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Biomedical subjects

J Kahn

Publications and source records attributed to J Kahn.

At least 37 records · Page 2Linked to original sources
PubMed1999

Evaluation of ofloxacin in the treatment of laparoscopically documented acute pelvic inflammatory disease (salpingitis).

OBJECTIVE: To evaluate the safety and efficacy of intravenous and oral ofloxacin monotherapy in the treatment of laparoscopically documented acute pelvic inflammatory disease (PID). METHODS: This study was conducted as an open-label, phase-III, uncontrolled, multicenter study. Patients identified with laparoscopic findings of salpingitis were treated with 400 mg of intravenous ofloxacin every 12 hours followed by 400 mg of oral ofloxacin every 12 hours for 10 to 14 days. Patients were evaluated five times for clinical and microbial efficacy. Since laparoscopy was performed only at admission, pathogens identified laparoscopically were presumed eradicated if they were present on the laparoscopic culture and the patient was clinically cured or improved at final evaluation. RESULTS: Of the 70 patients evaluable for safety (intent-to-treat population), the mean age was 25.6 years. Sixty-one of 70 patients (87%) were cured, one improved, one did not improve, and seven were unevaluable because they discontinued study participation. Fifty-one were evaluable for clinical efficacy: 50 (98%) were cured and one did not improve. Sixteen were evaluable for expanded microbiological efficacy: three had documented Neisseria gonorrhoeae; 12, Chlamydia trachomatis; and one, a mixed infection of both organisms. All cervical, laparoscopic, and endometrial cultured pathogens, including N. gonorrhoeae and C. trachomatis, were eradicated or presumed eradicated at the posttherapy visit. No serious or unexpected adverse events occurred. CONCLUSIONS: Ofloxacin monotherapy was effective and well tolerated in the treatment of laparoscopically proven PID in a geographically diverse population. Future studies are necessary to evaluate long-term outcomes and sequelae of PID treatment with single agent therapy.

Administration, Oral↗
PubMed1999

Prevalence of dental occlusal variables and intraarticular temporomandibular disorders: molar relationship, lateral guidance, and nonworking side contacts.

STATEMENT OF PROBLEM: The association between dental occlusion and the development of intraarticular temporomandibular disorders remains unclear. PURPOSE: This study evaluated the prevalence of molar relationship, lateral guidance and nonworking side contacts and intraarticular temporomandibular disorders. MATERIAL AND METHODS: Eighty-two asymptomatic volunteers and 263 symptomatic temporomandibular disorder (TMD) patients completed a subjective questionnaire that documented the absence of jaw pain, joint noise, locking, and a positive history for TMD. Participants also underwent clinical and dental examination for signs and symptoms commonly associated with TMD or internal derangements. RESULTS: The most prevalent molar relationship was Class I. Symptomatic patients had a higher prevalence of Class II, Division 1 relationships on the left side compared with the asymptomatic volunteers with normal joints. There was a higher prevalence of canine guidance (52.04%; P <.005) on the right side in the symptomatic patients with disk displacement (DD). Volunteers with normal joints had a higher prevalence of 1 or more nonworking side contacts compared with symptomatic patients with normal joints (P <.001) and symptomatic patients with DD (P <. 001). CONCLUSION: This study suggests there are no systematic dental occlusal differences that clearly separate symptomatic from asymptomatic patients. Results indicate that it is unclear as to the relationship of the 3 analyzed factors and of intraarticular TMDs.

Chi-Square Distribution↗
PubMed1999

Booster immunization of HIV-1 negative volunteers with HGP-30 vaccine induces protection against HIV-1 virus challenge in SCID mice.

Eleven HIV-1 seronegative subjects previously injected with an HIV-1 p17 synthetic peptide vaccine (HGP-30) were given two booster immunizations to evaluate memory cell responses and the ability to boost cellular and humoral immune responses. Five of 11 subjects showed a significant increase in their antibody titres to HGP-30 or p17 and 6/11 had T-cell proliferation responses to either HGP-30 or p17. HIV-1 virus challenge studies in SCID mice demonstrated that 39 of 50 mice (78%) receiving PBMC from 5 of the HGP-30 immunized subjects were protected from infection with a different strain of HIV-1 compared to 4 of 30 mice (13%) that received PBMC from 3 non-immunized subjects (p < 0.001). These studies show that booster immunizations with HGP-30 vaccine are safe and non-toxic and induce protective cell mediated immune responses.

AIDS Vaccines↗
PubMed1999

High pregnancy rates and successful prevention of severe ovarian hyperstimulation syndrome by 'prolonged coasting' of very hyperstimulated patients: a multicentre study.

In a multicentre trial, 65 in-vitro fertilization (IVF)-embryo transfer cycles were severely hyperstimulated. Instead of cancelling the cycle, gonadotrophins were withheld for a 'coasting period' until serum oestradiol concentrations had dropped below 10,000 pmol/l (mean 4.3 days), and then human chorionic gonadotrophin was administered. Four cycles were cancelled and there were 61 oocyte aspirations. A total of 103 fresh embryos was transferred to 53 patients, resulting in a pregnancy rate of 42% per started cycle (51% per embryo transfer), with an implantation rate of 31%. Only one patient developed severe ovarian hyperstimulation syndrome (OHSS). Four patients developed moderate OHSS. In all, two patients were hospitalized for OHSS. In order to optimize the coasting procedure, it seems important that each IVF centre identifies its appropriate cut-off limits for serum oestradiol concentrations and follicle size for initiating and ending of the coasting period. Correctly handled, it seems to be a major advance in the search for improved stimulation policies for high-responders.

Adult↗
PubMed1999

Resistance surveillance of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis isolated in the United States, 1997-1998.

A national antimicrobial resistance surveillance study was conducted from December 1997 to May 1998 to determine the prevalence of antimicrobial resistance in 6620 clinical isolates of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. In this centralized study, which involved 163 institutions located in 43 states, we determined MICs for representatives of five antimicrobial classes: beta-lactams (penicillin, co-amoxiclav, cefuroxime, ceftriaxone), macrolides (azithromycin, clarithromycin), co-trimoxazole, glycopeptides (vancomycin) and fluoroquinolones (levofloxacin). In most S. pneumoniae isolates, all antimicrobials were to be found active, but amongst penicillin-resistant isolates (MICs > or = 2 mg/L), resistance to other beta-lactams, macrolides and co-trimoxazole was common. For vancomycin and levofloxacin, however, activity was not associated with penicillin resistance. The prevalence of penicillin-nonsusceptible (intermediate and resistant) pneumococci was highest in the South Atlantic (44%) and East South Central (43%) regions and lowest in the Mid-Atlantic (28%) and New England (28%) regions. Resistance to beta-lactams, macrolides and co-trimoxazole was more commonly found amongst respiratory isolates than blood isolates and in strains from patients < or = 12 years old than from older patients. beta-lactamase, which was detected in 33% of H. influenzae and 92% of M. catarrhalis strains, did not affect the activity of the beta-lactams under study other than ampicillin. Certain agents, such as vancomycin and the fluoroquinolones, remain highly active, and well-designed surveillance systems that monitor MIC distributions would be needed to detect a potential for reduced susceptibility. In addition, surveillance programmes should be designed to collect information about associated resistance as well as differences in prevalence associated with region, specimen source and patient age.

Adolescent↗
PubMed1999

Hockey.

Hockey is a game of strength, speed, and skill. It is among the most difficult to master, the costliest to equip, the fastest to watch, and the most dangerous to play. It requires a combination of power, endurance, and flexibility applied within a confined space over a cold, hard, and slippery surface. It is a game of control and lack of control, both of emotions and flying objects. Hopefully, the reader will be better suited to understand the "culture" of hockey, both clinically and functionally, and can better interact with the men and women who play this fantastic sport, the one I hope to be playing for another 25 years, or until I finally get it right!

Adolescent↗
PubMed1998

Calmodulin regulates L-selectin adhesion molecule expression and function through a protease-dependent mechanism.

Expression of the L-selectin adhesion molecule is rapidly down-regulated upon cell activation through proteolysis at a membrane-proximal site. Here we demonstrate that calmodulin, an intracellular calcium regulatory protein, specifically coprecipitates with L-selectin through a direct association with the cytoplasmic domain of L-selectin. Furthermore, calmodulin inhibitors disrupt L-selectin-dependent adhesion by inducing proteolytic release of L-selectin from the cell surface. The effects of the calmodulin inhibitors on L-selectin expression and function can be prevented by cotreatment with a hydroxamic acid-based metalloprotease inhibitor. Our results suggest a novel role for calmodulin in regulating the expression and function of an integral membrane protein through a protease-dependent mechanism. These findings may have broader implications for other cell surface proteins that also undergo regulated proteolysis.

Amino Acid Sequence↗
PubMed1998

Clinical research designs for emerging treatments for Alzheimer disease: moving beyond placebo-controlled trials.

The design of clinical trials must evolve as new therapies become available. The demonstrated efficacy and clinical use of donepezil and vitamin E for Alzheimer disease (AD) has shifted the options for AD research design. There is now a compelling case for alternatives to trials that include a treatment arm with no active therapy (ie, a placebo control). With an existing therapy, such as donepezil or vitamin E, new drugs that are clearly superior to those drugs should be sought. Combination therapy is a likely strategy for the future, implying that clinical trials, if possible, should replicate actual practice. The long duration of future AD trials also will make placebo-controlled trials more difficult to justify and more difficult to recruit for. Add-on or active-control designs represent the alternative approaches. We believe that definitive clinical trials of new AD drugs that use one or the other of these designs would be more likely to bring about therapeutic advances than would comparisons with inactive treatments. Our argument is not a general rejection of placebo-control designs. Our recommendations apply only to the circumstances in which the field of AD drug therapy now finds itself.

Alzheimer Disease↗
PubMed1998

Association between dental occlusal variables and intraarticular temporomandibular joint disorders: horizontal and vertical overlap.

STATEMENT OF PROBLEM: It has been suggested that dental occlusion may play a role in the development of intraarticular temporomandibular joint disorders. PURPOSE: This study evaluated the relationship between horizontal and vertical overlap and intraarticular temporomandibular joint disorders. MATERIAL AND METHODS: Vertical and horizontal overlap of the anterior teeth of 82 asymptomatic volunteers and 263 symptomatic patients were examined. RESULTS: Fifty-five (67%) of the asymptomatic volunteers had normal joints and 27 (33%) had disk displacement. Two hundred and twenty-one patients (84%) had disk displacement and 42 (16%) had bilateral symptomatic normal joints. Horizontal overlap equal to or greater than 4 mm was more prevalent in the symptomatic patient group as compared with the asymptomatic volunteer group (p < 0.05). Vertical overlap equal to or greater than 4 mm demonstrated no significant differences. CONCLUSION: Horizontal overlap equal to or greater than 4 mm was greater in symptomatic patients with intraarticular temporomandibular joint disorders.

Adult↗
PubMed1998

Evolutionary pattern of human immunodeficiency virus (HIV) replication and distribution in lymph nodes following primary infection: implications for antiviral therapy.

Evolutionary patterns of virus replication and distribution in lymphoid tissue during the early phases of HIV infection have not been delineated. Lymph node (LN) biopsies were excised from patients at different times after the estimated time of primary infection. Within 3 months of the acute viral syndrome, HIV was mostly present in individual virus-expressing cells in LNs; trapping of virions in the follicular dendritic cell (FDC) network was minimal or absent, but was the predominant form of HIV detected in LNs of subjects with chronic infection, either recent (4-20 months after primary infection) or long-term (>2-3 years after primary infection). Plasma viremia was significantly higher in patients during the first 3 months than in those recently infected; however, there were no significant differences in the number of virus-expressing cells per square millimeter of LN tissue in these two groups. Numbers of virus-expressing cells in lymphoid tissue were significantly lower in the subjects with long-term infection than in the other two groups. Therefore, during the transition from primary to chronic HIV infection, the level of HIV replication in lymphoid tissue remains elevated despite the fact that viremia is significantly downregulated. These findings have implications for therapeutic strategies in primary HIV infection and in recent seroconvertors.

Acute Disease↗
PubMed1997

The association of weapon carrying and fighting on school property and other health risk and problem behaviors among high school students.

