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Biomedical subjects

R Gold

Publications and source records attributed to R Gold.

At least 217 records · Page 12Linked to original sources
PubMed1989

Epidemiologic study of 4684 hospital-acquired infections in pediatric patients.

During a 4-year period 4684 nosocomial infections occurred in a university pediatric hospital which admitted 78,120 patients (nosocomial infection rate (NIR) = 6.0). NIR varied from 0.17 to 14.0 on different wards or services; the highest rates (greater than or equal to 5.6) were found in the Neonatal Intensive Care Unit, infant neurosurgery, hematology/oncology, neonatal surgery, cardiology/cardiovascular surgery, Pediatric Intensive Care Unit and infant/toddler medicine areas. Infections were most common in patients less than or equal to 23 months (NIR = 11.5), were less common in the 2- to 4-year age group (NIR = 3.6) and occurred least frequently in patients greater than or equal to 5 years (NIR = 2.6). The median day of onset of infections was 15.3 days. The proportional frequencies of infections were: 35% gastrointestinal; 21% bacteremia; 16% respiratory (10% upper, 6% lower); 7% postoperative wound; 6% urinary tract; 5% skin (32% of these skin infections were related to intravascular lines); 5% eye; 3% cerebrospinal fluid; and 2% other. A similar proportional frequency of 379 infections in patients hospitalized for more than 100 days was observed. The etiologic agents were Gram-positive bacteria (50%), viruses (23%), Gram-negative bacteria (18%), fungi (4%) and mixed/other (5%).

Adolescent↗
PubMed1989

Review of 40 children with imported malaria.

Forty cases of imported malaria (1978 to 1988) are reviewed and management principles are discussed. All 15 cases of Plasmodium falciparum malaria were acquired in Africa, 5 of which were probably chloroquine-resistant. Most cases of Plasmodium vivax (80%) were acquired on the Indian subcontinent, including 2 cases of congenital malaria. Six children developed P. falciparum malaria despite chemoprophylaxis. All children had a history of fever, usually with other influenza-like symptoms. Two-thirds had splenomegaly, and one-third were afebrile on admission. Thrombocytopenia (70%) and anemia (70%) were often present. Forty-five percent received previous wrong diagnoses and treatments. Quinine or quinidine with either Fansidar or clindamycin were used to treat P. falciparum malaria. Clindamycin may be more effective if given for 7 instead of 3 days. There were no deaths or residual complications. As the prevalence and severity of drug-resistant P. falciparum spreads, prophylaxis and treatment choices become more difficult. Diagnosis requires a travel history and a high index of suspicion.

Adolescent↗
PubMed1989

Adverse reactions to diphtheria, tetanus, pertussis-polio vaccination at 18 months of age: effect of injection site and needle length.

Adverse reactions after diphtheria, pertussis, tetanus, polio vaccination at 18 months of age were investigated in three groups: 74 children injected in the deltoid muscle with a 16-mm (5/8-in) needle, 64 in the anterolateral thigh with a 16-mm needle, and 67 in the anterolateral thigh with a 25-mm (1-in) needle. No significant differences in systemic reactions were observed. Severe pain occurred in 30.5% of the groups injected in the thigh compared with only 8.1% of the group injected in the arm (P less than .001). Children vaccinated in the thigh had decreased movement of the extremity significantly more often than those injected in the arm (49.9% v 25.6%, P less than .0005), and two thirds of the former limped for 24 to 48 hours. Redness and swelling were observed more often after injection in the arm than in the thigh (58.1% v 26.7%, P less than .0005). The only effect of changing needle length in the groups injected in the thigh was the occurrence of more redness and swelling in children vaccinated with the 16-mm needle compared with the 25-mm needle. Overall, parents rated more reactions as moderate to severe among children injected in the thigh than among children injected in the arm (64.2% v 37.9%, P less than .001). The deltoid muscle appears to be the preferred site for administration of diphtheria, pertussis, tetanus, polio vaccine at 18 months of age.

Arm↗
PubMed1988

Nosocomial Pseudomonas aeruginosa conjunctivitis in a pediatric hospital.

