摘要:

BackgroundThe differential diagnosis of acute infection in elderly nursing home patients is often difficult. This study evaluated pulse oximetry in pneumonia in this population.MethodsA case-control study was performed in a veteran’s nursing home involving 2 analyses: (1) pneumonia patients (case subjects) were compared with patients with nonpulmonary infections (control subjects) at time of acute infection; (2) differences in paired values measured at time of infection versus a noninfected baseline were compared for pneumonia patients and control subjects. Vital signs including pulse oximetry were obtained routinely (at least monthly) and with acute illness.ResultsOxygen saturations were lower in 45 pneumonia patients than in 22 patients with acute nonpulmonary infections (P< 0.001). An oxygen saturation < 94 gave a sensitivity for pneumonia of 80%, specificity of 91%, and positive predictive value of 95%. The drop in oxygen saturation from the last baseline value was greater in pneumonia patients than in control subjects (P< 0.001). The sensitivity of an oxygen saturation drop >3% from baseline for pneumonia was 73% with specificity and positive predictive values of 100%.ConclusionsPulse oximetry may be very helpful in evaluating acutely infected nursing home residents. The present study suggests that in acutely infected nursing home patients, a decrease in oxygen saturation of >3 % from baseline, as well as a single oxygen saturation of <94, should suggest pneumonia. A decrease from baseline of <4 % or a single oxygen saturation of 94 or higher suggests that pneumonia is unlikely.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundCardiovascular disease is an important health problem among homeless adults; however, the common cardiac risk factors present in this population are unknown. This study was undertaken to identify the reversible cardiovascular risks present in the homeless.MethodsA retrospective chart review was performed randomly on 100 patients who were seen at a homeless clinic in New Orleans, Louisiana. These patients were compared with 200 matched nonhomeless patients who attended an inner-city primary care clinic. Each chart from the 2 groups was reviewed for the presence of hypertension, diabetes mellitus type 2, cigarette smoking, and hypercholesterolemia. Statistical comparisons were made between the homeless and the control subjects.ResultsHypertension was present in 65% of the homeless but only 52% of the nonhomeless [P< 0.05; odds ratio 1.78 (CI, 1.09 to 2.9)]. Smoking was far more common in the homeless than the nonhomeless, 75 versus 57%, respectively [P< 0.005; odds ratio 2.22 (CI, 1.27 to 3.88)]. There was no difference in the prevalence of diabetes or total cholesterol. Compared with national data hypertension, smoking and diabetes seem to be represented excessively in the homeless population.ConclusionsSmoking and hypertension are significantly more prevalent in the homeless population than in a matched cohort. Educational and preventive programs are needed to reduce the prevalence of cardiovascular disease and reduce the overutilization of expensive healthcare resources.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundEpidemiologic investigations suggest that fish oil, which contains eicosapentaenoic acid (EPA), has favorable cardiovascular effects. Fish oil improves endothelial function in subjects with hypercholesterolemia or diabetes. However, controversy persists regarding relationships between primary hypertriglyceridemia and endothelial dysfunction. Moreover, lipoproteins are more susceptible to oxidation in vitro after incorporation of fish oil.MethodsWe determined the effects of EPA on serum lipids, susceptibility of low-density lipoproteins (LDL) and very-low-density lipoproteins (VLDL) to oxidation, and endothelial function in hypertriglyceridemic (HTG) subjects. In 8 men with untreated primary hypertriglyceridemia (plasma triglyceride between 150 and 500 mg/dL) and 7 control subjects (triglyceride below 150 mg/dL), forearm blood flow (FBF) responses were tested. In HTG subjects, this was repeated 3 months after initiation of EPA (1800 mg / day). Cu2+-induced oxidation of VLDL and LDL was determined by serial measurement of conjugated dienes. We used lag time, which corresponded to the period when the lipoproteins were resistant to oxidation, as a parameter of oxidizability. FBF responses to acetylcholine and sodium nitroprusside were determined by strain-gauge plethysmography.ResultsPlasma triglyceride in HTG subjects fell 31% with EPA supplementation. Before EPA, VLDL and LDL lag times in HTG subjects were shorter than in control subjects. EPA further reduced lag time for VLDL but not LDL. The FBF response to acetylcholine (but not to nitroprusside) was significantly less in HTG subjects before EPA than in control subjects. EPA normalized the FBF response to acetylcholine.ConclusionsEPA improves endothelial function in HTG subjects despite increasing in VLDL oxidizability.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundSurvival in patients with infective endocarditis (IE) ranges from 4 to 50% depending on the type of organism, the type of valve involvement and the type of treatment.MethodsWe conducted a retrospective analysis of data in hemodialysis (HD) patients at our center from 1990 to 2000. Demographics, risk factors, and outcome data were extracted in the subgroup of patients with first-episode IE diagnosed primarily by echocardiography.ResultsA total of 2239 patients underwent HD at our center. Thirty-two (1.4%) had IE defined using the Duke Criteria. Permanent and temporary venous dialysis catheters, arteriovenous (AV) grafts, and AV fistulae were used in 19 (59%), 12 (38%), and 1 (3%) patient respectively. Mean access duration was 7.6 ± 7.9 months. Thirty (94%) patients had positive blood cultures, with the majority havingStaphylococcus aureusbacteremia. Two (7%) patients had positive echocardiographic findings but negative blood cultures due to the commencement of empiric antibiotic therapy prior to blood cultures. The mitral valve was mainly affected. Transesophageal echocardiography was performed in 23 (72%) patients and detected an intracardiac mass in all 23 patients. One-year mortality was 56.3%. A poor 1-year prognosis was associated with presenting features of low hemoglobin, elevated leukocyte count, hypoalbuminemia, severe aortic and mitral regurgitation, and annular calcification in mitral valve IE.ConclusionThe prevalence of IE in HD patients is 1.4%. One-year mortality was 56.3%. Close observation is required during the first year when patients with severe valvular regurgitation and hematological abnormalities have a high mortality.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundRenal cells are not fully differentiated at birth, representing a major risk in preterm infants. We evaluated glomerular and tubular functional integrity as well as structural integrity of renal tubules among healthy full-term and preterm infants as well as diseased preterm infants.MethodsA total of 50 newborns (10 healthy full-term, 10 healthy preterm, and 30 diseased preterm, at 38.9 ± 1.10, 34.2 ± 0.92, and 32 ± 2.47 weeks gestational age, respectively) were included in the present study. Glomerular function was assessed by measuring urinary levels of both microalbumin and immunoglobulin G as well as serum creatinine levels, whereas the proximal tubular function was investigated by measuring the urinary levels of both &agr;1-microglobulin and &bgr;2-microglobulin as well as retinol-binding protein. Also, distal tubular reabsorption capacity was investigated by assessing fractional excretion of sodium. Moreover, the structural integrity of renal proximal tubules was studied by measuring the urinary activities of both the brush-border membrane enzyme leucine-aminopeptidase (LAP) and the lysosomal enzymeN-acetyl-&bgr;-d-glucosaminidase. The preceding investigations were done on both the first and third days of life of all 50 newborns.ResultsGlomerular and tubular function and structure was relatively impaired at birth among both healthy and diseased preterm as well as healthy full-term neonates and improved rapidly thereafter. The diseased preterm neonates showed worse renal function and structure with minimal improvement regardless of the underlying sickness.ConclusionRenal insufficiency and renal immaturity could be evaluated using enzymuria and low- and high-molecular-weight proteinuria as noninvasive methods.