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Biomedical subjects

B Jacob

Publications and source records attributed to B Jacob.

At least 37 records · Page 2Linked to original sources
PubMed1997

Effects of a medical intensivist on patient care in a community teaching hospital.

OBJECTIVE: To determine the effect of adding a trained intensivist on patient care and educational outcomes in a community teaching hospital. MATERIAL AND METHODS: We retrospectively reviewed outcomes for patients admitted to the medical intensive-care unit (MICU) of a 270-bed community teaching hospital between July 1992 and June 1994. Mortality rates and durations of stay were determined for the year before (BD, 1992 through 1993) and the first year after (AD, 1993 through 1994) introduction of a full-time director of critical care. Performance of resident trainees on a standardized critical-care examination was measured for the same periods. RESULTS: Overall, 459 patients in the BD period were compared with 471 patients in the AD period. The mix of cases and severity of illness (acute physiology and chronic health evaluation or APACHE II scores) on admission were similar for the BD and AD periods. MICU mortality decreased from 20.9% during the BD to 14.9% during the AD period (P = 0.02), and in-hospital mortality decreased from 34.0% to 24.6% (P = 0.002). Disease-specific mortalities were lower during the AD period for most categories of illness. Detailed analysis of a subgroup of patients (those with pneumonia) demonstrated no differences in distribution of patients by gender, race, or acuity of illness (APACHE II scores). The mortality rate due to pneumonia decreased from 46% during the BD period to 31% during the AD period. This decrease was consistent across categories of APACHE II scores. From BD to AD periods, mean durations of total hospital stay decreased from 22.6 +/- 1.4 days to 17.7 +/- 1.0 days, and mean MICU stay decreased from 5.0 +/- 0.3 days to 3.9 +/- 0.3 days (P < 0.05). Critical-care in-service examination scores for 22 residents increased from 53.8 +/- 1.7% to 67.5 +/- 2.2% (P < 0.01), and AD scores were significantly higher than BD scores for residents at similar levels of training. CONCLUSION: Addition of a medical intensivist was temporally associated with improved clinical and educational outcomes in our community teaching hospital.

APACHE↗
PubMed1997

Preoperative pulmonary function tests do not predict outcome after coronary artery bypass.

PURPOSE: To evaluate the utility of preoperative pulmonary function tests in predicting postoperative complications and lengths of stay after coronary artery bypass grafting. METHODS: Medical records of 193 consecutive patients who underwent coronary artery bypass grafting from October 1993 to September 1994 were reviewed. Preoperative pulmonary function tests, comorbid conditions, smoking history, postoperative complications, and total days in the intensive care unit, hospital, and on mechanical ventilation were abstracted. Data were analyzed using linear regressions, analyses of variance, and nonpaired Student's t tests. RESULTS: Pulmonary function tests were normal in 56 subjects (29%, group 1), mildly impaired in 72 (37%, group 2), and moderately impaired in 35 (18%, group 3). Thirty patients (16%) had no pulmonary function tests. Group 3 subjects were older (71) compared to groups 1 and 2 (63 and 65, P < 0.05). There was no major difference in comorbid conditions or smoking status among the groups. All patients had atelectasis postoperatively. The most frequent postoperative complications were pleural effusions (43%), pulmonary edema or congestive heart failure (28%), and atrial fibrillation (35%). The repeat surgery rate was 3.6%. The mean length of hospital stay was 10.1 +/- 0.6 days, with 1.5 +/- 0.1 days of mechanical ventilation and 2.8 +/- 0.2 days of intensive care unit stay. Overall, pulmonary function tests had no predictive value for postoperative pulmonary and nonpulmonary complications, nor for durations of mechanical ventilation and intensive care unit stay. There was a trend toward increased length of hospital stay in patients with impaired pulmonary function tests (group 18.6 +/- 0.6, group 2 9.6 +/- 0.8, group 312.7 +/- 2.3 days, P = 0.09) but this was consistent with random variation. CONCLUSIONS: Preoperative pulmonary function tests were not useful in predicting postoperative outcomes in patients undergoing coronary artery bypass grafting.

Aged↗
PubMed1996

Transcriptional pattern of Escherichia coli ihfB (himD) gene expression.

Integration host factor (IHF) is a small heterodimer containing subunits encoded by the unlinked ihfA (himA) and ihfB (himD, hip) genes. The transcriptional pattern of ihfB expression in the logarithmic and stationary growth phases was investigated. The ihfB gene is expressed as both monocistronic and polycistronic (hybridizing also to an internal rpsA probe) transcript. The intensity of the polycistronic transcripts, initiated upstream of rpsA, decreased sharply upon growth cessation. In contrast, expression of the monocistronic ihfB transcript strongly increased when cells entered stationary growth phase. The observed growth rate-dependent regulation of the transcription of these transcripts is in agreement with the previously published data about the regulation of the rpsA and ihfB promoters (Pedersen et al., 1984; Aviv et al., 1994).

Bacterial Proteins↗
PubMed1996

The unassisted respiratory rate-tidal volume ratio accurately predicts weaning outcome.

PURPOSE: To assess the accuracies of four commonly used parameters in predicting weaning outcome and whether breathing pattern changes during weaning. PATIENTS AND METHODS: We prospectively examined the predictive accuracies of four weaning parameters in mechanically ventilated patients in the medical and cardiac intensive care units of a 270-bed community teaching hospital. The spontaneous respiratory rate:tidal volume ratio (RVRi), negative inspiratory force (NIF), and spontaneous minute volume (VE) at the onset of weaning, and the RVR at 30 to 60 minutes of weaning (RVR30) were measured. Weaning decisions were made by patients' primary physicians independent of this study. Threshold values for computations of predictive values were as follows: RVR 100 < or = breaths per minute/L, NIF < or = -20 cm H2O, VE < or = 10 Lpm. Receiver operator curves were generated for each parameter. RESULTS: One hundred medical/cardiac intensive care unit patients were studied. Their mean age was 64.6 +/- 15.8 years, mean APACHE II score of 15.8 +/- 6.7 and mean duration of mechanical ventilation before the study of 4.9 +/- 8.1 days. RVRi sensitivity was 89%, specificity was 41%, positive predictive value was 72%, negative predictive value was 68%, and accuracy was 71%. The RVR30 sensitivity was 98%, specificity was 59%, positive predictive value was 83%, negative predictive value was 94%, and accuracy was 85%. Accuracies for the NIF and VE were 66% and 62%, respectively. The area under the receiver operator curve of the RVR30 (0.92 +/- 0.03) was higher than the RVRi (0.74 +/- 0.05), NIF (0.68 +/- 0.06) and VE (0.54 +/- 0.06) (p < 0.05). CONCLUSIONS: The RVR is more accurate than other commonly utilized clinical tools in predicting the outcome of weaning from mechanical ventilation. The RVR measured at 30 minutes is superior to the RVR in the first minute of weaning. The predictive accuracy and unique simplicity of the RVR justify its use in the care of mechanically ventilated patients.

Aged↗
PubMed1996

Cardiac ischemia during weaning from mechanical ventilation.

In this prospective study, we measured the ST segments, heart rate-systolic BP product (RPP), respiratory rate to tidal volume ratio (RVR), and pulse oximetry saturations of patients in our medical/cardiac ICUs before and during weaning from mechanical ventilation. Ninety-three patients were enrolled with a mean age of 66.5 +/- 15.0 years (mean +/- SD), mean acute physiology and chronic health evaluation (APACHE) II score of 16.0 +/- 6.9, and mean duration of mechanical ventilation of 5.2 +/- 8.6 days. Forty-nine patients had coronary artery disease (CAD). Six of 93 patients (6.4%) experienced ECG evidence of ischemia during weaning. Five of these six had a precedent history of CAD and four failed initial weaning attempts (22% of patients with CAD who failed weaning). The RPP, for the group as a whole, increased significantly during weaning from 12.0 +/- 3.1 to 13.4 +/- 4.0 mm Hg.bpm.10(3) (p<0.01). The rate to volume ratio did not change significantly during weaning, except in the subgroup of patients who failed to wean, in whom it increased from 98.4 +/- 45.2 to 124.9 +/- 54.9 bpm/L (p<0.05). Oxygenation also decreased significantly from 0.98 +/- 0.02 to 0.96 +/- 0.03 and was significantly associated with weaning failure (risk ratio [RR]=3.9; 95% confidence interval [CI]=1.7 to 9.0). Thirty-seven patients failed the initial weaning attempt. Cardiac ischemia (RR= 1.8; 95% CI=1.0 to 3.4) and an increased RVR (RR=1.7; 95% CI=0.9 to 3.4) tended to increase the risk of weaning failure. Cardiac ischemia, although infrequent (6%) in the general population of weaning medical/cardiac ICU patients, should be considered in patients with CAD who fail to wean.

Adult↗
PubMed1994

Achondrogenesis type IB (Fraccaro): study of collagen in the tissue and in chondrocytes cultured in agarose.

A lethal chondrodysplasia characterized by extreme micromelia was diagnosed by ultrasound examination in two sibs whose nonconsanguineous parents were healthy. Radiographic and histopathologic data indicated that the two foetuses (18 and 21 weeks old) had achondrogenesis type IB (Fraccaro). Quantitation of total collagen extractable from dried cartilage samples demonstrated a 50% decrease when compared to an age-related control. This decrease was essentially related to type II collagen. Nevertheless, the alpha chains and the CB peptides of type II collagen had a normal electrophoretic mobility. A significant amount of collagen type I was also detected. The electrophoretic pattern of collagens type IX and XI did not differ significantly from control sample. The extracellular matrix elaborated by patient chondrocytes cultured in agarose for 10-12 days, contained less collagen type II than normal cells. Labelling with 14C-proline of cultured cells showed the presence of procollagen and type II collagen chains with a normal electrophoretic mobility, but an alpha 2(I) chain was detectable in the patient material, indicating the presence of collagen type I which supported the tissue findings. The significance of the type II collagen reduction in the patient's cartilage is unclear but it is unlikely to be the primary defect in achondrogenesis type I.

Blotting, Western↗
PubMed1994

[The influence of cations on the letality and on the formation of the toxin of Pasteurella multocida].

The stability of the Pasteurella multocida toxin has proven as very pH dependent. Therefore, a pH lower than 6 should be avoided. A concentration of 1 mM Cu2+ decreased the lethal effect of the toxin but the equimolecular addition of chelators compensated this effect. Possible structure-effect mechanisms were discussed. Iron supplement (100 microM) to two culture media examined did not influence the production of the toxin but during the cultivation in the low-iron medium TDHM the toxin level increased. This increased toxin production was not due to a more intensive multiplication of bacteria.

Animals↗
PubMed1993

Neuropathological studies in the brains of AIDS patients with opportunistic diseases.

The brains of 70 fatal cases with AIDS were studied by means of immunohistochemistry and in-situ hybridization in a consecutive autopsy series (1985-July 1992). In addition, the neuropathological changes were correlated with the neurological and neuroimaging findings. Opportunistic infections included toxoplasmosis (15 cases), cytomegalovirus (CMV)-encephalitis (6), progressive multifocal leucoencephalopathy (2) and fungal infections (3). Malignant lymphomas were found in 7 patients; 6 involved primarily the CNS, one was metastatic. In 14 cases the neuropathological changes were consistent with HIV encephalitis and HIV leucoencephalopathy. Non-specific lesions occurred in 31 cases. The clinical diagnosis in patients with opportunistic diseases (n = 27) diverged in 15 cases (55%) from the underlying pathology. Toxoplasma gondii, CMV and JC viruses were identified by immunohistochemistry and in-situ hybridization on serial paraffin sections. In addition, antibodies against lymphocyte subsets, tissue macrophages, the glial fibrillary acid protein (GFAP) and myelin basic protein were used to characterize the phenotype of cells and to highlight the degree of gliosis and demyelination. Our results show that the distribution and degree of morphological changes might be helpful for the differential diagnosis antemortem. Since neurological complications may represent the first or sole manifestation of AIDS and risk factors for AIDS are often not known, it should be taken into account that CNS manifestations of AIDS may contribute to a sudden and unexpected death or accident. Opportunistic diseases should be considered as a possible differential diagnosis in cases mimicking the clinical picture of apoplexia or dementia. Furthermore, CNS lesions may be detected postmortem in patients who were not known to suffer from Neuro-Aids during life, indicating that CNS involvement is more widespread than assumed.

AIDS Dementia Complex↗
PubMed1993

Suicidal yew leave ingestion--phloroglucindimethylether (3,5-dimethoxyphenol) as a marker for poisoning from Taxus baccata.

In a case of suicide in a depressive 19-year-old man with considerable ingestion of new leaves, resorption of yew ingredients could be demonstrated. The main substance could be identified as 3,5-dimethoxyphenol, the aglycone of taxicatine, which is a typical ingredient of yew leaves. 3,5-dimethoxyphenol was demonstrated in harvested yew leaves, stomach content and cardiac blood of the victim. Structure confirmation was achieved by means of HPLC, UV, GC-MS, IR and 1H-NMR spectroscopy. None of the Taxus alkoids could be identified. The components detected by TLC have not yet been identified. The results demonstrate that 3,5-dimethoxyphenol can be used as a marker in cases of intoxication by yew ingredients.

Adult↗
PubMed1992

[The importance of dermonecrotoxin and dermonecrotoxoid of Pasteurella multocida for the calf].

The i. m. application of dermonecrotoxin of P. multocida var. D led to an atrophy of nasal conchae, liver-swelling and to induration of liver and spleen. The intratracheal application caused a lobular pneumonia. The vaccination with toxoid resulted in an immunity against a challenge with toxin but not with P. multocida var. D. Correlations between antitoxic serum-titers and immunity have to be investigated in future.

Animals↗
PubMed1992

Laryngologic aspects of bolus asphyxiation-bolus death.

Among 12,982 forensic autopsies, 78 cases of café coronary due to bolus impaction in the larynx (bolus death) were observed from 1947 to 1988. In all cases bolus material occluded the entry to the larynx; only once was a singular occlusion of the glottis observed. The bolus frequently extended into the mouth, trachea, and bronchial tree or esophagus. In all cases small amounts of aspirated material were observed in the deeper parts of the bronchial tree. The most commonly observed bolus was not masticated meat or a meat product. In adults and the elderly the bolus was often too large to pass the physiological narrowings of the hypopharynx. It was commonly lodged above the arytenoid cartilages. Forty-five of the bolus events were observed by bystanders. In 43 of the victims vital reactions were observed by bystanders or at the autopsy. This justifies the hope that many lives could have been saved had the right diagnosis and immediate therapy been initiated. The first step should be manual extraction or use of the Heimlich maneuver; in cases of failure of both attempts, immediate tracheotomy followed by hospitalization and bronchial lavage are indicated.

Adolescent↗
PubMed1992

Enhancement of the immune response by intradermal vaccination in cattle with enterotoxigenic Escherichia coli (ETEC) vaccine without adjuvant.

A comparison was made of the efficiency of intradermal and subcutaneous routes of vaccination in immunizing cattle with a killed vaccine of Escherichia coli K99+. In this study 135 heifers aged 8-18 months were included. The effect of the number of intradermal injection sites was examined, as well as the optimal time interval between the initial and booster intradermal vaccination. The intradermal route was found to be significantly superior to the subcutaneous route. The optimal time for intradermal booster was approximately 2 weeks. Increasing the number of intradermal injection sites up to 50 (using the same amount of antigen) did not result in an enhancement of the antibody level.

Animals↗
PubMed1991

Prenatal diagnosis of lethal osteogenesis imperfecta in twin pregnancy.

Lethal osteogenesis imperfecta was diagnosed at 27 weeks amenorrea in one fetus of a bichorial twin pregnancy. Sonographic findings included: short-limb dwarfism, hypotrophy and hypoechoic bones. The affected fetus was so translucent that only the normal fetus could be seen on plain in utero radiography. The affected fetus died immediately after birth. Postmortem radiography and histology were typical of lethal osteogenesis imperfecta of type IIA. Aids to the etiological diagnosis of in utero dwarfism are presented. Sonographic features correlated with neonatal death are described.

Diagnosis, Differential↗
PubMed1990

Unexpected infant death attributable to cardiac tumor or cardiomyopathy. Immunohistochemical and electron microscopical findings in three cases.

The pathological findings, including immunohistochemical and electron microscopical findings, in three infants who died unexpectedly of cardiac tumor or cardiomyopathy are reported. The first was a 13-month-old boy with tuberous sclerosis and multiple rhabdomyomas of the heart, who presented with a postpartal cardiac murmur and moderate cardiomegaly. The further history was unknown. The rhabdomyoma nodules were composed of spider cells containing small amounts of desmin and myosin as well as isolated myofibrils. Microscopically small glioma nodules contained high amounts of GFAP. The second case, a boy 4 months of age, died of a large benign fibrous histiocytoma of the heart after an uneventful history. Tumor cells contained alpha-1-anti-chymotrypsin and lysozyme. The third case, a girl 2 months of age, died unexpectedly of histiocytoid cardiomyopathy. The affected cells contained fat droplets, glycogen granules, many leptomer myofibrils and small amounts of myosin and desmin.

Astrocytoma↗