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Dr. Joseph Jemsek Publications:
A Sample of Why He is a Gift to the Carolinas

I do not see many physicians in the Carolinas, the State Board of North Carolina or the Department of Health with this range of brilliance.

  1. Clin Infect Dis. 2006 Jan 15;42(2):273-80. Epub 2005 Dec 5.

    Body fat and other metabolic effects of atazanavir and efavirenz, each administered in combination with zidovudine plus lamivudine, in antiretroviral-naive HIV-infected patients.

    Jemsek JG, Arathoon E, Arlotti M, Perez C, Sosa N, Pokrovskiy V, Thiry A, Soccodato M, Noor MA, Giordano M.

    Jemsek Clinic, Huntersville, NC 28078, USA. jj@jemsekclinic.com

    BACKGROUND: Protease inhibitor treatment of human immunodeficiency virus (HIV)-infected individuals has been linked to the development of lipodystrophy. The effects of atazanavir on body fat distribution and related metabolic parameters were examined in antiretroviral-naive patients. METHODS: HIV-positive patients with CD4 cell counts > or = 100 cells/mm3 were randomized to 1 of 2 treatment arms: (1) atazanavir, 400 mg given once daily, plus efavirenz placebo; or (2) efavirenz, 600 mg given once daily, plus atazanavir placebo; each drug was administered with fixed-dose zidovudine (300 mg) and lamivudine (150 mg) given twice daily, and patients were treated for at least 48 weeks. Fat distribution measurements (visceral adipose tissue [VAT], subcutaneous adipose tissue [SAT], and total adipose tissue [TAT], as measured by computed tomography; and appendicular fat, truncal fat, and total fat levels, as measured by dual-energy x-ray absorptiometry), metabolic measurements (cholesterol and fasting triglyceride levels), and measurements of insulin resistance (fasting glucose and fasting insulin levels) were made at baseline and at week 48 of treatment for a subgroup of 111 atazanavir recipients and 100 efavirenz recipients. RESULTS: Atazanavir and efavirenz treatments resulted in minimal to modest increases in fat accumulation, as measured by VAT, SAT, TAT, appendicular fat, truncal fat, and total fat levels; results were comparable in both arms. In addition, atazanavir was associated with none of the metabolic abnormalities seen with many other protease inhibitors. CONCLUSIONS: Use of atazanavir for 48 weeks neither resulted in abnormal fat redistribution in antiretroviral-naive patients nor induced other metabolic disturbances commonly associated with HIV-related lipodystrophy. Longer-term assessments (e.g., at 96 weeks) will be important to confirm these findings.

    PMID: 16355341 [PubMed - in process]

  2. J Acquir Immune Defic Syndr. 2004 Aug 15;36(5):1011-9.

    Comparison of once-daily atazanavir with efavirenz, each in combination with fixed-dose zidovudine and lamivudine, as initial therapy for patients infected with HIV.

    Squires K, Lazzarin A, Gatell JM, Powderly WG, Pokrovskiy V, Delfraissy JF, Jemsek J, Rivero A, Rozenbaum W, Schrader S, Sension M, Vibhagool A, Thiry A, Giordano M.

    Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.