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Whereas the earlier conceptual targets of heart failure therapy, such as the cardio-renal and hemodynamic models, all fulfilled the basic needs of symptomatic relief and hemodynamic improvement, only the neurohormonal model has provided an effective target to address symptom relief in concert with survival benefits. Recent data allude to a disease-modifying effect of angiotensin-converting enzyme inhibitors (ACE-Is) in retarding the new development of heart failure in high-risk populations. Angiotensin receptor antagonists (ARBs) have not been demonstrated to be superior to ACE-Is and their value in achieving incremental benefits in addition to ACE-Is is limited to scenarios in which &bgr;-adrenergic receptor blocker therapy is not applicable. &bgr;-Adrenergic receptor blockade in addition to ACE inhibition offers incremental benefits that are achieved early and are beneficial in most stages of severity except in the presence of overt decompensation. Unlike ACE-Is, &bgr;-adrenergic receptor blockers cannot be construed as a class but are heterogeneous in their therapeutic response.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Vasculitis is a clinicopathologic process characterized by inflammation and damage to blood vessels. A broad and heterogenous group of syndromes may result from this process, because any type, size, and location of blood vessel may be involved. The cause of these conditions remains unclear, but an autoimmune inflammatory process, characterized by involvement of both neutrophils and endothelial cells, seems to play an important role. In 1951, Churg and Strauss described a clinical syndrome of severe asthma, hypereosinophilia with eosinophilic infiltrates, eosinophilic vasculitis, and granulomata in various organs. Asthma may precede this vasculitis by many years. We report a case of anti-neutrophil cytoplasmic antibody-positive, pauci-immune, crescentic, necrotizing glomerulonephritis with peripheral and interstitial eosinophilia but without asthma. This is very unusual in Churg-Strauss syndrome.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Antiphospholipid antibody syndrome is an acquired autoimmune disorder characterized by vascular thrombosis and/or recurrent pregnancy losses along with laboratory evidence of antiphospholipid antibodies. Anticoagulation rather than immunosuppression is the mainstay of treatment. Despite the effectiveness of oral anticoagulation for the prevention of recurrent thromboembolic episodes, thrombotic complications in the setting of apparently therapeutic oral anticoagulation have been observed; this may at times be due to difficulties in maintaining a consistently therapeutic level of anticoagulation. Low-molecular-weight heparin has been a useful alternative for long-term anticoagulation when there is difficulty in managing oral anticoagulant therapy and has the advantage of a consistent anticoagulant effect. In this report, we describe a woman with primary antiphospholipid antibody syndrome who developed extensive pulmonary embolism despite receiving a proven therapeutic dosage of low molecular weight heparin.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

We report the case of a 17-year-old woman with anorexia nervosa (AN) who developed an abetalipoproteinemia-like lipid profile and acanthocytosis. These abnormalities resolved slowly as her nutritional status improved. We considered 3 possible causes of an abetalipoproteinemia-like lipid profile in AN: (1) depletion of hepatic substrate for apolipoprotein B synthesis, (2) lack of exogenous fatty acids with exhaustion of endogenous stores of triglycerides in adipose tissue, and (3) preservation of the lipoprotein lipase (LPL) mass. This unusual case provides important clues that enhance our understanding of lipid metabolism under exogenous and endogenous fat deprivation and highlights the pivotal role of LPL as a gatekeeper of the energy source.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Chronic bibasilar alveolar infiltrates existed for more than 2 years in a 25-year-old woman infected with HIV for more than a decade. Bronchoscopically, there were copious, purulent secretions that grew methicillin-resistantStaphylococcus aureus(MRSA). Transbronchial biopsy specimens demonstrated plasma cell interstitial pneumonia (PCIP). Focal, transient radiographic improvement occurred after antistaphylococcal antimicrobial therapy. With recurrent and progressive symptoms, sustained clinical and radiographic improvement did not occur until corticosteroid therapy was instituted with tuberculosis chemoprophylaxis. Persistent antigenic stimulation in immunosuppressed patients causes PCIP. In this instance, the stimulus is MRSA. The previous model and support for this theory isPneumocystis carinii. There is good experimental reason for a plasma cell response in persons infected with HIV. To our knowledge, this is the first case of chronic plasma cell interstitial pneumonia caused by indolent MRSA infection.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID