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Biomedical subjects

M J Alter

Publications and source records attributed to M J Alter.

At least 109 records · Page 6Linked to original sources
PubMed1984

Community-acquired non-A, non-B hepatitis: clinical characteristics and chronicity.

The characteristics of 86 patients with acute non-A, non-B hepatitis were compared to 23 patients with acute hepatitis A and 76 with acute hepatitis B by medical record reviews of patients seen at 5 hospitals in Baltimore, Maryland, as part of case-control study of viral hepatitis. Results of serum aminotransferase levels, bilirubin, albumin, and prothrombin times alone could not distinguish the type of viral hepatitis because of extensive overlap. The alanine aminotransferase range for non-A, non-B hepatitis was 56 to 1819 IU/liters, for hepatitis A 250 to 1995 IU/liters, and for hepatitis B 203 to 2120 IU/liters. The ranges of aspartate aminotransferase and bilirubin for the types of hepatitis also overlapped. Fewer patients with non-A, non-B hepatitis or hepatitis A had a prolonged prothrombin time compared to patients with hepatitis B. Hepatic encephalopathy was seen only in two patients with hepatitis B. Forty-two percent of non-A, non-B hepatitis patients followed for 6 months or longer continued to have elevated alanine aminotransferase levels. Chronic alanine aminotransferase elevation was independent of the source of infection: transfusion, parenteral drug use, or all other sources. Prolonged follow-up is necessary to evaluate chronicity in patients with non-A, non-B hepatitis.

Alanine Transaminase↗
PubMed1983

Hepatitis B virus transmission associated with a multiple-dose vial in a hemodialysis unit.

Ten of sixty-one patients in a maintenance hemodialysis center seroconverted to hepatitis B surface antigen (HBsAg)-positive in August 1981. All but one were negative for antibody to hepatitis B core antigen, indicating early infection, and all received dialysis on the same days. Findings of case-control study showed that all "cases" received dialysis after the early morning shift, compared to 50% of controls (p = 0.01), and all cases used a multiple-dose vial of local anesthetic (bupivacaine), compared to 58% of controls (p = 0.03). At a common area used to prepare medications, an HBsAg carrier apparently stuck herself with a needle before drawing up bupivacaine, thus contaminating the vial that then served as the vehicle of transmission. Ten of eleven susceptible patients (those negative for antibody to HBsAg) who subsequently used bupivacaine and received dialysis seroconverted to HBsAg-positive, giving an attack rate of 91%. Serum samples from six of the ten cases were subtype Ad (or Adw), as was the implicated carrier's serum.

Bupivacaine↗
PubMed1982

Sporadic non-A, non-B hepatitis: frequency and epidemiology in an urban U.S. population.

Patients with acute viral hepatitis were identified at five hospitals in Baltimore, Maryland between February 1979-August 1980. Of the 295 patients with serologically diagnosed hepatitis, 42% had non-A, non-B hepatitis; 48% had hepatitis B; and 10% had hepatitis A. Compared with matched control patients with no liver disease, patients with non-A, non-B hepatitis more often had received a blood transfusion (11% vs. O, P less than 0.001), used parenteral drugs (42% vs. 4%, P less than 0.001), were employed as health workers in direct patient care or hospital laboratory work (6% vs. 3%, P less than 0.05), had personal contact with others who had hepatitis (16% vs. 1%, P less than 0.001), or had ingested raw shellfish (34% vs. 20%, P less than 0.01). A history of previous clinical hepatitis and serologic markers indicating previous hepatitis B infection were found in patients with non-A, non-B hepatitis more often than in the control patients. Chronic non-A, non-B hepatitis was found in 34 (42.5%) of 80 patients with non-A, non-B hepatitis.

Adolescent↗
PubMedDate not supplied

National surveillance of dialysis-associated diseases in the United States, 1988.

To determine trends in a variety of dialysis-associated diseases and practices, the Centers for Disease Control surveyed 1,734 chronic hemodialysis centers in the United States in 1988 in conjunction with the annual facility survey performed by the Health Care Financing Administration. The response rate to a mailed questionnaire was 91%. These 1,586 centers represented 107,804 patients and 28,501 staff members. Over the last 13 years, the incidence of hepatitis B virus (HBV) infection decreased from 3.0 to 0.2% among patients and from 2.6 to 0.1% among staff members. Over the same time, the prevalence of HBsAg-positivity declined from 7.8 to 1.5% among patients and from 0.9 to 0.3% among staff members. Hepatitis B vaccine was given by 90% of the centers. By the end of 1988, 17% of susceptible patients and 53% of susceptible staff members had received all three doses of hepatitis B vaccine. From 1982 to 1988, as a result of receiving vaccine, the prevalence of antibody to HBsAg increased from 12 to 20% among patients and from 18 to 54% among staff. The incidence of non-A, non-B hepatitis in 1988 was reported to be 1.0% among patients and 0.1% among staff members. Fifteen percent of the centers reported pyrogenic reactions in the absence of septicemia among their patients and 45% reported septicemia. The reported incidence of dialysis dementia among hemodialysis patients was 0.2%, with a case fatality rate of 25%. In 1988, 67% of centers reported that they reused disposable dialyzers; these centers treated 72% of the dialysis patient population. Among centers that reused disposable dialyzers, the average number of reuses ranged from 2 to 50 (mean, 11) and the maximum number of times a disposable dialyzer was reused ranged from 3 to 131 (mean, 28). Chemical germicides used for reprocessing dialyzers included formaldehyde; Renalin, a peracetic acid-hydrogen peroxide-based germicide; and glutaraldehyde-based germicides. Reuse of disposable dialyzers was not associated with any increased risk of acquiring HBV infection among either patients or staff. However, pyrogenic reactions occurring in clusters were more frequently reported in centers that reused conventional dialyzer membranes compared with centers that did not. This increased risk was only associated with centers that reused these dialyzers in a manual reprocessing system, a result consistent with those obtained in 1986 and 1987. Eighteen percent of centers reported treating at least some of their patients by high flux dialysis.(ABSTRACT TRUNCATED AT 400 WORDS)

Communicable Diseases↗
PubMedDate not supplied

National surveillance of dialysis associated diseases in the United States, 1995.

Chronic hemodialysis centers in the United States were surveyed in 1995 regarding a number of hemodialysis associated diseases and practices. A total of 2,647 centers, representing 224,954 patients and 54,194 staff members, responded. Seventy-seven percent of centers reported that they reused disposable dialyzers. At the end of 1995, 65% of patients were treated with an arteriovenous graft, 22% an arteriovenous fistula, and 13% a temporary or permanent central catheter. By the end of 1995, at least three doses of hepatitis B vaccine had been administered to 35% of patients and to 82% of staff members. Acute infection with the hepatitis B virus (HBV) occurred in 0.06% of patients, and was more likely to be reported by centers with lower proportions of patients vaccinated against HBV. The prevalence of antibody to hepatitis C virus (HCV) was 10.4% among patients and 2.0% among staff. At least one patient with vancomycin resistant enterococci (VRE) was reported by 11.5% of centers, more commonly by hospital (vs freestanding centers not located in hospitals) and government centers, and centers located in certain geographic areas. Vancomycin was received by 7.2% of patients in December 1995. The percentage of centers reporting patients with other pathogens was 7.9% for active tuberculosis, 39% for human immunodeficiency virus (HIV), and 40% for methicillin resistant Staphylococcus aureus (MRSA).

Arteriovenous Shunt, Surgical↗
PubMedDate not supplied

National surveillance of dialysis-associated diseases in the United States, 1989.