    BACKGROUND: Atazanavir, an azapeptide protease inhibitor (PI), has pharmacokinetics that allow once-daily dosing, and it is not associated with significant PI-associated dyslipidemia. METHODS: A randomized, double-blind, double-dummy, active-controlled, 2-arm study comparing the antiviral efficacy and safety of atazanavir 400 mg administered once daily with efavirenz 600 mg administered once daily in combination with open-label fixed-dose zidovudine plus lamivudine twice daily. The 810 treatment-naive patients were stratified by HIV RNA level. The primary efficacy end point was the proportion of treated patients with HIV RNA levels <400 copies/mL through week 48. RESULTS: At week 48, HIV RNA levels were <400 copies/mL in 70% of patients receiving atazanavir and 64% of patients receiving efavirenz (intent-to-treat, difference; 95% confidence interval: 5.2%; -1.2%, 11.7%). Median CD4 cell counts increased at comparable magnitudes and rates in the 2 treatment arms (mean change at week 48: 176 cells/mm with atazanavir, 160 cells/mm with efavirenz). Atazanavir-treated patients relative to comparator-treated patients did not demonstrate significant increases in total cholesterol, fasting low-density lipoprotein cholesterol, or fasting triglycerides over 48 weeks of therapy. Atazanavir-linked bilirubin elevations infrequently resulted in treatment discontinuation (<1%). Atazanavir treatment did not increase fasting glucose or insulin levels. CONCLUSIONS: For initial HIV treatment, a highly active antiretroviral therapy regimen of atazanavir/zidovudine/lamivudine is as efficacious and well tolerated as the combination of efavirenz/zidovudine/lamivudine.

    Publication Types:

    • Clinical Trial
    • Randomized Controlled Trial

    PMID: 15247553 [PubMed - indexed for MEDLINE]

  3. AIDS. 2000 Jul 28;14(11):1601-10.

    A comparison of stavudine, didanosine and indinavir with zidovudine, lamivudine and indinavir for the initial treatment of HIV-1 infected individuals: selection of thymidine analog regimen therapy (START II).

    Eron JJ Jr, Murphy RL, Peterson D, Pottage J, Parenti DM, Jemsek J, Swindells S, Sepulveda G, Bellos N, Rashbaum BC, Esinhart J, Schoellkopf N, Grosso R, Stevens M.

    University of North Carolina School of Medicine, Chapel Hill 27599-7030, USA.

    OBJECTIVE: Comparison of stavudine (d4T), didanosine (ddI) and indinavir (IDV) with zidovudine (ZDV), lamivudine (3TC) and IDV in HIV-1 infected patients. DESIGN: Randomized, open-label. SETTING: Fourteen HIV Clinical Research Centers. PATIENTS: Two-hundred and five patients with less than 4 weeks antiretroviral treatment, naive to 3TC and protease inhibitors and with CD4 cell counts > or = 200 x 10(6)/l and plasma HIV-1 RNA levels > or = 10,000 copies/ml. INTERVENTIONS: Stavudine 40 mg and ddI 200 mg twice daily plus IDV 800 mg every 8 h compared with ZDV 200 mg every 8 h or 300 mg twice daily, 3TC 150 mg twice daily plus IDV. MAIN OUTCOME MEASURES: The proportion of patients with plasma HIV-1 RNA levels < 500 copies/ml and < or = 50 copies/ml and changes in CD4 cell counts were compared. RESULTS: In an analysis of the primary endpoint, 61% of patients on d4T + ddI + IDV and 45% of patients on ZDV + 3TC + IDV had all HIV-1 RNA values obtained between weeks 40 and 48 < 500 copies/ml [95% confidence interval (CI) for the difference between proportions, 1.7-30.3%; P = 0.038]. In an intent-to-treat analysis, the percentage of all patients randomized with all HIV-1 RNA levels < 500 copies/ml between 40 and 48 weeks were 53% for the d4T + ddI + IDV arm and 41% for the ZDV + 3TC + IDV arm (95% CI, -1.4% to 25.7%; P = 0.068). At 48 weeks 41% and 35% were < or = 50 copies/ml for the stavudine- and ZDV-containing arms respectively (P > 0.2). The median time-weighted average increases in CD4 cells count over 48 weeks were 150 x 10(6)/l cells for the d4T arm and 106 x 10(6)/l cells for the ZDV arm (P= 0.001). The occurrence of serious adverse events was not significantly different between arms. CONCLUSION: The combination of stavudine, ddl and IDV resulted in potent antiretroviral effects over a 48-week period, comparable or superior to zidovudine, 3TC and IDV supporting the use of stavudine, ddI and a protease inhibitor as an initial antiretroviral treatment.

