Search PubMed⌕ Search

Biomedical subjects

G Friedland

Publications and source records attributed to G Friedland.

61 records · Page 4Linked to original sources
PubMedDate not supplied

Fever in hospitalized medical patients: characteristics and significance.

The occurrence of fever and the clinical profile of febrile patients on the medical service of a teaching hospital were studied prospectively. Thirty-six per cent of 972 patients developed fever (temperature exceeding 38 degrees C). Their 13% mortality rate and 13.2-day average hospital stay exceeded the 3% mortality and seven-day hospitalization for afebrile patients (p less than 0.0001 for both). Most fever episodes occurred during the first two hospital days. Approximately 30% of first and subsequent fever episodes were caused by bacterial infections; illnesses involving tissue necrosis (e.g., stroke, myocardial infarction) accounted for 20%. Five conditions comprised 53% of diagnoses: respiratory and urinary tract infections, neoplasm, myocardial infarction, and drug reaction. Only one patient had a fever of uncertain origin. Several clinical clues used frequently to identify bacterial infections were reevaluated. Patients with bacterial infections had higher temperatures on the first febrile day (mean 38.9 degrees C) and were more likely to have had prior infections than those with other causes of fever (mean 38.3 degrees C, p less than 0.001). Older patients (greater than 75 years) had a lower febrile response to bacterial infections than younger patients. Fever in hospitalized medical patients is a common and important concomitant of increased mortality and length of hospitalization.

Bacterial Infections↗
PubMedDate not supplied

Febrile inpatients: house officers' use of blood cultures.

The so-called "fever work-up" is time-consuming and costly. The authors examined the practices of medical house officers in obtaining blood cultures, an important part of this evaluation, as well as the ability of these physicians to predict bacteremia in febrile patients. They studied all 344 medical inpatients who experienced episodes of fever during two 30-day periods, as well as all 50 cases of bacteremia detected during these and two additional 30-day periods. House officers drew blood for culture within one day after the onset of fever in 52% of fever episodes. In 20% of these episodes only one set of cultures (representing one venipuncture) was obtained. House officers estimated the likelihood of bacteremia to be 20% or less in 15 of 40 bacteremic patients. They failed to obtain blood cultures promptly in 10% of bacteremic episodes and in 27% of episodes where the cause of fever was a nonbacteremic bacterial infection. They obtained prompt blood cultures in only a bare majority of febrile episodes, frequently underestimated the likelihood of bacteremia, and inadequately sampled blood for bacteremia. In this study, clinical judgment was not an adequate substitute for routinely obtaining blood cultures for febrile medical inpatients.

Aged↗
PubMedDate not supplied

Pyrogen reactions associated with the infusion of normal serum albumin (human).

In November, 1974, eight patients in three hospitals had pyrogen reactions associated with the infusion of 25% Normal Serum Albumin from the same lot. The reactions were recognized because the same physician or nurse observed several patients having recurrent reactions or because a single patient receiving several vials had consecutive reactions. The remaining albumin in three vials associated with reactions had apparent endotoxin concentrations of 4, 16, and 32 ng/ml and that 22 vials from recalled supplies had a median concentration of 4 ng/ml (range: 2 to 64) as determined by the Limulus amebocyte lysate test, but the lot again passed the rabbit pyrogen test. In a prospective study to determine the efficacy of the Limulus test in quality control, patients had their temperatures taken hourly during albumin infusions and the remaining fluid was tested by the Limulus assay. The albumin in 443 of the 662 vials infused (65%) gave a positive test and 311 of these vials (45%) had apparent endotoxin concentrations of 4 to 64 ng/ml, but no patient had a reaction. Because of the limitations of both the rabbit pyrogen and Limulus test, the detection of some pyrogenic lots continues to depend on hospital surveillance and reporting os suspect reactions.

Adult↗
PubMedDate not supplied

Demographic characteristics, drug use, and sexual behavior of i.v. drug user with AIDS in Bronx, New York.

Intravenous (i.v.) drug users are a key factor in the transmission of human immunodeficiency virus (HIV) infection, yet epidemiologic information about this population, especially those with acquired immunodeficiency syndrome, is scarce. The demographic characteristics, drug use behavior, and sexual practices of i.v. drug users who developed AIDS were prospectively studied at the Montefiore Medical Center from October 1984 to February 1988. The early wave of i.v. drug users with AIDS was characterized by poverty, minority overrepresentation (more than 80 percent were black or Hispanic), and initiation of i.v. drug use at an early age (median age 19 years). Injection of drugs and sharing of needles was frequent. Most had used so-called shooting galleries, but only for a minority of injection episodes. Heroin or cocaine use was almost universal, nearly always accompanied by abuse of another substance, usually alcohol or marijuana. Fewer than a third had ever participated in a methadone maintenance program, but more than 40 percent had been in prison since 1978. All patients had been sexually active, often with partners who were not i.v. drug users. The research suggests a complex interaction existing between high-risk demographic characteristics, drug use practice, and certain types of sexual behavior, all of which contributed to the early spread of HIV infection in this population. Efforts that are directed toward interrupting i.v. drug user-related transmission of HIV need to include consideration of these characteristics.

Acquired Immunodeficiency Syndrome↗