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Biomedical subjects

F N Judson

Publications and source records attributed to F N Judson.

At least 55 records · Page 3Linked to original sources
PubMed1990

National surveillance of antimicrobial resistance in Neisseria gonorrhoeae. The Gonococcal Isolate Surveillance Project.

The Gonococcal Isolate Surveillance Project is a national sentinel surveillance system to estimate levels and monitor trends of antimicrobial resistance in prospectively collected isolates of Neisseria gonorrhoeae. Of 6204 isolates evaluated from 21 clinic sites between September 1987 and December 1988, 21% met at least one of the surveillance criteria for resistance to penicillin, tetracycline, cefoxitin, or spectinomycin; 2.2% were penicillinase-producing N gonorrhoeae; 1.0% had high-level plasmid-mediated tetracycline resistance; and 16.8% of the isolates without plasmid-mediated resistance had chromosomally mediated resistance (defined as a minimum inhibitory concentration greater than or equal to 2 micrograms/mL) to penicillin, tetracycline, or cefoxitin. Three isolates were resistant to spectinomycin. All isolates were susceptible to ceftriaxone. Resistant isolates were identified from all participating centers. Patient demographic and behavioral characteristics were not predictive of infections caused by resistant organisms. These results demonstrate the wide distribution of antimicrobial-resistant N gonorrhoeae and support recent changes in Centers for Disease Control therapy recommendations for gonococcal infections that no longer recommend tetracycline and penicillin as first-line therapies.

Adolescent↗
PubMed1990

A 62-dose, 6-month therapy for pulmonary and extrapulmonary tuberculosis. A twice-weekly, directly observed, and cost-effective regimen.

STUDY OBJECTIVE: To evaluate the efficacy and toxicity of a 62-dose, four-drug, 6-month, and directly observed regimen for treatment of pulmonary and extrapulmonary tuberculosis. DESIGN: An open, nonblinded clinical trial, with intended follow-up of patients for 36 months after the completion of therapy. SETTING: A metropolitan tuberculosis clinic in a public health department. PATIENTS: From March 1981 through April 1989, we enrolled 160 patients with suspected or known tuberculosis; 35 of these patients were excluded from the analysis. INTERVENTIONS: Isoniazid, rifampin, pyrazinamide, and streptomycin were administered daily for 2 weeks; these drugs were then given in higher doses twice weekly for 6 weeks, followed by isoniazid and rifampin twice weekly for 6 weeks, followed by isoniazid and rifampin twice weekly for 18 weeks. A total of 62 doses were administered, and all therapy was directly observed by a nurse or an outreach worker. MEASUREMENTS AND MAIN RESULTS: Of the 125 evaluable patients, 101 (81%) had pulmonary tuberculosis, 7 (6%) had both pulmonary and extrapulmonary involvement, and 17 (13%) had extrapulmonary disease only. Seventy-one (57%) patients had a history of recent alcoholism. There were two relapses (1.6% +/- 2.2%), occurring 6 and 56 months after the completion of therapy. The time at which sputum samples became culture negative in pulmonary patients ranged from 1 to 19 weeks (median, 4.6 weeks); 40% +/- 9.6% of patients were culture-negative after 4 weeks of therapy, 75% +/- 8.5% after 8 weeks, 94% +/- 4.7% after 12 weeks, 97% +/- 3.3% after 16 weeks, and 100% after 20 weeks. Adverse drug reactions included hyperuricemia (greater than 178 mumol/L [3 mg/dL] above normal) secondary to pyrazinamide in 80 patients (64%), twofold or greater elevations of aspartate aminotransferase in 21 patients (17%), 1.5-fold or greater elevations of alkaline phosphatase in 33 patients (27%), cutaneous abnormalities in 8 patients (6%), nausea in five patients (4%), and dizziness in 1 patient (1%). CONCLUSIONS: This 62-dose, largely twice-weekly tuberculosis treatment regimen is efficacious and relatively nontoxic and is especially useful for patients in whom directly observed therapy is indicated.