Conjunctivitis accounted for 5% of nosocomial infections occurring in a university-affiliated pediatric hospital between January 1984 and April 1986. Pseudomonas aeruginosa was recovered from the conjunctiva of 30 patients. The primary diseases of these patients were chronic and debilitating. Eighty percent of patients were under 18 months of age although only 30% of admissions are represented in this age group. Seventy percent of cases occurred in pediatric intensive care unit/neonatal intensive care unit patients. Seventy percent of patients who had antecedent nasopharyngeal/endotracheal cultures obtained were colonized with P aeruginosa. All patients except one had one or more of the following interventions prior to the onset of conjunctivitis: tracheostomy, endotracheal tube, oxygen by hood, or suctioning. Two children (7.4%) have residual corneal scars. Improvements in eye care including protection of the eye during suctioning, other respiratory care, and nasogastric tube procedures are warranted.

Conjunctivitis, Bacterial↗
PubMed1988

Nosocomial infections in a pediatric intensive care unit.

In a prospective 30-month study of nosocomial infections in a pediatric ICU (PICU), the incidence, sites, and causes of infection were determined. Factors associated with increased risk of infection were investigated. In 1,388 patients who remained in the PICU for a minimum of 72 h, 116 infections occurred (6.1 infections/100 admissions). Primary bacteremias comprised 38% of PICU infections and lower respiratory infections comprised 15%. The remaining infections were divided equally among GI, skin, eye, upper respiratory, postoperative wounds, and other sites. Coagulase-negative staphylococci, Pseudomonas aeruginosa, and Staphylococcus aureus were the most prevalent pathogens. Surgical patients had similar rates of infection to medical patients. Patients in the first 2 yr of life, particularly those between 7 and 30 days of age, had the highest rate of infection. Onset of infection was more common after the first week in the PICU with 11% of patients staying 14 to 20 days, 27% of patients staying 21 to 27 days, 48% of patients staying 28 to 34 days, and 52% of patients staying more than 35 days before the onset of infection. The risk of nosocomial infection increases with arterial and central line use, prolonged intubation, ventilation, intracranial pressure monitoring, and paralysis.

Age Factors↗
PubMed1988

Sepsis in febrile neutropenic children with cancer.

Infection is the leading cause of death in children with cancer. A retrospective review of 100 episodes of sepsis in 80 children with cancer for a 21-month period showed that 74% of isolates were Gram-positive bacteria. Coagulase-negative staphylococci were the most common pathogens, accounting for 35% of all isolates. Initial empiric antibiotic therapy of fever in neutrogenic cancer patients was piperacillin and tobramycin. All but 12% of the Gram-negative isolates were susceptible to one or both of the antibiotics. However, 31% of the Gram-positive isolates were resistant to both antibiotics and 38% of the coagulase-negative staphylococci were methicillin-resistant. All of the latter were susceptible to vancomycin. The increasing incidence of coagulase-negative staphylococci as causes of sepsis in cancer patients suggests that the choice of antibiotics for initial empiric therapy may need to include vancomycin or an antistaphylococcal penicillin depending on the local incidence of methicillin resistance.

Adolescent↗
PubMed1988

Overview of the worldwide problem of diarrhoea.

Acute infectious diarrhoea is the major killer of children in the Third World. It is also the principal cause of malnutrition in children under 5 years of age. More than 4 million children die each year of diarrhoea and its complications. Acute diarrhoea kills by causing dehydration, which leads to hypovolaemia and metabolic acidosis. Recurrent episodes of diarrhoea lead to malnutrition as the result of anorexia, catabolism from infection, and lack of adequate caloric and protein intake because of the widespread custom of 'starving' diarrhoea. Oral rehydration therapy (ORT) is effective in the prevention and treatment of dehydration caused by diarrhoea. Because it is cheap, easy to administer and very effective, ORT has the potential to allow substantial reductions in the morbidity and mortality of acute diarrhoea in children living in less developed countries. The major obstacles to achieving its potential are the social ones of production and distribution of oral rehydration solutions and of educating parents in how to use ORT.

Child, Preschool↗
PubMed1987

Electrocardiographic and electrophysiologic effects of pirmenol in ventricular tachycardia.

Twenty patients with ventricular tachycardia refractory to drug treatment underwent electrophysiologic study with pirmenol. Patients ranged in age from 39 to 84 years (mean 61); the presenting arrhythmia was sustained ventricular tachycardia in 15, nonsustained ventricular tachycardia in 3 and ventricular fibrillation in 2. After discontinuation of all antiarrhythmic drugs (for at least 5 half-lives) and assessment of electrocardiographic and electrophysiologic parameters in the drug-free state, patients underwent comprehensive intracardiac electrophysiologic evaluation with intravenous pirmenol (mean dose 195 +/- 46 mg). Programmed ventricular stimulation began at least 30 minutes after pirmenol infusion was started in each patient. There was significant shortening of sinus cycle length in all patients, from 746 +/- 155 to 683 +/- 107 ms (mean +/- standard deviation). In 7 patients in whom ventricular tachycardia could not be induced after intravenous pirmenol, an oral pirmenol regimen was begun. The dosage was 200 or 250 mg (both 3 times/day) in 2 and 5 patients, respectively. Seven hours after the third dose of oral drug was given, these patients underwent repeat electrophysiologic testing. Intravenous and oral pirmenol significantly prolonged the PR, QT, QTc and JT intervals compared with baseline. Intravenous pirmenol also significantly prolonged the QRS interval compared with baseline. Oral pirmenol significantly prolonged the sinus node recovery time compared with intravenous pirmenol. Intravenous pirmenol significantly increased the HV interval compared with control; oral pirmenol did not demonstrate a significant prolongation of the HV interval, but this is due to the smaller number of patients studied while taking oral drug.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1987

Survey of parents' attitudes to the recommended Haemophilus influenzae type b vaccine program.

A survey was conducted in a general pediatric practice to determine parents' attitudes to and compliance with the recommended Haemophilus influenzae type b vaccine program. Of 133 families surveyed 127 (95%) responded to the questionnaire. About one third of the parents did not have their children vaccinated. The decision against vaccination was made despite parent education, follow-up telephone contact and the pediatrician's expressed support of the vaccine program. Most of the respondents (86%) had no previous knowledge of the vaccine. The factor of greatest concern was the possibility of an adverse reaction. This concern was significantly more common among the parents who decided not to have their children vaccinated than among those who had their children vaccinated (chi 2 = 6.52, p less than 0.025). One third of the parents who indicated that they intended to have their children vaccinated required a telephone reminder. The findings suggest a need for public education about the vaccine, with particular emphasis directed at allaying fears about side effects.

Attitude to Health↗
PubMed1987

Carbohydrate metabolism of dog skeletal muscle during immobilization.

The effect of immobilization and the following mobilization on muscle carbohydrate metabolism was investigated in dogs. Total carbohydrate and glycogen content of skeletal muscle fell during immobilization. The glycogen-degrading enzyme phosphorylase was activated 1 week after immobilization (a/b ratio 40.6 +/- 7.6 vs. 27.1 +/- 6.5%). Thereafter, the enzyme activity decreased and remained significantly lowered even 2 weeks after the following mobilization. In contrast, muscle glucose and lactate concentration were unchanged. Our data indicates glycogen breakdown of dog skeletal muscle during immobilization. Even after 2 weeks of mobilization muscle glycogen content has not reached glycogen values of the untreated dogs.

Animals↗
PubMed1987

Pseudomonas species contamination of cystic fibrosis patients' home inhalation equipment.

A prevalence study was undertaken to determine whether aerosol equipment used at home by patients with cystic fibrosis (CF) could provide a reservoir for Pseudomonas aeruginosa or Pseudomonas cepacia. Home maintenance of this equipment was also evaluated for its relationship to contamination. In nine of 36 patients, Pseudomonas species were isolated from one or more pieces of home equipment. Only patients colonized with P. aeruginosa had contaminated equipment. P. aeruginosa was recovered from equipment used by five patients; no P. cepacia was recovered. Aerosolization masks were the most commonly contaminated pieces of equipment (20%), followed by nebulizers (17%), medication syringes (10%), connective tubing (6%), and saline solution (4%). Nebulizers and syringes were significantly more likely to be contaminated if they had been in use for 1 month or longer; nebulizers and masks were more likely to be contaminated if they were cleaned or were rinsed only with tap water after use. We conclude that equipment may serve as a reservoir to reintroduce or perpetuate colonization of some patients with CF, but that contamination of equipment with P. aeruginosa is not common.