    Publication Types:

    • Clinical Trial
    • Multicenter Study
    • Randomized Controlled Trial

    PMID: 10983647 [PubMed - indexed for MEDLINE]

  4. Ann Intern Med. 1997 Mar 1;126(5):355-63.

    Clinical efficacy of monotherapy with stavudine compared with zidovudine in HIV-infected, zidovudine-experienced patients. A randomized, double-blind, controlled trial. Bristol-Myers Squibb Stavudine/019 Study Group.

    Spruance SL, Pavia AT, Mellors JW, Murphy R, Gathe J Jr, Stool E, Jemsek JG, Dellamonica P, Cross A, Dunkle L.

    Health Sciences AIDS Center, University of Utah School of Medicine, Salt Lake City 84132, USA.

    BACKGROUND: Stavudine is a promising antiretroviral agent, but its clinical efficacy has not been determined. OBJECTIVE: To evaluate the clinical effect of stavudine (2',3'-didehydro-3'-deoxythymidine) monotherapy in patients with human immunodeficiency virus (HIV) infection. DESIGN: Randomized, controlled, double-blind trial. SETTING: 56 outpatient clinics in private practices, universities, and contract research organizations in the United States, France, and Italy. PATIENTS: 822 HIV-infected adults who had 50 to 500 CD4+ cells/mm3 and had previously received at least 6 months of zidovudine treatment. INTERVENTION: Monotherapy with peroral stavudine capsules or peroral zidovudine capsules. MEASUREMENTS: The primary end point was clinical progression, which was defined as all occurrences of acquired immunodeficiency syndrome (AIDS)-defining events or death. RESULTS: Patients receiving stavudine reached clinical end points at a rate of 26 per 100 person-years, compared with 32 per 100 person-years for patients receiving zidovudine (relative risk, 0.75 [95% CI, 0.58 to 0.98]; P = 0.03). The risk for death alone was 26% lower in the stavudine group than in the zidovudine group, but the comparison was not statistically significant (relative risk, 0.74 [CI, 0.53 to 1.02]; P = 0.066). The benefit of stavudine therapy was seen in all CD4+ cell strata (< or = 100 cells/mm3, 101 to 300 cells/mm3, and > 300 cells/mm3) and clinical stages of HIV disease (asymptomatic, symptomatic, and AIDS). Four weeks after treatment began, CD4+ cell counts were 30 cells/mm3 higher in the stavudine group than in the zidovudine group; this difference was sustained for 96 weeks (P < 0.001). Nausea and vomiting were more common in patients receiving zidovudine (P < 0.01), and neuropathy occurred more frequently in those receiving stavudine (12% in the stavudine group compared with 4% in the zidovudine group; P < 0.001). Neuropathy resolved completely in many patients (63%) after interruption of stavudine treatment; these patients could resume stavudine therapy at a lower dose. CONCLUSIONS: Stavudine was well tolerated and delayed progression of HIV disease in patients who had previously received 6 or more months of zidovudine treatment. Benefits were apparent in all CD4+ cell strata and clinical stages of HIV disease. Stavudine is an important agent to consider for trials of combination chemotherapy.

    Publication Types:

    • Clinical Trial
    • Multicenter Study
    • Randomized Controlled Trial

    PMID: 9054279 [PubMed - indexed for MEDLINE]

  5. N Engl J Med. 1996 Aug 8;335(6):384-91.

    Comment in:

    • ACP J Club. 1997 Jan-Feb;126(1):8.
    • N Engl J Med. 1996 Aug 8;335(6):428-30.

    A randomized trial of clarithromycin as prophylaxis against disseminated Mycobacterium avium complex infection in patients with advanced acquired immunodeficiency syndrome.

    Pierce M, Crampton S, Henry D, Heifets L, LaMarca A, Montecalvo M, Wormser GP, Jablonowski H, Jemsek J, Cynamon M, Yangco BG, Notario G, Craft JC.

    Vanderbilt University, Nashville, USA.

    BACKGROUND: Disseminated infection with Mycobacterium avium complex is the most common opportunistic infection in patients with advanced stages of the acquired immunodeficiency syndrome (AIDS). We studied the efficacy and safety of prophylactic treatment with clarithromycin, a macrolide antibiotic. METHODS: We conducted a randomized, placebo-controlled, double-blind study of clarithromycin in patients with AIDS in the United States and Europe. Entry criteria included blood cultures that were negative for M. avium complex, a Karnofsky performance score of 50 or higher, a CD4 cell count of 100 or less per cubic millimeter, and a life expectancy of at least six months. RESULTS: After the first interim analysis, the study was stopped. M. avium complex infection developed in 19 of the 333 patients (6 percent) assigned to clarithromycin and in 53 of the 334 (16 percent) assigned to placebo (adjusted hazard ratio, 0.31; 95 percent confidence interval, 0.18 to 0.53; P<0.001). During the follow-up period of about 10 months, 32 percent of the patients in the clarithromycin group died and 41 percent of those in the placebo group died (hazard ratio, 0.75; P=0.026). In the clarithromycin group, isolates from 11 of the 19 patients with M. avium complex infection were resistant to clarithromycin. Prophylaxis with clarithromycin was associated with an increased incidence of taste perversion (11 percent in the clarithromycin group vs. 2 percent in the placebo group, P<0.001) and rectal disorders (8 percent vs. 3 percent, P = 0.007); however, the frequency of more severe adverse events was similar in the two groups (7 percent and 6 percent, respectively). CONCLUSIONS: In patients with advanced AIDS, the prophylactic administration of clarithromycin is well tolerated, prevents M. avium complex infection, and reduces mortality.

    Publication Types:

    • Clinical Trial
    • Multicenter Study
    • Randomized Controlled Trial

    PMID: 8663871 [PubMed - indexed for MEDLINE]

  6. Clin Ther. 1996 Jan-Feb;18(1):84-94.

    Antibiotic prophylaxis during clean neurosurgery: a large, multicenter study using cefuroxime.

    Holloway KL, Smith KW, Wilberger JE Jr, Jemsek JG, Giguere GC, Collins JJ.

    Virginia Commonwealth University, Richmond, Virginia, USA.

    Cefuroxime is a second-generation cephalosporin with in vitro activity against the organisms that are commonly associated with neurosurgical wound infections. Other properties of cefuroxime are an elimination half-life of 1.3 hours, which yields prolonged serum concentrations, and its ability to penetrate the blood-brain barrier in proportion to the degree of inflammation. A prospective, multicenter, open-label study was conducted to evaluate the efficacy and safety of cefuroxime for antibiotic prophylaxis in patients undergoing clean neurosurgery. Cefuroxime 1.5 g was given intravenously 25 to 60 minutes before surgery; for procedures lasting more than 3 hours, cefuroxime 750 mg was given intravenously 8 hours after the initial dose. Patients were examined before surgery, daily during hospitalization, and at 8 weeks after surgery. A total of 956 adults were enrolled in the study. The most common procedures in study patients were laminectomy (41.8% of patients) or craniotomy (24.3%), and the mean duration of surgery was 3.2 hours. Infection occurred in 2 (0.3%) of 592 assessable patients by the time of discharge and in 1 additional patient by the 8-week follow-up evaluation for a total of 3 (0.5%) of 560 assessable patients. Drug-related adverse events occurred in 5 (0.5%) of 956 patients. These results indicate that antibiotic prophylaxis with cefuroxime is associated with a low incidence of postoperative wound infection and is well tolerated in patients undergoing clean neurosurgery.