Adolescent↗
PubMed1990

The changing epidemiology of hepatitis B in the United States. Need for alternative vaccination strategies.

To determine trends in the incidence and epidemiology of acute hepatitis B in the United States we conducted intensive surveillance for viral hepatitis in four sentinel counties from October 1, 1981, to September 30, 1988. The overall incidence of hepatitis B remained relatively constant throughout the study period (average, 13.2 cases per 100,000 population), but disease transmission patterns changed significantly. The proportions of hepatitis B cases accounted for by homosexual activity and health care employment decreased 62% and 75%, respectively; the proportions of cases accounted for by parenteral drug use and heterosexual exposure increased 80% and 38%, respectively. The percentage of patients for whom no risk factor was identified (30% to 40%) did not change over time. These patients tended to belong to minority populations, and their socioeconomic level was low. The decline in the number of hepatitis B cases among homosexual men probably results from the modification of high-risk sexual behavior; the decline among health care workers is due mostly to hepatitis B immunization. The current strategy for prevention of hepatitis B, which targets high-risk groups for immunization, has failed to have a significant impact on the incidence of disease.

Acute Disease↗
PubMed1990

Antenatal microbiologic and maternal risk factors associated with prematurity.

In a prospective study of 202 women (gestational age 24 +/- 4 weeks), we evaluated possible influences of lower genital tract infection or bacterial conditions on obstetric outcomes, including preterm labor, preterm premature rupture of membranes, and preterm birth. The presence of bacterial vaginosis (18.7%) was associated with an increased risk of preterm labor (relative risk, 2.6; 95% confidence interval, 1.08 to 6.46). For women with bacterial vaginosis who also had Mobiluncus species morphotypes identified on Gram stain, the relative risk of preterm labor was 3.8 (95% confidence interval, 1.32 to 11.5). Presence of vaginal Mycoplasma hominis (10.8% of patients) was associated with both preterm labor (relative risk, 1.8; 95% confidence interval, 0.77 to 4.4) and preterm birth (relative risk, 5.1; 95% confidence interval, 1.45 to 17.9). Recovery of Staphylococcus aureus (3.0%) was associated with preterm labor (relative risk, 3.1; 95% confidence interval 1.12 to 8.7). Identification of two or more bacterial-linked abnormalities was also associated with preterm labor (relative risk, 3.3; 95% confidence interval, 1.44 to 7.58). An increased level of vaginal wash protease (greater than or equal to 10 trypsin units) (16%) was associated with preterm labor and was noted in 50% of women with preterm premature rupture of membranes. A history of prior preterm birth was the single best historical predictor of both preterm labor (relative risk, 3.6; 95% confidence interval, 1.92 to 6.83) and preterm birth (relative risk, 6.7; 95% confidence interval, 2.2 to 20.4). History of three or more abortions, antenatal urinary tract infection, and occurrence of medical complications during pregnancy also correlated with increased risk of preterm labor. These findings affirm and refine associations of various maternal reproductive tract infections with preterm labor, premature rupture of membranes, and birth, allowing for controlled treatment trials aimed at prevention of preterm birth.

Adult↗
PubMed1990

Cervicovaginal microflora and pregnancy outcome: results of a double-blind, placebo-controlled trial of erythromycin treatment.

