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Biomedical subjects

D Stamboulian

Publications and source records attributed to D Stamboulian.

At least 19 recordsLinked to original sources
PubMed2003

Persistence of immunity and seroprotection 4 years after a primary vaccination schedule with a Hansenula polymorpha recombinant hepatitis B vaccine.

To evaluate the persistence of the immune response in a population of healthy volunteers that had been vaccinated with a new Hansenula polymorpha recombinant hepatitis B vaccine in a previous clinical study 4 years before, we measured the titre of anti-HBs. All, but one of the evaluated volunteers remained protected. None of them had experienced any adverse event related to the vaccine from the moment of immunization, to the present. The vaccine proved to be immunogenic and to confer long-term protection in this group.

Adolescent↗
PubMed2000

Influenza.

Influenza is an acute respiratory illness of global importance that causes considerable morbidity and mortality every year. At the beginning of the millennium, influenza will still be an emergent or re-emergent infection because of the viral ability to mutate. Global influenza surveillance indicates that influenza viruses may vary within a country and between countries and continents during an influenza season. Virologic surveillance is of critical importance in monitoring antigenic shift and drift. Disease surveillance is important in assessing the impact of the epidemics. Both types of information provide the basis of vaccine composition and the correct use of antivirals. Laboratory diagnosis is of critical importance for the global surveillance of influenza and may allow the timely use of antiviral drugs. Viral isolation remains the gold standard for laboratory diagnosis; however, several new rapid diagnostic tests are available or in development. The clinical spectrum of the disease varies from asymptomatic infection to the classic flu syndrome, and respiratory and nonrespiratory complications are observed particularly in high-risk groups. Current inactivated influenza vaccines have shown efficacy and effectiveness in preventing influenzalike illness, hospitalization for pneumonia, and death and in reducing health care costs. Because of the annual administration of the vaccine and the short period of time where it can be administered, strategies directed at improving vaccine coverage are of critical importance. In this sense, experiences obtained in different countries, such as with the National Immunization Campaigns developed in Argentina, provide one model of massive vaccine administration. In addition to current vaccines, new live attenuated vaccines will permit a most effective prevention of influenza in the community in the near future. A new type of antiviral, neuraminidase inhibitors, offers valuable benefits in the prevention and treatment of influenza A and B. A future pandemic of influenza seems inevitable. There is wide recognition that preparation for the next pandemic requires that infrastructure be in place during interpandemic periods for implementing preventive and therapeutic measures. The WHO has established a pandemic influenza task force, and a number of countries in Latin America have developed formal pandemic plans. These national and international efforts are essential to reduce the mortality and morbidity in the next influenza pandemic.

Aged↗
PubMed1997

A cost-benefit analysis of programmatic use of CVD 103-HgR live oral cholera vaccine in a high-risk population.

BACKGROUND: Cholera spread to Latin America in 1991; subsequently, cholera vaccination was considered as an interim intervention until long-term solutions involving improved water supplies and sanitation could be introduced. Three successive summer cholera outbreaks in northern Argentina and the licensing of the new single-dose oral cholera vaccine, CVD 103-HgR, raised questions of the cost and benefit of using this new vaccine. METHODS: This study explored the potential benefits to the Argentine Ministry of Health of treatment costs averted, versus the costs of vaccination with CVD 103-HgR in the relatively confined population of northern Argentina affected by the cholera outbreaks. Water supplies and sanitation in this area are poor but a credible infrastructure for vaccine delivery exists. RESULTS: In our cost-benefit model of a 3-year period (1992-1994) with an annual incidence of 2.5 case-patients per 1000 population and assumptions of vaccine efficacy of 75% and coverage of 75%, vaccination of targeted high risk groups would prevent 1265 cases. CONCLUSION: Assuming a cost of US$602 per treated case and of US$1.50 per dose of vaccine, the total discounted savings from use of vaccine in the targeted groups would be US$132,100. The projected savings would be altered less by vaccine coverage (range 75-90%) or efficacy (60-85%) changes than by disease incidence changes. Our analysis underestimated the true costs of cholera in Argentina because we included only medical expenditures; Indirect losses to trade and tourism had the greatest economic impact. However, vaccination with CVD 103-HgR was still cost-beneficial in the base case.

Adolescent↗
PubMed1997

Recognition, management and prophylaxis of endocarditis.

Infective endocarditis (IE) remains a disease with high morbidity and mortality. In recent years, a higher frequency of IE has been observed in the elderly, in intravenous drug users and in patients with prosthetic valves. The diverse manifestations of this disease demand a high degree of suspicion from the practitioner, in order to make an early diagnosis. Advances in and increasing use of echocardiography (especially transoesophageal) allow us to identify valvular changes earlier and more precisely. The use of the new Duke's diagnostic criteria, based on clinical manifestations and microbiological and echocardiographic findings, facilitates the diagnosis and categorisation of IE. An increase in staphylococci and other problem pathogens, such as penicillin-resistant streptococci, enterococci resistant to beta-lactams, aminoglycosides and methicillin-resistant staphylococci has been observed. Important changes have also taken place in the management of IE. There is a clear trend towards the use of shorter treatment courses, oral and once-daily regimens and outpatient programmes, all of which aim to reduce costs and provide patients with improved quality of life. Antibiotic prophylaxis for the prevention of IE is still controversial. In the past few years more rational regimens have been used, and indications are now more precise. In spite of all this, however, few cases are prevented and patient compliance to the prophylaxis regimens remains low.

Cephalosporins↗
PubMed1995

Outpatient treatment of endocarditis in a clinic-based program in Argentina.

The major cost in the treatment of infective endocarditis (IE) is the length of hospitalization required for the administration of intravenous antibiotics. This can be reduced by substituting shorter regimens and by the introduction of outpatient parenteral antibiotic therapy (OPAT). Careful selection of patients is vital for the success of OPAT in IE. The patients should be hemodynamically stable and without clinical complications. The delivery of OPAT for IE followed a clinical and home-based program involving an endocarditis team whose members included an infectious diseases physician, a microbiologist, a cardiologist and a nurse trained in intravenous techniques. Among the antimicrobial agents used in OPAT of IE, single-agent ceftriaxone for four weeks followed by a short course of amoxicillin or ceftriaxone in combination with an aminoglycoside for two weeks (short course) are effective modes of treatment for streptococcal endocarditis, the most common cause of IE. This treatment is also effective for carefully selected patients with other types of endocarditis, such as those due to the HACEK group (Haemophilus aphrophilus/paraphrophilis, Actinobacillus actinomycetem comitans, Caradiobacterium hominis, Eikenella corrodens and Kingella kingae). Staphylococcus aureus, enterococci and late prosthetic valve endocarditis associated with a streptococcus may also be treated on an outpatient basis after stabilization (approximately 2 weeks). As a result of their need for prolonged treatment periods, these patients are also very good candidates for OPAT. In conclusion, new regimens utilizing ceftriaxone once daily and short-term therapy on a clinical or home basis offer the potential benefits of cheaper safer and more convenient treatment for patients with IE.

Ambulatory Care Facilities↗
PubMed1995

Treatment of streptococcal endocarditis with a single daily dose of ceftriaxone and netilmicin for 14 days: a prospective multicenter study.

A 2-week course of ceftriaxone (2 g) plus netilmicin (4 mg/kg), administered as one short daily iv infusion, was evaluated for the treatment of streptococcal endocarditis in an open multicenter study. Of the 52 patients, 31 were infected with viridans streptococci, 18 with Streptococcus bovis, two with Gemella morbillorum, and one with group C Streptococcus; 48 patients were assessable. Infection was cured in 42 cases, 35 treated medically and seven treated both medically and surgically. Five patients died without evidence of active infection, and one relapsed. The bacteriologic failure was due to a strain of G. morbillorum against which no synergy of ceftriaxone and netilmicin was evident in vitro. The serum creatinine level increased during treatment in four cases, all involving patients > 65 years old who had renal risk factors; in two of these cases, values did not return to baseline during follow-up. Of 40 patients assessed for auditory function, only one developed decreased perception of borderline significance. Other adverse reactions were mild. This regimen was efficacious, safe, and cost-effective for the treatment of streptococcal endocarditis. However, it must be used with caution for patients with preexisting renal impairment or concomitant exposure to other potentially nephrotoxic agents.

Adolescent↗
PubMed1994

Ceftriaxone therapy of bacterial meningitis: cerebrospinal fluid concentrations and bactericidal activity after intramuscular injection in children treated with dexamethasone.

Antibiotic therapy is administered intravenously to children with bacterial meningitis to achieve the highest possible blood and cerebrospinal fluid (CSF) concentrations. However, intravenous access for the entire duration of therapy may be difficult in some children. Intramuscular therapy offers a more versatile option; however, CSF concentrations and bactericidal activity following im injection in children concurrently treated with dexamethasone have not been studied. We prospectively evaluated 37 children given an im dose of ceftriaxone on either the 3rd, 6th or 9th day of antibiotic therapy while receiving dexamethasone for the first 4 days of treatment. All children were required to have normal peripheral perfusion at the time of im injection. Four to 6 hours after im injection CSF was obtained. The average age of study patients was 28 months; Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae type b were responsible for 95% of all infections. All children studied had detectable CSF ceftriaxone concentrations, with mean (+/- SD) concentrations (microgram/ml) on Days 3, 6 and 9 of therapy of 5.7 +/- 5.5 (n = 12), 5.2 +/- 5.0 (n = 14) and 2.0 +/- 2.6 (n = 10), respectively. All CSF bactericidal titers for N. meningitidis, S. pneumoniae and H. influenzae type b, regardless of day of im injection, were > or = 1:64. Intramuscular ceftriaxone therapy of bacterial meningitis may be a reasonable therapeutic option for the convalescing child with good peripheral perfusion.

Ceftriaxone↗
PubMed1994

Health advice for travelers to Latin America.

Practical and precise information about the potential infectious health hazards that travelers to Latin America may encounter is reviewed in this article. Some diseases are briefly described, others are only mentioned. The countries have been grouped into four geographical areas following the classification of the World Health Organization. The discussion on each area includes information on travelers' diarrhea, malaria, cholera, typhoid fever, yellow fever, and other diseases or special problems.

Diarrhea↗
PubMed1990

[Analysis of urinary infection in the 1st month after kidney transplantation. Value of short prophylaxis with norfloxacin].

Urinary tract infection is the most common complication in the first month after renal transplant, and it is associated with rejection and relapses. In addition, it is the leading cause of gram negative bacilli bacteremia. In a program of continuous epidemiological surveillance from March 1979 to October 1988, we evaluated the urinary tract infections in the first month after renal transplant, considering the following variables: duration of bladder catheterization, urologic complications, type of immunosuppression and preoperative and postoperative antibiotic prophylaxis. There were no differences between the development of urinary tract infections in relation with the duration of bladder catheterization (7 vs 4 days), the reduction of urologic complications (21 vs 6%), or with the introduction of cyclosporin to the conventional immunosuppressive regimen. However, when the group of 46 patients receiving postoperative antibiotic prophylaxis (norfloxacin 800 mg/day every 12 h during the time of vesical catheterization less than or equal to 4 days) was compared with the 147 without postoperative antibiotic prophylaxis, the rate of urinary tract infection in the first month was 8.7% vs 32.8%, respectively (p less than 0.01). Short-term prophylaxis with norfloxacin was a useful regimen, with good oral tolerance and a similar therapeutic efficacy as the sustained regimens reported in the literature.

Adolescent↗