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Biomedical subjects

D Kaye

Publications and source records attributed to D Kaye.

At least 109 records · Page 6Linked to original sources
PubMed1986

Lack of association between bacteriuria and symptoms in the elderly.

In a study of bacteriuria in elderly (mean age 85 years, range 69 to 101), mostly middle- and upper-class Jewish subjects, attempts were made to determine if bacteriuria without dysuria is otherwise asymptomatic. Seventy-two subjects (59 women and 13 men) without dysuria were questioned about other urinary symptoms (incontinence, frequency, urgency, suprapubic pain, flank pain, fever) and symptoms indicating a lack of well-being (anorexia, difficulty in falling asleep, difficulty in staying asleep, fatigue, malaise, weakness) when they were with and without bacteriuria. Twenty-two subjects had bacteriuria that resolved spontaneously; bacteriuria subsequently developed in 24 nonbacteriuric subjects; and 26 subjects had bacteriuria that resolved with antimicrobial therapy. Subjects occasionally reported urinary symptoms (especially incontinence) and commonly reported symptoms indicating a lack of well-being when they were with and/or without bacteriuria. However, no differences in symptoms were found when bacteriuric subjects were compared with themselves when they were nonbacteriuric. Thus, bacteriuria without dysuria in the elderly appears to be asymptomatic.

Aged↗
PubMed1986

Immunologic response in an elderly population with a mean age of 85.

Previous studies of changes in immune responses in the elderly have been limited in both number and age of elderly subjects and have produced conflicting results. Using 260 subjects, mean age 84.6, the present study conclusively demonstrates that T cell response is decreased in the elderly. Decreases in response to phytohemagglutinin and concanavalin A were demonstrated in groups aged 70 to 79, 80 to 84, and 85 to 89, although a group 90 to 106 years old showed a decreased response only to phytohemagglutinin. None of the groups had a decreased response to pokeweed mitogen. No response to all three mitogens was observed in 13 percent of the group aged 70 to 89, but in none of the group aged 90 to 106 or in the young groups. No differences in natural killer cell cytotoxicity were observed among the elderly groups. In contrast to previous studies, these results suggest that: the decreased immune response of the elderly is not directly related to age, over age 70; and there may be a selection process in which subjects who live to the age of 90 are those in whom the least decrease in immune response is demonstrated.

Adult↗
PubMed1986

Teicoplanin compared with vancomycin for treatment of experimental endocarditis due to methicillin-resistant Staphylococcus epidermidis.

This study compared teicoplanin with vancomycin without and with gentamicin and/or rifampin for treatment of experimental endocarditis due to methicillin-resistant Staphylococcus epidermidis. In rabbits treated for three days and killed 12 hr after the last doses of antimicrobial agents, no significant difference in reducing bacterial titers of vegetations was detected between vancomycin and teicoplanin without and with gentamicin and/or rifampin. Addition of gentamicin and/or rifampin to vancomycin or teicoplanin significantly reduced bacterial titers of vegetations compared with vancomycin or teicoplanin alone. Addition of rifampin alone or gentamicin plus rifampin was significantly more effective than addition of gentamicin alone. In rabbits treated for three days and killed seven days after the last doses of antimicrobial agents, no significant difference in sterilizing vegetations was detected between vancomycin and teicoplanin with gentamicin and/or rifampin. However, there was a trend (probably due to the longer elimination half-life of teicoplanin in serum) that clearly favored teicoplanin over vancomycin. Teicoplanin plus rifampin without or with gentamicin is at least as effective as vancomycin plus rifampin without or with gentamicin for treatment of experimental endocarditis due to methicillin-resistant S. epidermidis.

Animals↗
PubMed1986

Enoxacin compared with vancomycin for the treatment of experimental methicillin-resistant Staphylococcus aureus endocarditis.

Enoxacin administered orally was compared with vancomycin administered intravenously for the treatment of experimental methicillin-resistant Staphylococcus aureus endocarditis. The MICs and MBCs of both enoxacin and vancomycin for an inoculum of 5.0 X 10(5) CFU of the methicillin-resistant S. aureus strain per ml were 1.56 microgram/ml. With an inoculum of 10(8) CFU/ml, enoxacin at 6 micrograms/ml and vancomycin at 180 micrograms/ml resulted in similar decreases in numbers of methicillin-resistant S. aureus in broth. Methicillin-resistant S. aureus endocarditis in rabbits was treated with enoxacin at 100 mg/kg orally every 12 h or vancomycin at 30 mg/kg intravenously every 12 h for 3 or 5 days. Enoxacin treatment for 3 or 5 days and vancomycin treatment for 5 days significantly reduced bacterial counts of vegetations compared with those in untreated control rabbits after 1 day of infection. Bacterial counts of vegetations after vancomycin treatment for 3 days did not differ significantly from those of untreated controls. Bacterial counts of vegetations in the four therapeutic groups did not differ significantly from one another. In uninfected rabbits single doses of vancomycin at 30 mg/kg administered intravenously achieved much higher concentrations in serum than did single doses of enoxacin at 100 mg/kg administered orally. Enoxacin had an elimination half-life in serum that was approximately 1.5 times longer than that of vancomycin. This study demonstrated that enoxacin administered orally is as effective as vancomycin administered intravenously for the treatment of experimental methicillin-resistant S. aureus endocarditis.

Animals↗
PubMed1986

Enhancement of Escherichia coli adherence to epithelial cells derived from estrogen-stimulated rats.

The effect of exogenous estrogen administered to male and oophorectomized female rats was investigated with regard to in vitro adherence of eight uropathogenic strains of Escherichia coli to exfoliated bladder and vaginal epithelial cells. Uroepithelial cells obtained from estrogenized male and estrogenized oophorectomized female rats and vaginal cells obtained from estrogenized oophorectomized female rats demonstrated significantly enhanced (P less than 0.005) host cell avidity for E. coli attachment, irrespective of bacterial adhesin expressed, when compared with such cells from nonestrogenized male and female oophorectomized rats. These animal studies suggest that female reproductive hormones may contribute to urinary-tract infection in premenopausal females by enhancing susceptibility to E. coli colonization of uroepithelial cells.

Adhesiveness↗
PubMed1986

Prophylaxis for infective endocarditis: an update.

The American Heart Association has updated its recommendations for prevention of bacterial endocarditis. The major changes are less emphasis on administration of parenteral agents and a reduction of the period of prophylaxis. The simplified new recommendations should make compliance easier and should be assiduously implemented by dental and medical practitioners. However, several changes are suggested for possible consideration: Because of the relatively low risk, prophylaxis may not be needed for persons with mitral valve prolapse (unless there is a holosystolic murmur) or for most gastrointestinal endoscopic procedures. Consideration should be given to using a single oral 3-g dose of amoxicillin for dental procedures in all patients at risk and for genitourinary and gastrointestinal tract procedures in patients at risk who have natural cardiac valves. Vancomycin should probably be the agent of choice for prophylaxis in cardiac valve surgery.

American Heart Association↗
PubMed1985

Changing pattern of infective endocarditis.

There has been a significant trend toward an increase in the age of patients with endocarditis, and it seems likely that the age of these patients will continue to increase as the population ages. The proportion of patients with endocarditis who have rheumatic heart disease as an underlying lesion has decreased from about 40 percent in patients studied from 1950 to 1970 to about 25 percent in more recent series, and this trend will probably continue. Prosthetic valves and degenerative heart disease will undoubtedly become increasingly important underlying heart lesions in patients with endocarditis. Another large group of patients with infective endocarditis have no diagnosable underlying heart disease and comprise an increasing proportion of patients with endocarditis. Because of the aging of the population, more Streptococcus bovis and enterococcal endocarditis should be expected. With more prosthetic valves and with the aging of the population, more staphylococcal endocarditis should be anticipated. Economic forces will probably result in earlier discharge from the hospital, with either shorter courses of therapy or completion of therapy at home and perhaps more valve replacements.

Adult↗
PubMed1985

The experience of a department of medicine with a clinical medical library service.

Five years of experience using the services of a full-time clinical medical librarian (CML) by the Department of Medicine at the Hospital of the Medical College of Pennsylvania have been reviewed. Over the five years there was a marked increase in queries from faculty and house staff members with an accompanying decrease in CML-initiated questions, while requests by students and others remained constant. The largest category of queries was patient-related. There were increases in the use of the CML for patient-related queries, for research, and for oral presentations. The number of requests obtained on rounds or in conferences decreased, while the number obtained by phone, in the library, or elsewhere increased. Requests for computer searches remained constant.

Faculty, Medical↗
PubMed1985

Enoxacin compared with cefoperazone for the treatment of experimental Enterobacter aerogenes endocarditis.

This study compared enoxacin administered orally with cefoperazone administered intramuscularly for the treatment of Enterobacter aerogenes endocarditis in rabbits. The MICs and MBCs of both enoxacin and cefoperazone for an inoculum of 10(5) CFU/ml of the E. aerogenes strain used were 0.8 micrograms/ml, respectively. With an inoculum of 10(8) organisms per ml, enoxacin at 2 and 5 micrograms/ml and cefoperazone at 60 and 155 micrograms/ml were effective in reducing titers of E. aerogenes in broth. E. aerogenes endocarditis in rabbits was treated with enoxacin (100 or 25 mg/kg orally every 6 h) or cefoperazone (60 mg/kg intramuscularly every 6 h) for 5 or 10 days. Enoxacin at 100 and 25 mg/kg significantly reduced bacterial titers of vegetations compared with those of untreated controls. Enoxacin at 100 mg/kg was significantly more effective than enoxacin at 25 mg/kg and cefoperazone. Enoxacin at 25 mg/kg and cefoperazone did not differ significantly. Cefoperazone and controls did not differ significantly. In uninfected rabbits single doses of cefoperazone achieved much higher concentrations in serum than single doses of enoxacin (25 and 100 mg/kg). The half-lives of enoxacin at 25 and 100 mg/kg were approximately three times longer than that of cefoperazone.