Available information suggests that some instances of preterm birth or premature rupture of membranes are associated with clinically unrecognized infection and inflammation of the lower uterine segment, decidua, and fetal membranes. Various cervicovaginal microorganisms have been recovered from these sites. Many of these microorganisms produce factors that may lead to weakening of the fetal membranes, release of prostaglandins, or both. This study evaluated the presence of various lower genital tract microflora and bacterial conditions in 229 women enrolled in a double-blind, placebo-controlled trial of short-course erythromycin treatment at 26 to 30 weeks' gestation to prevent preterm birth. Demographic, obstetric, and microbiologic parameters were prospectively evaluated. Premature rupture of membranes occurred less frequently (p less than 0.01) among women who received erythromycin (6%) versus placebo (16%). Preterm premature rupture of membranes also occurred less frequently, although not significantly (p = 0.3) in patients who received erythromycin (2%) versus placebo (5%). Erythromycin treatment significantly decreased the occurrence of premature rupture of membranes among women who were initially positive for Chlamydia trachomatis infection. Logistic regression analysis demonstrated that C. trachomatis (p = 0.05; odds ratio, 9), vaginal wash phospholipase C (p = 0.08; odds ratio, 6) and prior preterm birth (p = 0.007; odds ratio 17) were associated with increased risk of preterm birth. Bacterial vaginosis, Mycoplasma hominis, Ureaplasma urealyticum were not significantly associated with increased risk of preterm birth or preterm rupture of membranes. These findings support a role for selected lower genital tract microflora in preterm birth and premature rupture. Large controlled treatment trials of specific infections or conditions associated with preterm birth and premature rupture of membranes are required to confirm the value of antimicrobial treatments in prevention of microbial-associated preterm birth.

Adolescent↗
PubMed1990

Gonorrhea.

During a 10-year period from 1976 to 1985, N. gonorrhoeae demonstrated remarkable genetic resiliency in developing clinically important antimicrobial resistance through a variety of chromosomal mutations and by acquiring either entire plasmids or resistance determinants on plasmids from other species. Gonococcal resistance is widespread, and few communities will be spared all types. None of the newer diagnostic technologies has provided any performance or cost advantages over traditional Gram-stained smears and cultures. The two most important components of a control program are (1) the National Gonococcal Isolate Surveillance project and (2) treatment with ceftriaxone, 125 or 250 mg intramuscularly, which is active against all known types of resistance and will cure all forms of uncomplicated gonorrhea, including the more difficult-to-treat infections of the pharynx and anorectum. Fear of AIDS has had a powerful motivating effect on sexual behavior, and in the United States has been associated with an overall reduction in incidence of gonorrhea in homosexual men of over 95%. After peaking in 1985, incidence of gonorrhea in white heterosexual men and women has declined as well. A diagnosis of gonorrhea in 1990 implies recent high-risk behavior for acquiring HIV infection. The gonorrhea epidemic in the United States is rapidly contracting down around poor urban minorities; although this is not good, at least it tells us where to target our resources.

Drug Resistance, Microbial↗
PubMed1990

Seroprevalence of human T-lymphotropic virus type I or II in sexually transmitted disease clinic patients in the USA.

Serum specimens from patients attending sexually transmitted disease (STD) clinics in Denver and several southeastern US cities were tested for antibody to human T-lymphotropic virus type I or II (HTLV-I/II). In Denver, 8 (2.1%) of 384 patients with a history of intravenous (IV) drug use, versus none of 201 non-IV-drug users, were HTLV-I/II seropositive. Only 2 (0.18%) of 1095 STD clinic patients from the southeastern USA had antibodies to HTLV-I/II. These data document a low prevalence of HTLV-I/II in STD clinic patients from the southeastern USA and confirm that IV drug use is an important risk factor for HTLV-I/II in the USA.

Adult↗
PubMed1990

A randomized trial of combination therapy with intralesional interferon alpha 2b and podophyllin versus podophyllin alone for the therapy of anogenital warts.

To determine the value of combining interferon with standard local therapy in the treatment of human papillomavirus infection, 97 patients with anogenital warts were randomized to a short course of either interferon plus podophyllin or podophyllin alone. Interferon alpha 2b (1.5 x 10(6) IU) was injected intralesionally and podophyllin resin applied topically to each of three warts once weekly for 3 weeks. Maximal responses occurred within 2 weeks of therapy, and overall there was complete clearance of treated warts in 67% of interferon and podophyllin versus 42% of podophyllin recipients (P less than .05, chi 2). Clearance rates were greater in women, patients with warts of less than or equal to 12 months' duration, and HIV-seronegative patients. Of patients with complete clearance, 67% of interferon and podophyllin and 65% of podophyllin recipients experienced recurrences. Thus, in short treatment courses of anogenital warts, intralesional interferon enhanced the effect of topical podophyllin, and trials of combination therapy using more intensive or prolonged regimens of interferon are warranted.