Child↗
PubMed1987

Randomized trial of ceftazidime versus placebo in the management of acute respiratory exacerbations in patients with cystic fibrosis.

A randomized trial of ceftazidime versus placebo was conducted in patients with cystic fibrosis hospitalized for acute respiratory exacerbations. Patients 12 years of age or older were included if they had mild to moderately severe illness according to the following criteria: erythrocyte sedimentation rate less than or equal to 50 mm/hr and less than three other abnormalities (leukocyte count greater than or equal to 15,000/microliter, pulse greater than or equal to 100 beats/min, respirations greater than or equal to 30/min, or temperature greater than or equal to 38.5 degrees C). In all 16 episodes treated with ceftazidime, the patients were rated improved in comparison with 10 of 12 patients treated with placebo. Three placebo-treated patients dropped out of the study within 3 to 5 days because they wanted antibiotic therapy. None of the 15 placebo-treated patients showed clinical deterioration. There were no significant differences in rate of improvement of symptom score, weight gain, or pulmonary function between the two treatment groups. There was no difference in the course during the 6 to 24 months after the study period. Intravenous antibiotics are not essential in the management of all acute respiratory exacerbations of mild to moderate severity in patients with cystic fibrosis.

Adolescent↗
PubMed1987

Isolation usage in a pediatric hospital.

In a prospective 12-month study at a university-affiliated pediatric hospital, isolation usage was quantitated by ward/service, season, isolation category and type of infection (community-acquired vs nosocomial). Such information may be helpful in designing hospitals, recognizing time utilization of the pediatric infection control nurse, and defining educational and isolation needs. Hospitals with multiple bed rooms and inadequate numbers of single rooms may be unable to meet current federal isolation guidelines. The mean number of isolation days was 153 per 1000 patient days or 15.3% of bed days used. This ranged from 18.5% on the infant/toddler/preschool medical ward to 2.8% on child/teenage orthopedic surgery. Isolation requirements vary seasonally and rose to 32% in winter on one ward. Proportional frequencies of isolation category included enteric--29%, protective--28%, strict--16%, barrier (contact)--10%, multiply resistant organism (MRO)--8%, wound--5%, pregnant women (careful handwashing)--3%, blood and body fluid precautions--1%. Isolation of patients with and contacts of nosocomial infections account for 32% of isolation usage. During one third of the 365-day year, the hospital is unable to provide adequate numbers of single rooms for one to 20 patients.

Adolescent↗
PubMed1987

"High-dose" calcitriol for control of renal osteodystrophy in children on CAPD.

High doses of calcitriol were used prospectively for 11 to 29 months to raise serum calcium levels in an effort to control renal osteodystrophy in 16 children undergoing CAPD. Serum Ca, P, iPTH and alkaline phosphatase were measured monthly; hand radiographs were obtained every six months, and a semiquantitative score of bone abnormalities was evaluated by two independent observers. During the study, serum Ca increased from 9.9 +/- 0.9 to 11.0 +/- 0.6 mg/dl (P less than 0.001); serum iPTH decreased by 113 +/- 131 microliter Eq/ml (P less than 0.005); serum P was unchanged; and serum alkaline phosphatase fell by 33 +/- 46% (P less than 0.02), 530 +/- 397 to 204 +/- 551 IU/liter. The radiographic score fell from 4.8 +/- 4.6 to 0.9 +/- 1.2 (P less than 0.005). The average and maximal doses of calcitriol were 0.61 +/- 0.37 and 0.95 +/- 0.56 microgram/day or 28 +/- 18 and 46 +/- 28 ng/kg body wt/day, respectively. Transient and asymptomatic hypercalcemia occurred in nine patients and two patients had reversible conjunctivitis in association with the hypercalcemia. Thus, "high dose" calcitriol prevented or controlled progression of hyperparathyroid bone disease in most pediatric CAPD patients. The failure to suppress PTH or reverse secondary hyperparathyroidism until the serum Ca rose to 10.5 to 11.0 mg/dl could reflect an increase in the "set point" for PTH suppression by serum calcium in many uremic children.

Adolescent↗