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Biomedical subjects

E D Shapiro

Publications and source records attributed to E D Shapiro.

104 records · Page 6Linked to original sources
PubMed1980

Efficacy of rifampin in eliminating pharyngeal carriage of Haemophilus influenzae type b.

Household contacts less than 6 years of age of children with Haemophilus influenzae type b meningitis are at increased risk of developing systemic H influenzae type b disease. Positive oropharyngeal cultures for H influenzae type b were found in 17/97 patients (18%) and 7/62 staff members (11%) at a chronic area facility at which two patients had developed ampicillin-resistant H influenzae type b meningitis. H influenzae type b colonization was eliminated in 8/9 carriers treated with a single daily oral dose of rifampin, 20 mg/kg/day (maximum 600 mg) for four days; colonization persisted in 9/10 control subjects (Fisher's exact test P < .001; corrected chi 2 P < .005). After treatment of additional H influenzae type b-positive individuals and the remaining control subjects, rifampin was found to have eradicated H influenzae type b in a total of 24/25 carriers (96%). All isolates of H influenzae type b were sensitive to rifampin at either 0.5 or 1.0 microgram/ml. Rifampin is effective in eliminating the H influenzae type b carrier state and may be useful in preventing associated H influenzae type b disease in close contacts of children with H influenzae type be meningitis.

Carrier State↗
PubMed1975

The mentally ill physician as practitioner.

Mentally ill physicians may hurt patients through direct involvement of physicians' symptoms. Not all mentally ill physicians are disqualified by their illness from practicing medicine. Some may be disqualified for some time or permanently; some may be able to continue to function effectively. Certain characteristics of the physician-patient relationship and physicians' beliefs about their own and their colleagues' work make it difficult to discern harm done to patients.

Family Practice↗
PubMedDate not supplied

Predictors of outcome of myocarditis.

Heart failure from myocarditis may be transient or may progress to unremitting severe cardiac failure. This study was performed to determine the outcomes and prognostic features of pediatric patients with myocarditis. Patients with the diagnosis of myocarditis between 1990 and 2001 were identified through the coding system of Yale-New Haven Hospital. A total of 28 patients were included, with ages ranging from 1 day to 20 years. Before discharge, 11 patients developed unremitting severe cardiac failure. Of the remaining 17 patients, at the time of discharge 10 had normal systolic function and 7 had decreased systolic function. Unremitting cardiac failure developed in 9 of 14 patients (64%) with an ejection fraction < 30% and in only 2 of 14 (14%) of those with an ejection fraction > or = 30% on admission (p < 0.01). Furthermore, shortening fraction < 15%, left ventricular dilatation, and moderate to severe mitral regurgitation on admission as well as arrhythmia were significantly associated with development of unremitting severe cardiac failure. In this series of patients with myocarditis, by the time of discharge 39% of the patients had developed unremitting severe cardiac failure, 25% had depressed systolic function, and 36% had normal systolic function. Predictive factors at admission for poor outcome were ejection fraction < 30%, shortening fraction < 15%, left ventricular dilatation, and moderate to severe mitral regurgitation.

Adolescent↗
PubMedDate not supplied

Fresh water swimming as a risk factor for otitis externa: a case-control study.

A case-control study was conducted in which the amount and sites (fresh-water lakes and rivers, chlorinated pools, or the ocean) of recent swimming by 105 patients with otitis externa were compared with that of 239 controls. Swimming during the week prior to the visit was strongly associated with otitis externa. When the 80 cases and 127 controls with a history of recent swimming were compared, otitis externa was positively associated with the amount of swimming during the preceding week. Otitis externa was also positively associated with swimming in fresh water compared with ocean or pool swimming with the magnitude of this association being more pronounced at higher levels of exposure.

Adult↗
PubMedDate not supplied

Resolving the pneumococcal vaccine controversy: are there alternatives to randomized clinical trials?

It has been more than five years since the relicensure of pneumococcal vaccine. There are few data, however, with which to evaluate the efficacy of pneumococcal vaccine for the conditions constituting current vaccine indications. As a result, recommendations for the use of pneumococcal vaccine remain controversial, and it is widely agreed that further clinical studies should be undertaken. Recommendations for future studies have emphasized the need for randomized clinical trials, which offer the best opportunity to assure scientifically valid results. Generally not considered are the substantial ethical and logistic problems that may impede the conduct of randomized clinical trials capable of resolving the current uncertainty. Observational studies, which include cohort, quasi-cohort, and case-control studies, are alternative approaches for evaluating pneumococcal vaccine. Although lacking the scientific strength of randomized clinical trials, certain observational designs, particularly case-control studies, pose no ethical difficulties and offer logistic advantages that will permit the rapid acquisition of statistically meaningful estimates of the efficacy of the vaccine for patients with current indications. When conducted with careful attention to measures for minimizing bias, observational designs offer attractive alternative strategies for resolving the pneumococcal vaccine controversy.

Bacterial Vaccines↗
PubMedDate not supplied

Policies for the exclusion of ill children from group day care: an unresolved dilemma.

Although the problem of how to manage children with mild infectious illnesses who attend group day care programs arises often, appropriate criteria for the exclusion of ill children have not been determined. Substantial variation in the policies of different programs for excluding ill children exists. Studies of the epidemiology of common infectious illnesses indicate that asymptomatic children may transmit infections and that symptomatic children often shed infectious particles both before the onset and after the resolution of symptoms. The little information that is available supports the contention that the exclusion of mildly ill children has little effect on the incidence of infections among children who attend group day care programs. Consequently, policies for exclusion should focus on the needs and behavior of the ill child rather than on easily measured but less germane factors such as the child's body temperature. If the facilities and staff available are adequate to meet the needs of both the ill child and other children in the group, it is appropriate to allow children with mild infectious illnesses to attend group day care programs.

Child↗
PubMedDate not supplied

Periorbital cellulitis and paranasal sinusitis: a reappraisal.

The terms periorbital (preseptal) and orbital cellulitis are often used interchangeably, obscuring important differences in their pathogenesis, bacterial etiology, clinical presentation and appropriate therapy. A review of 56 cases of periorbital cellulitis indicated that the patients could be divided into three groups: Group 1, cases secondary to paranasal sinusitis, more correctly termed inflammatory edema because the periorbital swelling is due to venous obstruction (a specific bacterial etiology is rarely documented in these patients because aspiration and culture of the sinuses are usually not performed and the infection is not associated with bacterial invasion of either the soft tissue or the blood stream); Group 2, cases associated with disruption of local skin integrity which are usually due to Staphylococcus aureus or Group A streptococci; and Group 3, cases associated with bacteremia usually occurring in infants and young children without other apparent foci of infection and caused by Haemophilus influenzae type b or Streptococcus pneumoniae. Actual infection of the orbital contents (orbital cellulitis or abscess), marked by proptosis and ophthalmoplegia, is rare and is due either to advanced purulent sinusitis or to penetrating orbital trauma.

Adolescent↗
PubMedDate not supplied

Prophylaxis for contacts of patients with meningococcal or Haemophilus influenzae type b disease.

The diagnosis of meningitis often causes profound fear and occasionally overt hysteria in family members and acquaintances of affected patients. Recent studies have indicated that in cases of meningitis caused by either Neisseria meningitidis or Haemophilus influenzae type b this fear, at least in part, is justified. Close contacts of patients with either illness are at considerably increased risk of contracting the disease. Consequently physicians are called upon to decide what preventive measures, if any, must be taken. Because prospective controlled studies in nonepidemic periods are difficult to perform, the role of prophylaxis is not entirely clear. Recommendations of experts in the field have been contradictory. This review will attempt to summarize current understanding of secondary spread of these diseases and the role of prophylaxis in their prevention.

Anti-Bacterial Agents↗