ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Predictions that infectious diseases would be eliminated as a major threat to human health have been shattered by emerging and reemerging infections, among them acquired immunodeficiency syndrome (AIDS), hemorrhagic fevers, marked increases in infections caused by antimicrobial-resistant bacteria, and the resurgence of tuberculosis and malaria. Understanding the dynamics of emerging and reemerging infections is critical to efforts to reduce the morbidity and mortality of such infections, to establish policy related to preparedness for infectious threats, and for decisions on where to use limited resources in the fight against infections. In order to offer a multidisciplinary perspective, 23 infectious disease specialists, epidemiologists, geneticists, microbiologists, and population biologists participated in an open forum at Emory University on emerging and reemerging infectious diseases. As summarized below, the group addressed questions about the definition, the identification, the factors responsible for, and multidisciplinary approaches to emerging and reemerging infections.

ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The purpose of prophylactic vaccination is to reduce morbidity and mortality in a population. Many questions related to the design of vaccines and vaccination programs require a population standpoint for their sharp formulation and laboratory and field studies to understand their immunologic background. Practical suggestions of the workshop included increased studies of age-specific immunity, better immunoepidemiologic surveillance, better design of efficacy studies, and more systematic sampling of parasite strains to study the evolutionary pressure exerted by vaccines. Theoretical immunology has much to contribute. One of the realizations of the workshop was the value of a strong interdisciplinary approach in vaccine development, utilizing relevant contributions from immunology, population biology, mathematical modeling, epidemiology, molecular biology, and virology.

ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The growing problem of resistance to antimicrobial chemotherapy was discussed by participants at the February 1995 workshop at Emory University on population biology, evolution, and control of infectious diseases. They discussed the nature and source of this problem and identified areas of research in which information is lacking for the development of programs to control of the emergence and spread of resistant bacteria. Particular attention was given to theoretical (mathematical modeling) and empirical studies of the within and between-host population biology (epidemiology) and the evolution of microbial resistance to chemotherapeutic agents. Suggestions were made about the kinds of models and data needed, and the procedures that could be employed to stem the ascent and dissemination of resistant bacteria. This article summarizes the observations and recommendations made at the 1995 meeting and in the correspondence between participants that followed. It concludes with an update on the theoretical and empirical research on the between- and within-host population biology and evolution of resistance to antimicrobial chemotherapy most of which has been done since that meeting.

ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

A complex but crucial relationship exists between blood volume and blood pressure in human subjects; it has been recognized that in essential hypertension, renovascular hypertension, and pheochromocytoma, the relationship between plasma volume and diastolic blood pressure is an inverse one. This phenomenon has not been studied in individuals with low normal and reduced blood pressures. Orthostatic intolerance is a commonly encountered abnormality in blood pressure regulation often associated with tachycardia in the standing position. Most of these patients have varying degrees of reduced blood volume. We tested the hypothesis that the relationship previously found between plasma volume and diastolic blood pressure in pressor states would also hold in orthostatic intolerance. We studied 16 patients with a history of symptomatic orthostatic intolerance associated with an elevation in plasma norepinephrine in the upright posture and hypovolemia in 9 patients and normovolemia in 7 patients.Our studies demonstrate an inverse relationship between plasma volume and diastolic blood pressure in patients with orthostatic intolerance. This finding also holds for the change in diastolic blood pressure in response to upright posture. In this relationship, patients with orthostatic intolerance with high plasma norepinephrine resemble those with essential hypertension, renovascular hypertension, and pheochromocytoma. We conclude that in a variety of conditions at both ends of the blood pressure spectrum, the seemingly paradoxical association of hypovolemia and diastolic blood pressure is preserved.

ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

We examined the racial differences in left ventricular (LV) geometric pattern in relation to 24-hour ambulatory blood pressure (BP) monitoring and the presence or absence of a nocturnal BP dip. Our study confirms the blunting of nocturnal BP dip among black hypertensives. Body mass index, rather than race, was a major determinant of left ventricular hypertrophy. We did not observe a difference in prevalence of left ventricular hypertrophy by race. However, left ventricular adaptation to hypertension differed in hypertensive black and white individuals; whereas most of the white patients with Stage 1-2 hypertension had a normal ventricular pattern, LV concentric remodeling and concentric hypertrophy were the most common adaptive ventricular patterns in blacks with Stage 1-2 hypertension. A six-fold higher prevalence of concentric remodeling was observed in blacks as compared with whites. The impaired nocturnal BP dip in blacks may contribute to the different hemodynamic pattern. Determinants of myocardial oxygen consumption were significantly higher in black hypertensives.

ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Objective:This study was designed to adapt commercially available home blood pressure monitors for use in children ages 4 to 18 years and to compare the recordings obtained from the adapted devices to those obtained using a standard mercury sphygmomanometer.Methods:Sequential same-arm blood pressures were measured by trained observers in 106 children, ages 4 to 18 years, using a calibrated mercury-gravity manometer (reference device) as the standard method, and 3 test devices (an aneroid manometer and two semiautomated oscillometric devices). For each patient, mid-arm circumference was measured and appropriate blood pressure cuff size was selected. Systolic and diastolic pressures were measured by trained observers using the reference device and the aneroid manometer in accordance with criteria established by the Second Task Force on Blood Pressure Control in Children. Other than variation in cuff size, all manufacturers' recommendations were followed for each test device.Results:Outcome was assessed using criteria established by the British Hypertension Society (BHS) and the Association for the Advancement of Medical Instrumentation (AAMI). The aneroid manometer consistently received a grade of A using BHS criteria and also passed using AAMI criteria. Neither of the two semi-automated monitors achieved a passing grade, although the Labtron monitor performed slightly better than the Marshall 85 monitor.Conclusions:Home blood pressure monitors must be validated for use in children prior to widespread use. Given appropriate training and verification of observer accuracy, the aneroid manometer can be recommended for home use in children ages 4 to 18 years.

ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

To determine predictors of left ventricular mass (LVM) and hypertrophy(LVH), 56 black and 30 white normotensive healthy youths (mean age 12.6± 2.3 years at initial visit) were studied twice, 2.5 years apart. During the initial visit, anthropometric variables and hemodynamics were measured at rest and before, during, and after 4 physical and behavioral stressors. 2-D directed M-mode echocardiography was performed to derive LVM. Hierarchical multiple regression analyses indicated that follow-up LVM was predicted by initial LVM, weight, height (ht), and gender (males > females; total model R2= 0.77,P< 0.0001). Predictors of LVM/ht2.7were initial LVM/ht2.7, weight, ethnicity (blacks > whites), and the aggregate index of blood pressure reactivity (total model R2= 0.66,P< 0.0001). Youth with LVH at follow-up were taller, heavier, and exhibited greater blood pressure reactivity at initial evaluation. These findings are important since interventional strategies can be developed that target obesity and exaggerated reactivity to stress.

ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Chronic recurrent multifocal osteomyelitis (CRMO) was first described by Giedion in 1972 as a self-limited replasing noninfectious inflammatory condition usually affecting children and adolescents. The association of CRMO with psoriasis, palmoplantar pustulosis, and SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, and osteitis) has been described. In this case report, we present a 49-year-old man with CRMO coexisting with Crohn's disease. To our knowledge, this is the first report of CRMO with Crohn's disease without the presence of pustular skin lesions or other features of SAPHO syndrome.

ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID