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Biomedical subjects

G F Hayden

Publications and source records attributed to G F Hayden.

At least 19 recordsLinked to original sources

Periurethral colonization and urinary leukocytes as markers for bacteriuria in children with neurogenic bladder.

Bacteriuria and associated renal damage is common in children with a neurogenic bladder, but the pathogenesis of urinary tract infection (UTI) is undefined. We examined the association between periurethral bacterial colonization and the presence of urinary leukocytes in 76 catheter urine specimens from children with neurogenic bladders. Although all the children were asymptomatic, 38/76 (50%) of the urine cultures were positive. Periurethral colonization was significantly more common with positive than with negative urine cultures, suggesting a pathogenetic role for periurethral bacteria in infection of the neurogenic bladder. Urinary leukocytes were present in 24/38 (63%) with positive cultures, as against none (0/38) of those with negative urine cultures, and their presence represents a host response to bladder bacteriuria.

Bacteriuria

Acyclovir treatment of varicella in otherwise healthy adolescents. The Collaborative Acyclovir Varicella Study Group.

STUDY OBJECTIVE: To determine whether orally administered acyclovir is of therapeutic benefit for varicella in otherwise healthy adolescents, and to compare the severity of the disease in adolescents with that in younger children. DESIGN: Multicenter, randomized, placebo-controlled, double-blind trial. SETTING: Patients' homes and university hospital clinics. PATIENTS: Sixty-eight adolescents between 13 and 18 years of age with varicella entered the study. Of the 62 adolescents with laboratory-confirmed varicella who were included in the final analysis, 31 received acyclovir and 31 received placebo. INTERVENTIONS: Placebo or an 800 mg acyclovir tablet was given orally four times daily for 5 days, beginning within 24 hours of onset of rash. MEASUREMENTS AND MAIN RESULTS: Acyclovir recipients had significant reductions in times to cessation of new lesion formation (p less than 0.001), maximum number of lesions (p = 0.019), and defervescence (p = 0.045). Mean constitutional illness score was significantly reduced on day 4 (0.5 vs 1.5, p = 0.05), as was the mean number of residual hypopigmented lesions present on 28-day follow-up examination (22.7 vs 92.7, p = 0.018). Two complications, both bacterial superinfections, occurred in placebo recipients. Adverse experiences and varicella-zoster virus antibody titers measured 28 days after enrollment were similar in both treatment groups. Comparison of placebo recipients with children 2 to 12 years of age participating in a companion study indicated that varicella is more severe in adolescents: mean maximum total lesions (421 vs 347, p = 0.003), mean maximum constitutional illness score (3.1 vs 2.2, p = 0.032), and mean number of residual lesions (92.7 vs 33.2, p = 0.01) were all greater in the adolescent population. CONCLUSIONS: Oral acyclovir therapy is safe and effective for treatment of varicella in otherwise healthy adolescents; this may be an appropriate subgroup for treatment with antiviral drugs because the disease is more severe in them than in younger children.

Acyclovir

Latex agglutination testing directly from throat swabs for rapid detection of beta-hemolytic streptococci from Lancefield serogroup C.

A latex agglutination method for the rapid detection of beta-hemolytic streptococci from Lancefield serogroup C in throat swabs from 403 university students with symptomatic pharyngitis was evaluated. Compared with culture, the rapid test was poorly sensitive (34.4%) but very specific (98.4%) in detecting group C beta-hemolytic streptococci. The sensitivity of the rapid test improved with an increasing quantity of growth on culture.

Adolescent

Vaccine storage practices in pediatric offices.

Fifty pediatric offices and clinics in the metropolitan Los Angeles area were visited to assess vaccine storage practices. Questionnaires were administered to the personnel responsible for vaccine storage and the vaccine refrigerators were inspected. Only 16% of vaccine storage coordinators could cite appropriate storage temperatures for vaccines and 18% were unaware that heat can harm certain vaccines. Refrigerator thermometers were checked at least weekly in only 20% of offices, and 22% of the refrigerators had inappropriately high temperatures. Vaccines were routinely stored outside of the refrigerator uninsulated during the practice day in 16% of the offices visited. It is concluded that vaccine storage errors occur in pediatric offices at an unacceptably high frequency. Pediatricians should familiarize themselves with the guidelines for optimal vaccine storage in order to minimize the potential for vaccine failure in primary care practice.

Bacterial Vaccines

A controlled trial of acyclovir for chickenpox in normal children.

BACKGROUND: Chickenpox, the primary infection caused by the varicella-zoster virus, affects more than 3 million children a year in the United States. Although usually self-limited, chickenpox can cause prolonged discomfort and is associated with infrequent but serious complications. METHODS: To evaluate the effectiveness of acyclovir for the treatment of chickenpox, we conducted a multicenter, double-blind, placebo-controlled study involving 815 healthy children 2 to 12 years old who contracted chickenpox. Treatment with acyclovir was begun within the first 24 hours of rash and was administered by the oral route in a dose of 20 mg per kilogram of body weight four times daily for five days. RESULTS: The children treated with acyclovir had fewer varicella lesions than those given placebo (mean number, 294 vs 347; P less than 0.001), and a smaller proportion of them had more than 500 lesions (21 percent, as compared with 38 percent with placebo; P less than 0.001). In over 95 percent of the recipients of acyclovir no new lesions formed after day 3, whereas new lesions were forming in 20 percent of the placebo recipients on day 6 or later. The recipients of acyclovir also had accelerated progression to the crusted and healed stages, less itching, and fewer residual lesions after 28 days. In the children treated with acyclovir the duration of fever and constitutional symptoms was limited to three to four days, whereas in 20 percent of the children given placebo illness lasted more than four days. There was no significant difference between groups in the distribution of 11 disease complications (10 bacterial skin infections and 1 case of transient cerebellar ataxia). Acyclovir was well tolerated, and there was no significant difference between groups in the titers of antibodies against varicella-zoster virus. CONCLUSIONS: Acyclovir is a safe treatment that reduces the duration and severity of chickenpox in normal children when therapy is initiated during the first 24 hours of rash. Whether treatment with acyclovir can reduce the rare, serious complications of chickenpox remains uncertain.

Acyclovir

Association of group C beta-hemolytic streptococci with endemic pharyngitis among college students.

Throat cultures were performed throughout 2 school years to determine whether non-group A beta-hemolytic streptococci (NGA BHS) could be isolated more frequently in 232 college students who had symptomatic pharyngitis than from 198 age-matched controls with noninfectious problems. Duplicate throat swabs were inoculated onto plates that contained sheep blood agar, one plate being incubated in a 5% CO2 atmosphere and the other in an anaerobic environment. The BHS were grouped using latex agglutination. Among the NGA BHS, only those from group C were isolated significantly more often among the patients compared with the controls (26% vs 11%). Quantitative colony counts of isolates of group C BHS were generally higher among patients than controls. Patients with group C BHS had fever, exudative tonsillitis, and anterior cervical adenopathy significantly more frequently than did patients who had throat cultures that were negative for group C BHS. Group C BHS were epidemiologically associated with endemic pharyngitis in this college student population.

Adult

Worldwide control of disease through immunization. Progress and prospects.

In summary, tremendous advances have been made over the past 15 years toward the development of effective national immunization programs throughout the world. Immunization levels among children in the developing world have risen dramatically, and in some instances, now equal or exceed levels in industrialized nations. There is no room for complacency, however, because millions of children remain incompletely immunized and many die each year from measles, pertussis, and neonatal tetanus. Immunization activities need to be intensified, accelerated, and sustained within the context of the primary health care system. Expansion of immunization programs to include additional vaccines and other simple health interventions will yield further benefits in the years ahead.

BCG Vaccine

Non-group A streptococci in the pharynx. Pathogens or innocent bystanders?