Administration, Topical↗
PubMed1990

Comparative study of 5% permethrin cream and 1% lindane lotion for the treatment of scabies.

A multicenter, randomized, investigator-blind controlled trial was conducted to compare the safety and efficacy of a single, whole-body application of 5% permethrin cream with that of 1% lindane lotion for the treatment of scabies in 467 patients. At 14 +/- 3 days after treatment, the mean active lesion count decreased from pretreatment levels of 85 (range, 4 to 600) in both treatment groups to 14 (range, 0 to 133) in the permethrin group and to 15 lesions (range, 0 to 500) in the lindane group. At 28 +/- 7 days after treatment, complete resolution had occurred in 181 (91%) of 199 patients treated with permethrin and in 176 (86%) of 205 patients given lindane. Pruritus due to scabies persisted at 28 +/- 7 days in 14% of the permethrin group and in 25% of the lindane group. The most frequent adverse effects were new or increased pruritus and mild, transient burning or stinging; the latter was slightly more frequent following permethrin treatment and appeared to be related to severity of infestation. Because of a lower potential for neurologic toxicity, permethrin may be preferable to lindane for the treatment of scabies particularly in children.

Adolescent↗
PubMed1990

Sexual behavior before AIDS: the hepatitis B studies of homosexual and bisexual men.

Data on sexual practices, collected during studies of hepatitis B virus (HBV) infection in 1978 and 1979, were analyzed for 4910 homosexual and bisexual men from Chicago, Denver, Los Angeles, San Francisco, and St Louis. Data on sexual practices in 1978 showed that white participants had larger numbers of non-steady male sexual partners and engaged in oral-genital activities more frequently but were equally likely to engage in anal intercourse as black and Hispanic participants. San Francisco participants had more non-steady sex partners and were more likely to engage in receptive anal intercourse with non-steady partners than participants from all other sites. Analysis of data on 606 HBV-antibody-negative men interviewed on three occasions in 1978 and 1979 showed no changes in risk indices for insertive and receptive anal intercourse between these years, except in San Francisco where significant declines occurred in insertive anal intercourse and receptive anal intercourse without ejacultion in a small, highly select group of participants.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Delta hepatitis in homosexual men in the United States.

To assess the incidence and prevalence of delta hepatitis in homosexual men, we tested serum specimens for delta markers in participants in two previous studies: a hepatitis B vaccine trial among homosexual men conducted in the early 1980's and the Centers for Disease Control sentinel counties hepatitis study for 1983-1984. In the vaccine trial, men found to be hepatitis B surface antigen positive at the time of enrollment and those men who had serologic evidence of new hepatitis B virus infection during follow-up were tested. In the sentinel counties study that determined risk factors for viral hepatitis in reported cases, all homosexual men with acute and chronic hepatitis B virus infections were tested for delta markers. Specimens were tested for delta antigen and IgM and total delta antibody. In seven different cities, among 321 men found to be HBsAg positive at the time of screening, eight (2%) were positive for any delta marker. Among 290 men with new hepatitis B virus infections during follow-up, three (two coinfections, one superinfection) had serologic evidence of delta hepatitis. In the sentinel counties study, 0/63 acute hepatitis B virus infections in homosexual men were associated with delta hepatitis. This study indicates that the delta agent is an infrequent cause of viral hepatitis in homosexual men in the United States.

Hepatitis D↗
PubMed1989

Comparison of intramuscular recombinant alpha interferon (rIFN-2A) with topical acyclovir for the treatment of first-episode herpes genitalis and prevention of recurrences.