    Publication Types:

    • Clinical Trial
    • Multicenter Study

    PMID: 8851455 [PubMed - indexed for MEDLINE]

  7. N Engl J Med. 1995 Dec 21;333(25):1662-9.

    Comment in:

    • N Engl J Med. 1995 Dec 21;333(25):1704-5.

    Treatment with lamivudine, zidovudine, or both in HIV-positive patients with 200 to 500 CD4+ cells per cubic millimeter. North American HIV Working Party.

    Eron JJ, Benoit SL, Jemsek J, MacArthur RD, Santana J, Quinn JB, Kuritzkes DR, Fallon MA, Rubin M.

    University of North Carolina at Chapel Hill 27599-7030, USA.

    BACKGROUND. The reverse-transcriptase inhibitor lamivudine has in vitro synergy with zidovudine against the human immunodeficiency virus (HIV). We studied the activity and safety of lamivudine plus zidovudine as compared with either drug alone as treatment for patients with HIV infection, most of whom had not previously received zidovudine. METHODS. Three hundred sixty-six patients with 200 to 500 CD4+ cells per cubic millimeter who had received zidovudine for four weeks or less were randomly assigned to treatment with one of four regimens: 300 mg of lamivudine every 12 hours; 200 mg of zidovudine every 8 hours; 150 mg of lamivudine every 12 hours plus zidovudine; or 300 mg of lamivudine every 12 hours plus zidovudine. The study was double-blind and lasted 24 weeks, with an extension phase for another 28 weeks. RESULTS. Over the 24-week period, the low-dose and high-dose regimens combining lamivudine and zidovudine were associated with greater increases in the CD4+ cell count (P = 0.002 and P = 0.015, respectively) and the percentage of CD4+ cells (P < 0.001 for both) and with greater decreases in plasma levels of HIV-1 RNA (P < 0.001 for both) than was treatment with zidovudine alone. Combination therapy was also more effective than lamivudine alone in lowering plasma HIV-1 RNA levels and increasing the percentage of CD4+ cells (P < 0.001 for all comparisons), and these advantages persisted through 52 weeks. Adverse events were no more frequent with combination therapy than with zidovudine alone. CONCLUSIONS. In HIV-infected patients with little or no prior antiretroviral therapy, treatment with a combination of lamivudine and zidovudine is well tolerated over a one-year period and produces more improvement in immunologic and virologic measures than does treatment with either agent alone.

    Publication Types:

    • Clinical Trial
    • Multicenter Study
    • Randomized Controlled Trial

    PMID: 7477218 [PubMed - indexed for MEDLINE]

  8. J Acquir Immune Defic Syndr. 1992;5(8):847-8.

    Recombinant human erythropoietin and the treatment of anemia in patients with AIDS or advanced ARC not receiving ZDV.

    Henry DH, Jemsek JG, Levin AS, Levine JD, Levine RL, Abels RI, Nelson RA, Thompson D, Rudnick SA.

    Publication Types:

    • Clinical Trial
    • Letter
    • Randomized Controlled Trial

    PMID: 1517970 [PubMed - indexed for MEDLINE]

  9. Am J Surg. 1988 May 31;155(5A):91-5.

    A multicenter comparative study of cefotetan once daily and cefoxitin thrice daily for the treatment of infections of the skin and superficial soft tissue.

    Geckler RW, Eng RH, Fabian TC, Echols RM, Jemsek JG, LeFrock JL, Mogabgab WC, Wilson SE.

    Division of Infectious Diseases, Mercy Hospital, Baltimore, Maryland 21202.

    To compare the effectiveness of cefotetan administered at 2 g once a day with cefoxitin at 1 or 2 g three times a day in the treatment of hospitalized patients with skin and superficial soft tissue infections, 194 patients from eight centers were enrolled in an open, randomized trial. Most of the 104 evaluable patients in the cefotetan group and 50 in the cefoxitin group were young men with community-acquired, moderate or severe cellulitis, or abscesses of the upper and lower extremities caused by Staphylococcus aureus, Streptococcus species, Escherichia coli, Proteus mirabilis, Bacteroides fragilis and other species of bacteroides, peptococcus species, and peptostreptococcus species. The mean duration of treatment was 7.5 days for cefotetan and 7.1 days for cefoxitin. A successful clinical response was achieved in 97 percent of the cefotetan patients and in 94 percent of the cefoxitin patients. Of the 88 and 39 bacteriologically evaluable patients in the cefotetan and cefoxitin groups, respectively, a satisfactory bacteriologic response occurred in 96 percent and 87 percent of the patients. No clinically significant changes in clinical laboratory determinations were noted. The incidence of adverse reactions in the cefotetan group (17 percent) was significantly different from that for the cefoxitin group (6 percent) (p less than 0.05); however, the incidence of treatment-related reactions was not significant and the events were mild. Discontinuation of therapy was necessary only in two patients in whom allergic-type reactions developed. A once-daily regimen of cefotetan was as effective as thrice-daily cefoxitin in this study in the treatment of primarily polymicrobial, moderate, or severe infections of the skin and superficial soft tissue.

    Publication Types:

    • Clinical Trial
    • Randomized Controlled Trial

    PMID: 3287976 [PubMed - indexed for MEDLINE]

  10. Am J Surg. 1988 May 31;155(5A):61-6.

    Cephalosporin therapy in intraabdominal infections. A multicenter randomized, comparative study of cefotetan, moxalactam, and cefoxitin.

    Wilson SE, Boswick JA Jr, Duma RJ, Echols RM, Jemsek JG, Lerner R, Lewis RT, Najem AZ, Press RA, Rittenbury MS, et al.

    Department of Surgery, Harbor-UCLA Medical Center, Torrance.

    Three broad-spectrum cephalosporins (cefotetan, moxalactam, and cefoxitin) proved effective in this randomized, prospective trial for treatment of 303 surgical patients with moderately severe regional peritonitis.

    Publication Types:

    • Clinical Trial
    • Randomized Controlled Trial

    PMID: 3287971 [PubMed - indexed for MEDLINE]

  11. Am J Obstet Gynecol. 1988 Mar;158(3 Pt 2):728-35.

    Erratum in:

    • Am J Obstet Gynecol 1989 Apr;160(4):1025.

    Comparative study of cefotetan and cefoxitin in the treatment of intra-abdominal infections.

    Lewis RT, Duma RJ, Echols RM, Jemsek JG, Najem AZ, Press RA, Stone HH, Ton GT, Wilson SE.

    Queen Elizabeth Hospital, Montreal, Quebec, Canada.

    One hundred eighty-eight patients were enrolled in a multicenter, randomized clinical trial to compare the safety and effectiveness of 1 to 2 gm cefotetan every 12 hours with those of 1 to 2 gm cefoxitin every 6 hours in patients with intra-abdominal infections. Most of the infections were community acquired, were associated with gastrointestinal tract perforation, and were caused by both anaerobic and aerobic bacteria. The median duration of therapy was 6 days for each group. The clinical response rate for the 95 evaluable patients in the cefotetan group was 98%, and that for the 43 evaluable patients in the cefoxitin group was 95%. Bacteriologically, 97% of the 58 evaluable patients in the cefotetan group and 89% of the 27 evaluable patients in the cefoxitin group had a satisfactory or presumed satisfactory response; two patients in the cefotetan group and three in the cefoxitin group were considered bacteriologic failures. Cefotetan was as effective as cefoxitin in eradicating Bacteroides fragilis and other species of Bacteroides, Clostridium sp., and gram-negative bacilli. The incidence of treatment-related adverse reactions for cefotetan (27%) was not statistically different from that for cefoxitin (17%). No clinically significant differences were detected between the treatment groups in changes in the results of clinical laboratory tests performed before and after treatment; a decrease in hematocrit among the cefotetan group was statistically greater (p = 0.04) than that for the cefoxitin group, and a decrease in serum creatinine level for the cefoxitin group was greater than that for the cefotetan group (p = 0.02). Cefotetan may represent an effective, safe, and cost-saving alternative to cefoxitin for the prompt treatment of community-acquired intra-abdominal infections.