OBJECTIVE: To examine the association between weapon carrying on school property and engaging in health risk and problem behaviors such as fighting and substance use on school property, fear of attending school, and victimization at school. DESIGN: A complex 2-stage probability survey (Massachusetts Youth Risk Behavior Survey). SETTING: High schools in Massachusetts. PARTICIPANTS: Three thousand fifty-four high school students. MAIN OUTCOME MEASURE: Number of days a weapon was carried on school property during the 30 days prior to the survey. RESULTS: The prevalence of self-reported weapon carrying on school property was 15% among male students and 5% among female students (P < .001). Weapon carrying on school property was significantly (P < .001) associated with frequency of physical fights on school property (r = 0.26), being a victim of threat or injury with a weapon on school property (r = 0.27), being a victim of stolen or damaged goods on school property (r = 0.14), not attending school owing to fear (r = 0.15), and substance use while at school, including smoking cigarettes (r = 0.20), using chewing tobacco (r = 0.18), smoking marijuana (r = 0.24), and using alcohol (r = 0.29). The association between weapon carrying and alcohol use in school was higher among students who were afraid to come to school (r = 0.49) than among students who were not afraid (r = 0.28). Students who had engaged in same-sex sexual activity (P < .001) or had been offered, given, or sold illicit drugs at school (P < .001) were more likely to carry a weapon at school. Multiple regression analysis showed that male sex and the frequencies of physical fighting, being a victim of a threat or injury, drinking alcohol, smoking cigarettes, and being offered or sold an illicit drug while on school property accounted for 21% of the variance in weapon carrying in school. When weapon carrying was dichotomized and analyzed with logistic regression, a model containing age, male sex, lower academic achievement, days not attending school owing to fear, times threatened or injured with a weapon at school, frequency of fighting at school, cigarette smoking, alcohol use, and being offered or sold illicit drugs on school property correctly classified 91.83% of the students who did or did not carry weapons. CONCLUSIONS: Weapon carrying at school was more strongly associated more with use of violence and the use of substances at school than with previous victimization and fear of attending school. However, there is a subgroup of students that seems to have been victimized at school, is afraid to come to school, is using alcohol at school, and is carrying weapons at school.

Adolescent↗
PubMed1997

Surveillance of antimicrobial resistance in Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in the United States in 1996-1997 respiratory season. The Laboratory Investigator Group.

A U.S. surveillance study of antimicrobial resistance in respiratory tract pathogens in the respiratory season (1996-1997) is reported that included 11,368 isolates from 434 institutions in 45 states and the District of Columbia. beta-lactamase was produced by 33.4% of Haemophilus influenzae and 92.7% of Moraxella catarrhalis. Of the 9,190 Streptococcus pneumoniae isolates tested, 33.5% were not susceptible to penicillin (MIC > or = 0.12 microgram/mL), with 13.6% having high-level resistance (MICs > 1 microgram/mL). For H. influenzae, the most active antimicrobials (based on percent of strains susceptible) were levofloxacin (100%) and ceftriaxone (99.9%); the least active were ampicillin (67.2%) and clarithromycin (58.1%). For M. catarrhalis, the most active drugs were amoxicillin-clavulanate, ceftriaxone, and levofloxacin (100%); the least active was ampicillin. The order of the activity of the drugs against S. pneumoniae were levofloxacin (97.3%) > ceftriaxone (87.1%) > amoxicillin-clavulanate (81.7%) = clarithromycin (80.9%) > cefuroxime (74.5%) > penicillin (66.5%). The activity of the beta-lactams and clarithromycin against isolates of S. pneumoniae was closely associated with the resistance to penicillin. Levofloxacin was more active against S. pneumoniae overall, because it exhibited no cross-resistance. These data indicate that the incidence of beta-lactamase production in H. influenzae (33.4%) and M. catarrhalis (92.7%) is similar to other recent studies, and that the incidence of penicillin-intermediate and -resistant S. pneumoniae is increasing, particularly the high-level penicillin-resistant (MICs > 1 microgram/mL) strains, which were often multi-resistant.

Amoxicillin-Potassium Clavulanate Combination↗
PubMed1997

Low albumin gradient ascites complicating severe pseudomembranous colitis.

Pseudomembranous colitis (PMC) is a frequently severe, sometimes fatal iatrogenic disease that is antibiotic-associated in almost all cases. The most common clinical features of PMC include abdominal pain, watery diarrhea, fever, leukocytosis, hypoalbuminemia, and hypovolemia. Ascites, not considered a well-known feature of PMC, is fairly common, based on a review of the English language literature but has not been characterized fully. This case report describes 5 patients with PMC who presented with low serum-ascites albumin gradient (SAAG) and neutrocytic ascites, without evidence of infectious, malignant, or inflammatory peritoneal disease, which has not been reported previously. In 1 patient, massive low SAAG ascites was the presenting manifestation of PMC, a feature also not reported previously. Three of the 5 (60%) patients had acquired immunodeficiency syndrome. The characteristics of the fluid specimens in these 5 patients and the possible pathogenetic mechanisms are proposed. The findings suggest that PMC should be included in the differential diagnosis of low SAAG ascites, especially in patients with acquired immunodeficiency syndrome.

Acquired Immunodeficiency Syndrome↗