OBJECTIVE: To determine whether beta-hemolytic streptococci from groups other than A are an important cause of sporadic pharyngitis in children. DESIGN: Cross-sectional, case-referent survey. SETTING: General pediatric clinic at a military base in Ohio. PARTICIPANTS: One hundred fifty children with symptomatic pharyngitis and 150 controls matched for age and time of presentation over a 20-month study period. INTERVENTIONS: None. MEASUREMENTS/MAIN RESULTS: Anaerobic culture technique was used to improve isolation of beta-hemolytic streptococci. Group A beta-hemolytic streptococci were detected significantly more often among the ill children than among the controls (39% vs 16%, respectively). In contrast, non-group A beta-hemolytic streptococci were isolated in similar frequency from the ill and control children (17% vs 21%, respectively). Non-group A beta-hemolytic streptococci from groups B, C, F, and G were each isolated in similar frequency among the ill and control children. The isolation rate of non-group A organisms increased with age among both patients and controls. CONCLUSIONS: Non-group A beta-hemolytic streptococci seemed not to be an important cause of sporadic pharyngitis in this pediatric population.

Adolescent

Comparison of three topical antimicrobials for acute bacterial conjunctivitis.

One hundred fifty-eight patients, 21 years of age or less, presenting with culture-positive (Haemophilus influenzae or Streptococcus pneumoniae) conjunctivitis were treated with trimethoprim-polymyxin B (TP), gentamicin sulfate (GS) or sodium sulfacetamide (SS) ophthalmic solution for 10 days. Clinical response at 3 to 6 days after start of therapy was similar for all test agents: 26 of 55 (47%) patients cured, 25 of 55 (45%) improved for TP; 28 of 57 (49%) cured, 26 of 57 (46%) improved for GS; and 19 of 46 (41%) cured, 22 of 46 (48%) improved for SS. Clinical response at 2 to 7 days after completion of therapy was also similar: 46 of 55 (84%) patients cured, 5 of 55 (9%) improved for TP; 50 of 57 (88%) cured, 5 of 57 (9%) improved for GS; and 41 of 46 (89%) cured, 2 of 46 (4%) improved for SS. Bacteriologic response at 2 to 7 days after completion of therapy was similar for all antimicrobials: 44 of 55 (83%) patients for TP; 39 of 57 (68%) for GS; and 33 of 46 (72%) for SS.

Administration, Topical

Nosocomial varicella. Part II: suggested guidelines for management.

Because of the potential severity of varicella among patients with compromised immunity in hospitals, a case of nosocomial varicella demands immediate attention. Patients with varicella should be discharged or placed in strict isolation. Other patients in the hospital should be screened for varicella exposure and susceptibility, and isolated as necessary. Exposed staff members must also be screened for susceptibility. Prompt institution of these measures should prevent or reduce transmission of nosocomial varicella.

Chickenpox

Current status of mumps and mumps vaccine in the United States.

Reported mumps in the United States has declined to all-time low levels following the increasingly widespread use of mumps-virus vaccine. Mumps vaccine has proven safe and effective. Its incorporation into combined live-virus vaccines, especially measles-mumps-rubella, has made mumps vaccination a practical and economically feasible component of routine immunization activities. Because of the favorable experience to date with mumps vaccine and the associated drop in mumps morbidity and mortality, mumps control programs likely will receive increasing public health attention in the coming years.

Adolescent

Immunization.

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Immunization

Current status of rubella in the United States, 1969-1975.

Implementation of the rubella immunization policy in the United States has resulted in marked decreases in the number of reported cases of both rubella and CRS. Emphasis on immunization of one- to 12-year-old children has resulted in a dramatic reduction in reported rubella in this age group. Accordingly, the proportion of reported cases occurring in adolescents and young adults has increased. Therefore, it seems appropriate to place more emphasis on immunizing susceptible adolescent and adult females as an adjunct to routine immunization in early childhood. This joint strategy should result in a further decrease in the incidence of rubella and CRS.

Adolescent