    Publication Types:

    • Clinical Trial
    • Randomized Controlled Trial

    PMID: 3281463 [PubMed - indexed for MEDLINE]

  12. Medicine (Baltimore). 1983 Mar;62(2):81-97.

    Herpes zoster-associated encephalitis: clinicopathologic report of 12 cases and review of the literature.

    Jemsek J, Greenberg SB, Taber L, Harvey D, Gershon A, Couch RB.

    Herpes-zoster associated encephalitis (HZAE) is an uncommon complication of herpes zoster. Over 8 years, we evaluated 12 patients with this clinical diagnosis. The majority of our patients were elderly, immunosuppressed, and found to have disseminated skin lesions prior to the onset of CNS symptoms. All patients had abnormal EEGs, and CSF pleocytosis was found in most. In the seven patients who were tested, specific antibody to the varicella-zoster membrane antigen (FAMA) was detected in spinal fluid during the course of the illness. Although three patients died during the period of active infection, the virus could not be definitively implicated as the cause of death. These HZAE patients could not be distinguished from our other herpes zoster patients on the basis of age, initially involved dermatome, or mortality rate. However, among herpes zoster patients who survived, duration of hospitalization was significantly longer in those with a diagnosis of HZAE. All surviving HZAE patients had a slow but eventual return to their prior cognitive status.

    Publication Types:

    • Case Reports
    • Review

    PMID: 6298562 [PubMed - indexed for MEDLINE]

  13. Antimicrob Agents Chemother. 1981 Apr;19(4):532-3.

    Effects of sodium piperacillin on platelet function in normal volunteers.

    Gentry LO, Jemsek JG, Natelson EA.

    Piperacillin is a new semisynthetic penicillin which is similar in structure to carbenicillin and ticarcillin. Since the latter antibiotics have been shown to cause abnormalities in hemostasis, we studied the effects of piperacillin on blood coagulation and platelet function. Fifteen healthy volunteers received the drug in doses of either 100, 200, or 300 mg/kg per day for a period of 7 days. Serial studies showed no abnormalities in blood coagulation in any subject. Decreased platelet aggregation responses to adenosine diphosphate, epinephrine, collagen, and achidonic acid were commonly noted, but prolongation of the bleeding time occurred in only 3 of 15 subjects after 7 days of piperacillin administration. These results suggest that although piperacillin also induces platelet dysfunction, these effects may be less than those caused by ticarcillin or carbenicillin at an equivalent dosage.

    PMID: 6454385 [PubMed - indexed for MEDLINE]

  14. J Infect Dis. 1980 Mar;141(3):310-6.

    Antimicrobial susceptibility testing of Haemophilus parainfluenzae by a kinetic killing-curve method.

    Jemsek JG, Martin RR, Greenberg SB, Gentry LO.

    A kinetic killing-curve method, designed to mimic several aspects of clinical therapy in endocarditis, was used to test 10 strains of Haemophilus parainfluenzae against 28 antibiotic regimens. In an effort to simulate changing in vivo levels of antibiotic in serum, concentrations of three penicillins, three cephalosporins, gentamicin, and chloramphenicol were sequentially adjusted over a 12-hr period. Against six beta-lactamase-negative strains, gentamicin in combination with penicillin or cephalosporin invariably resulted in an additive or synergistic effect. Chloramphenicol and a penicillin or cephalosporin usually displayed an indifferent effect, but chloramphenicol was often antagonistic when combined with gentamicin. With four beta-lactamase-positive strains, variable responses were noted to penicillin-aminoglycoside combinations; cephalosporin-aminoglycoside combinations were usually synergistic. This dynamic approach to killing-curve studies may be more appropriate than a static system for in vitro examination of the effect of antimicrobial combinations against selected organisms.