To determine trends in a variety of dialysis-associated diseases and practices, the Centers for Disease Control surveyed 1,867 chronic hemodialysis centers in the United States in 1989 in conjunction with the annual facility survey performed by the Health Care Financing Administration. The response rate to a mailed questionnaire was 92%. These 1,726 centers represented 122,734 patients and 32,486 staff members. The following results were found. 1) During the last 14 years, the incidence of hepatitis B virus (HBV) infection decreased from 3.0 to 0.1% among patients, and from 2.6 to 0.1% among staff members. Over the same time, the prevalence of hepatitis B surface antigen (HBsAg) positivity declined from 7.8 to 1.4% among patients and from 0.9 to 0.3% among staff members. Hepatitis B vaccine was given by 92% of the centers. By the end of 1989, 19% of susceptible patients and 55% of susceptible staff members had received all three doses of hepatitis B vaccine. From 1982 to 1989, as a result of receiving vaccine, the prevalence of antibody to HBsAg (anti-HBs) increased from 12 to 19% among patients and from 18 to 54% among staff. The incidence of non-A, non-B hepatitis in 1989 was reported to be 0.7% among patients and 0.1% among staff members. 2) Twenty-two percent of the centers reported pyrogenic reactions in the absence of septicemia among their patients, and 51% reported septicemia. 3) The reported incidence of dialysis dementia among hemodialysis patients was 0.2%, with a case fatality rate of 23%. 4) In 1989, 68% of centers reported that they reused disposable dialyzers; these centers treated 73% of the dialysis patient population. Among centers that reused disposable dialyzers, the average number of reuses ranged from 1 to 50 (mean, 12) and the maximum number of times a disposable dialyzer was ever reused ranged from 3 to 150 (mean, 28). Chemical germicides used for reprocessing dialyzers included formaldehyde, Renalin (a peracetic acid-hydrogen peroxide-based germicide), and glutaraldehyde-based germicides. Reuse of disposable dialyzers was not associated with any increased risk of acquiring HBV infection among either patients or staff. However, pyrogenic reactions occurring in clusters were reported more frequently in centers that reused conventional dialyzer membranes compared with centers that did not. This increased risk was associated only with centers that used Renalin or glutaraldehyde for reprocessing (not formaldehyde) and occurred with both automated and manual reprocessing systems.(ABSTRACT TRUNCATED AT 400 WORDS)

Dementia↗
PubMedDate not supplied

National surveillance of dialysis-associated diseases in the United States, 1987.

The Centers for Disease Control surveyed 1,630 chronic hemodialysis centers in the United States in 1987 in conjunction with the annual facility survey done by the Health Care Financing Administration. Information was obtained on the following diseases and practices: 1) hepatitis B virus (HBV) infection in patients and staff members; 2) infection control procedures for hepatitis B surface antigen (HBsAg)-positive patients; 3) frequency of HBsAg serologic screening; 4) use of hepatitis B vaccine; 5) non-A, non-B hepatitis in patients and staff members; 6) pyrogenic reactions and septicemia; 7) dialysis dementia; 8) new dialyzer syndrome; 9) high flux dialysis; 10) reuse of dialyzers, dialyzer caps, bloodlines, transducer filters; 11) cleaning and disinfection procedures; and 12) human immunodeficiency virus (HIV) infection. The response rate to a mailed questionnaire was 91%. These 1,486 centers represented 97,225 patients and 27,123 staff members. During the last 12 years, the incidence of HBV infection decreased from 3.0% to 0.2% among patients and from 2.6% to 0.1% among staff members. Over the same time, the prevalence of HBsAg-positivity declined from 7.8% to 1.7% among patients and from 0.9% to 0.4% among staff members. Hepatitis B vaccine was given by 88% of the centers. By the end of 1987, 14% of susceptible patients and 49% of susceptible staff members had received all three doses of hepatitis B vaccine. From 1982 to 1987, as a result of receiving vaccine, the prevalence of antibody to HBsAg (anti-HBs) increased from 12% to 18% among patients and from 18% to 50% among staff. The incidence of non-A, non-B hepatitis in 1987 was reported to be 1.2% among patients and 0.2% among staff members. Fourteen percent of the centers reported pyrogenic reactions among their patients, and 46% reported septicemia in the absence of pyrogenic reactions. Pyrogenic reactions were significantly more likely to be reported by centers that practiced high flux dialysis. The reported incidence of dialysis dementia among hemodialysis patients was 0.2%, with a case fatality rate of 29%. Among patients developing dialysis dementia, the case fatality rate was higher in those centers that used deionization (DI) without reverse osmosis (RO) (47%) compared with centers that used RO (28%) (not significant, p greater than 0.05). In 1987, 64% of centers reported that they reused disposable dialyzers. These centers treated 70% of the dialysis patient population.(ABSTRACT TRUNCATED AT 400 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

National surveillance of dialysis associated diseases in the United States, 1992.

To determine trends in a number of hemodialysis associated diseases and practices, the Centers for Disease Control and Prevention, in collaboration with the Health Care Financing Administration, completed a mail survey of chronic hemodialysis centers in the United States in 1992. Of 2,321 centers surveyed, 2,170 (93%) representing 170,028 patients and 43,535 staff members responded. In 1992, 2,049 (94%) centers used bicarbonate dialysate as the primary method of dialysis, 765 (35)% used high flux dialysis, and 1,569 (72%) reused dialyzers, continuing the trends toward increased use of these methods. Central (subclavian or jugular) venous catheters were used in > or = 1 patient as permanent vascular access for hemodialysis at 69% of dialysis centers. Hepatitis B surface antigen was present at low frequency in patients (incidence = 0.1%, prevalence = 1.2%) and staff members (incidence - 0.03%, prevalence = 0.3%). Among centers that had > or = 1 hepatitis B surface antigen positive patient, the incidence of hepatitis B virus infection was lower in those centers that used a separate room for dialysis of patients positive for hepatitis B surface antigen. From 1991 to 1992, reported hepatitis B vaccine coverage increased from 17% to 24% among patients and from 56% to 69% among staff members; in absolute terms, these were the largest single year increases since introduction of hepatitis B vaccine. The prevalence of antibody to hepatitis C virus was 8.1% among patients and 1.6% among staff members. Pyrogenic reactions in the absence of septicemia were reported by 19% of centers and associated with use of high flux dialysis. New dialyzer syndrome was reported by 24% of centers, most frequently by centers using regenerated cellulose or cuprophan membranes. Human immunodeficiency virus was known to be present in 1.5% of patients; 34% of centers reported providing hemodialysis to one or more patients infected with HIV.

Antibodies, Viral↗
PubMedDate not supplied

National surveillance of dialysis associated diseases in the United States, 1991.

To determine trends in a number of hemodialysis associated diseases and practices, the Centers for Disease Control and Prevention in collaboration with the Health Care Financing Administration performed a mail survey of chronic hemodialysis centers in the United States in 1991. Of 2,123 centers surveyed, 2,046 (96%), representing 155,877 patients and 40,298 staff members, responded. The 1991 survey found that certain hemodialysis practices are increasing in frequency, including use of bicarbonate dialysate and high-flux dialysis and reuse of disposable dialyzers (in 1991, 71% of centers reused dialyzers). Hepatitis B surface antigen (HBsAg) was present at low frequency in patients (incidence = 0.2%, prevalence = 1.3%) and staff (incidence = 0.04%, prevalence = 0.3%). Among centers that had > or = HBsAg positive patient, the incidence of hepatitis B virus (HBV) infection was lower in those centers that used a separate room for dialysis of HBsAg positive patients. Reuse of dialyzers, blood lines, transducer filters, or dialyzer caps was not associated with an increased risk of acquiring HBV infection among either patients or staff. Antibody to HBsAg was present in 21% of patients and 53% of staff, and was significantly related to levels of hepatitis B vaccine coverage. Pyrogenic reactions in the absence of septicemia were reported by 20% of centers and associated with the reuse of dialyzers. Human immunodeficiency virus (HIV) was known to be present in 1.2% of patients; 29% of centers reported providing hemodialysis to one or more HIV infected patients.

Fever↗