF-containing regimens.

Adolescent↗
PubMed1979

The Ottawa County project: a report of a tuberculosis screening project in a small mining community.

Following a retrospective review of tuberculosis cases reported from Ottawa County, Oklahoma, from 1969 through 1973, a selective tuberculosis screening project was implemented. Screening of a "target group" of the population, 519 former miners, greater than or equal to 50 years of age, resulted in the discovery of abnormal chest X-rays in 182; (103 with silicosis, 36 with silicotuberculosis, 12 with inactive tuberculosis, and 31 with other abnormalities). Eighty-five of these persons had positive tuberculin skin tests. Preventive therapy was recommended for 50, and 36 completed the prescribed course of treatment. Eight new bacteriologically confirmed cases of tuberculosis were found and treated. A large number of persons (1,904) residing in the same area who were not part of the target group were also screened for tuberculosis. This group contained a large number of positive tuberculin reactors but very few were candidates for isoniazid preventive therapy. Thirteen persons in this group had abnormal chest X-rays consistent with inactive tuberculosis but 12 had been identified and given preventive therapy before the project began. These data suggest that selective approaches to screening for tuberculosis in a community which are based on an in-depth retrospective review of the tuberculosis case register can be highly successful.

Aged↗
PubMed1978

Efficacy of BCG vaccination in prevention of cancer: an update.

From 1949 to 1951, a controlled trial of BCG vaccinations was conducted in Puerto Rico. The 191,827 children, 1-18 years of age, initially enrolled in the study were skin-tested with tuberculin to determine their eligibility for vaccination. A total of 82,269 children were classified as reactors and not vaccinated. Of the 109, 558 nonreactors, 31,586 refused vaccination, 50,634 were vaccinated with BCG, and 27,338 were left unvaccinated as controls. We ascertained the incidence of cancer over an average follow-up period of 23.3 years in the latter two groups using the Puerto Rico Central Cancer Registry. By the end of December 1973, a total of 77 cancers had been diagnosed among the controls and 150 among the vaccinees. The overall incidence of cancer among the two groups was similar. Although a number of differences existed between the vaccinee group and the controls in regard to the incidence of cancer at various "sites", none of these differences was statistically significant. However, when cases of lymphosarcoma and Hodgkin's disease were combined for analysis, a statistically significant excess of cases occurred among the vaccinees. We concluded that BCG vaccination had no protective effect on the subsequent development of cancer in this population. The slight excess of cases of lymphosarcoma and Hodgkin's disease among the vaccinees raised the possibility that BCG may have had an adverse effect.

Adolescent↗
PubMed1978

Isoniazid-related hepatitis: a U.S. Public Health Service cooperative surveillance study.

After an outbreak of hepatitis in Washington, D.C. in 1970 among a group of persons taking isoniazid to prevent tuberculosis, an isoniazid surveillance study was conducted among 13,838 persons in 21 participating health departments. Age appeared to be the predominant factor influencing the risk of developing isoniazid-related hepatitis, i.e., increasing age was associated with an increasing risk. Drinking alcohol, especially on a daily basis, also seemed to enhance the risk of hepatitis among persons concurrently taking isoniazid. In general, case rates among males and females of the same race, and rates among different races, were not markedly different; however, there were striking differences in the case rates among males of different races. The incidence of hepatitis varied greatly among the 21 cities, but was not unique to any geographic region, nor was it related to a specific manufacturer of isoniazid. The onset, in most cases, occurred within the first few months of treatment. Eight fatalities were reported by the 21 participating health departments, 7 occurring in one city. Black females accounted for 5 of the 8 deaths. This information provides a basis for weighing the benefits of isoniazid in preventing tuberculosis against the risk of its causing hepatitis. Close monitoring for overt signs or symptoms of hepatitis among persons receiving isoniazid preventive therapy is indicated, especially for persons greater than or equal to 35 years of age and those who drink alcoholic beverages on a daily basis.

Adult↗
PubMed1977

Adenylate cyclase activity in lymphocyte subcellular fractions. Characterization of non-nuclear adenylate cyclase.

Human peripheral lymphocytes were broken in a Dounce homogenizer and subcellular fractions enriched in plasma membranes or microsomal particles and mitochondria were isolated by centrifugation through a discontinuous sucrose gradient. Various agents that promote cyclic AMP accumulation in intact lymphocytes were compared in their ability to stimulate adenylate cyclase activity in the individual fractions. Plasma-membrane-rich fractions that were essentially free of other subcellular particles as judged by electron microscopy and marker enzyme measurements responded to fluoride, but weakly or not at all to prostaglandin E1 and other prostaglandins. Microsomal and mitochondrial-rich fractions responded markedly to both prostaglandin E1 and fluoride. In some, but not all, experiments phytohaemagglutinin produced a modest increase in enzyme activity in plasma-membrane-rich fractions. Catecholamines, histamine, parathyrin, glucagon and corticotropin produced little or no response. In the absence of theophylline, adenosine (1-10 micronM) stimulated basal enzyme activity, although at higher concentrations the responses to prostaglandin E1 and fluoride were inhibited. GTP (1-100 micronM) and GMP(5-1000 micronM) respectively inhibited or stimulated the response to fluoride, whereas the converse was true with prostaglandin E1.

Adenylate Kinase↗
PubMed1977

Urinary tract cancer and isoniazid.

A case control study was conducted in Washington County, Md. to assess the possibility that isoniazid might be associated with the production of malignant neoplasms of the urinary tract. One hundred and forty-two cases of bladder cancer and 48 cases of renal cancer were found in the follow-up of a 1963 census population. Each case was matched to two other persons of the same race, sex, and age enumerated in the census. The tuberculosos register for the county was searched to see whether any case or control subject had ever received isoniazid. Two members of the entire study group had a record of isoniazid administration; both were control subjects. No evidence was found to associate isoniazid with cancers of the urinary tract.

Female↗
PubMed1977

An assessment of the possible association of isoniazid with human cancer deaths.

The data from 2 U. S. Public Health Service trials of isoniazid preventive therapy were reviewed in an effort to evaluate the risk of death from cancer among persons who received such therapy. Each of these prospective trials used random assignment to either isoniazid or placebo. More than 25,000 persons participated in each of the trials. The length of follow-up ranged from 10 to 14 years in one trial and from 9 to 11 years in the other. No significant difference in the incidence of death from cancer was noted between groups treated with placebo or with isoniazid in either of the studies. This was true even when deaths due to specific types of cancer and age-specific cancer death rates were compared. These data do not support a carcinogenic effect of isoniazid in humans.

Adolescent↗