    PMID: 6444977 [PubMed - indexed for MEDLINE]

  15. Chest. 1979 Dec;76(6):695-7.

    Malignant group B streptococcal endocarditis associated with saline-induced abortion.

    Jemsek JG, Gentry LO, Greenberg SB.

    A 20-year-old woman developed acute group B streptococcal endocarditis following saline-induced abortion. In the pre-antibiotic era, most cases of group B streptococcal endocarditis occurred in parturient or postabortal women. Currently, this disease is rarely described in obstetrical patients, and no previous cases following saline-induced abortion have been reported. Purulent pericarditis and a perivalvular abscess were present in our patient and represent only the second instance in which these findings have been documented in this disease.

    PIP: This case report describes a 20-year-old woman who developed acute group B streptococcal endocarditis after a saline-induced abortion. She was admitted 2 weeks after an uncomplicated saline-induced abortion for a 16-week pregnancy with a 1-week history of fever, headaches, dizziness, and shortness of breath. The patient showed poor response to antibiotic therapies (initially to nafcillin and gentamicin and then to aqueous penicillin G). 6 to 6 blood cultures after hospital admission showed group B streptococcus which was penicillin sensitive by tetracycline resistant. On Day 3 of admission, a pericardial friction rub was noted and repeat chest x-rays showed marked enlargement of the cardiac shadow. Surgery was performed, and the mitral valve posterior leaflet was necrotic, and a mitral valve prosthesis was placed and an aortic embolectomy was performed. Postoperatively, she was treated with an additional 6-week course of intravenous penicillin, and subsequently, she has remained asymptomatic after 6 months. An addendum to this report, which was only the 2nd such report of endocarditis after saline abortion, describes another case of group B streptococcal endocarditis in a drug abuser after a saline-induced abortion. She required tricuspid valvulectomy and is slowly improving postoperatively.

    Publication Types:

    • Case Reports

    PMID: 389576 [PubMed - indexed for MEDLINE]

  16. Antimicrob Agents Chemother. 1979 Mar;15(3):379-83.

    Quantitative nasal cultures from carriers of Staphylococcus aureus: effects of oral therapy with erythromycin, rosamicin, and placebo.

    Wilson SZ, Martin RR, Putman M, Greenberg SB, Wallace RJ Jr, Jemsek JG.

    Publication Types:

    • Clinical Trial
    • Randomized Controlled Trial

    PMID: 464564 [PubMed - indexed for MEDLINE]

  17. Am J Med. 1979 Jan;66(1):51-7.

    Haemophilus parainfluenzae endocarditis. Two cases and review of the literature in the past decade.

    Jemsek JG, Greenberg SB, Gentry LO, Welton DE, Mattox KL.

    Publication Types:

    • Case Reports

    PMID: 420249 [PubMed - indexed for MEDLINE]

  18. Postgrad Med J. 1979;55 Suppl 4:62-6.

    Treatment of acute bacterial bronchitis and pneumonia with cefaclor.

    Mogabgab WJ, Pollock B, Beville RB, Gentry LO, Jemsek JG.

    Sixty patients with pneumonia and/or bronchitis were treated with cefaclor, a new orally administered cephalosporin. Of those 60, 27 adults were treated with 500 mg every 8 hours, 26 adults with 250 mg every 6 hours, and 7 children with 50 mg/kg/day. In the adults, pneumonia was caused most frequently by Streptococcus pneumoniae and Haemophilus influenzae. The 7 children had pneumococcal pneumonia. All but 2 adults, both elderly patients with chronic obstructive pulmonary disease, were successfully treated. One instance of drug hypersensitivity occurred. All 7 children responded rapidly, with no side effects, to cefaclor therapy.

    PMID: 44908 [PubMed - indexed for MEDLINE]

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