Intramuscular recombinant alpha interferon (rIFN-2A; 9 million IU given for 5 days during a 9-day treatment period) was compared with topical acyclovir in a double-blind, placebo-controlled trial for the treatment of first-episode genital herpes simplex virus (HSV) infection and for subsequent alteration of the frequency of recurrences. rIFN-2A (within 96 h of onset of the first episode) was not superior to topical acyclovir in a well-matched group of 105 patients. The early use of rIFN-2A also did not alter the frequency or severity of genital HSV recurrences within either the first or second 6 months following therapy. Separate analyses by HSV type and by type of infection (primary versus nonprimary) did not change this conclusion. Furthermore, there was significant toxicity associated with rIFN-2A therapy. rIFN-2A is not indicated for the treatment of genital HSV infections.

Acyclovir↗
PubMed1989

What do we really know about AIDS control?

For the near term, control of the AIDS epidemic depends entirely upon altering the human behavior which results in HIV transmission. How best to achieve the required changes has been controversial with approaches ranging from education/information only, to a vast array of largely unproven voluntary behavior modification techniques, to mandatory testing and restrictive measures. Given the complexity of human behavior and the reality of a still uncontrolled epidemic, at least among poor urban drug using minorities, there is a legitimate role for most approaches and any promising behavior modification strategy deserves evaluation. However, because voluntarism will not work for some individuals, society still must choose between effective public health law--including restrictive measures--now, and a much larger reservoir of HIV infection and more deaths from AIDS for many generations to come.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Genital Chlamydia infections.

The past decade has seen a breakthrough in laboratory methods for the diagnosis of chlamydial infections. Antigen detection methods have made screening for C. trachomatis available in most clinical laboratories. These methods are highlighted and evaluated. Current culture methods and the antibiotic susceptibility of C. trachomatis are also discussed.

Antibodies, Bacterial↗
PubMed1988

Condoms as physical and chemical barriers against human immunodeficiency virus.

In an in vitro model, 20 condoms containing 0.9 mL of 6.6% (vol/vol) nonoxynol 9 and ten condoms without nonoxynol 9 were tested as physical and chemical barriers against human immunodeficiency virus (HIV). Each condom was mounted on a hollow dildo and placed in a glass cylinder. The HIV inoculum and HIV-free medium were placed on opposite sites of the condom. Intercourse was simulated by pumping the dildo up and down in the cylinder before and after deliberate rupture of the condom. Samples for HIV culture were taken from outside and inside the condom, before and after rupture. After rupture of nonoxynol 9-containing condoms, an outside nonoxynol 9 concentration of 0.25% was reached. No condom without nonoxynol 9 leaked HIV before rupture, but after rupture HIV could be detected in medium outside of seven of ten condoms tested. In none of 20 nonoxynol 9-containing condoms could HIV be detected in outside medium after rupture. Thus, undamaged condoms provide an effective physical barrier against HIV, and nonoxynol 9 may provide an effective chemical barrier as well.

Contraceptive Devices, Male↗
PubMed1988

Class-specific antibody response to pneumococcal capsular polysaccharides in men infected with human immunodeficiency virus type 1.

We characterized the effect of infection with human immunodeficiency virus type 1 (HIV) on levels of total immunoglobulins and pneumococcal vaccine-specific immunoglobulins in 28 heterosexual and 25 homosexual men seronegative for HIV; 27 asymptomatic, seropositive homosexual men; and 21 patients with AIDS. Total serum IgG levels were increased in both HIV-seropositive groups compared with the HIV-seronegative men (P less than .001). Total IgM levels, however, were elevated only in the asymptomatic, HIV-seropositive men (P less than .08); total IgA levels were elevated only in the patients with AIDS (P less than .05). Vaccine-specific serum IgG, IgM, and IgA significantly increased over baseline three and six weeks after immunization in all groups (P less than .05). Responses to vaccine among the HIV-seronegative groups were similar but were greater for all antibody classes than were responses among the HIV-seropositive groups (P less than .05).

Acquired Immunodeficiency Syndrome↗