Animals↗
PubMed1985

Conducting clinical research in geriatric populations.

Clinical research on geriatric populations requires adaptation of traditional methodologies, modification of expectations, and the development of new procedures. Some aspects of research methodology are unique to studies of geriatric populations. Experience in this relatively new area of geriatric research indicates that new partnerships between researchers and long-term care providers are needed. These new relationships require an understanding of the needs of geriatric populations and of the differences between providers of long-term care and of acute-care. Researchers must consider heterogeneity of the population, the probability of multiple diagnoses and treatments, subject attrition, and the possibility of invalid data. Such considerations require extra staff, more time, and increased funding as well as new thinking about study design and protocol implementation.

Aged↗
PubMed1984

Host factors in the pathogenesis of urinary tract infections.

Classic animal studies conducted two decades ago provided the basic understanding of the pathogenesis of urinary tract infections. Those studies emphasized the natural resistance of the urinary tract to colonization and infection. Urinary obstruction, stasis, and reflux remain of great importance in all age groups in predisposing to infection. Recent studies of the crucial role of bacterial adherence to epithelial cells lining the genitourinary tract have shed new light on the pathogenesis of urinary infection. Information from adherence studies may have considerable clinical relevance with regard to the development of vaccines that prevent bacterial invasion particularly in the upper urinary tract. The normal defense mechanisms present in the human urinary tract are discussed. Despite progress in our understanding of the pathogenesis of urinary infection, considerable controversy still exists particularly with regard to host susceptibility to recurrent lower urinary tract infections in women with anatomically normal urinary tracts. Recent studies also have emphasized the significance of the host's normal immunologic mechanisms in contributing to intrinsic renal damage after upper urinary tract invasion by bacteria.

Adult↗
PubMed1983

Pharmacokinetics of cefoperazone in normal subjects and patients with hepatosplenic schistosomiasis.

The pharmacokinetics of cefoperazone were studied and compared in four normal subjects and six patients with hepatosplenic schistosomiasis (HSS) with mild liver disease but marked portal hypertension. All subjects received a 2 g intravenous infusion of cefoperazone over 15 min. Although most pharmacokinetic parameters did not differ significantly between normal subjects and patients with HSS, the serum beta half-life of cefoperazone was longer in patients with HSS compared to normal subjects (3.0 h vs. 1.7 h). This demonstrates only mild impairment of excretion of cefoperazone in patients with HSS.

Adult↗
PubMed1983

Cefoperazone pharmacokinetics in normal subjects and patients with cirrhosis.

The pharmacokinetics of cefoperazone were studied and compared in six normal subjects and six patients with severe liver disease. All subjects received a 2-g intravenous infusion of cefoperazone over 15 min. Significantly different results were noted between normal subjects and patients with cirrhosis (range [mean]) for the following: peak serum concentrations (203 to 345 [239] versus 82 to 206 [141] micrograms/ml; P less than 0.01); serum beta half-lives (1.0 to 1.8 [1.5] versus 2.3 to 9.9 [4.5] h; P less than 0.05); renal excretion (17 to 27 [21] versus 32 to 60 [50]%; P less than 0.01); and apparent volumes of distribution at steady state (4.1 to 7.8 [6.3] versus 12.7 to 23.8 [15.9] liters/1.73 m2; P less than 0.01). Lower peak serum levels in the patients with cirrhosis were probably related to an increased apparent volume of distribution secondary to ascites and to decreased serum protein binding of cefoperazone. Longer beta half-lives in the patients with cirrhosis were probably secondary to both decreased hepatic excretion caused by severe liver disease and to increased apparent volume of distribution. However, the longest beta half-life among the patients with cirrhosis was in a subject with a serum creatinine level of 2.1 mg/dl. We conclude that, although mild to moderate impairment of cefoperazone excretion occurs in patients with hepatic disease, adjustment of dosage may be necessary only with concomitant renal insufficiency.

Adult↗
PubMed1983

Single-dose cefonicid therapy for urinary tract infections.

The efficacy of single-dose therapy with cefonicid (1 g intramuscularly) and multidose therapy with amoxicillin (500 mg orally three times a day for 7 days) was compared for the treatment of uncomplicated lower urinary tract infection in women. Of 50 patients with symptoms of lower urinary tract infection randomized to receive either cefonicid or amoxicillin, 39 were infected with greater than or equal to 10(5) bacteria per ml. At early posttherapy follow-up (5 to 18 days), 19 of 21 (90%) cefonicid-treated patients and 16 of 18 (89%) amoxicillin-treated patients were cured. At late posttherapy follow-up (6 to 7 weeks), 16 of 18 (89%) cefonicid-treated patients and 14 of 15 (93%) amoxicillin-treated patients were cured. One patient was lost to follow-up in each late follow-up group. There were fewer side effects in the cefonicid-treated group. There were significantly more organisms resistant to amoxicillin than to cefonicid in the study population. Considering the small size of the series, single-dose therapy with cefonicid for lower urinary tract infection in women appears to be as safe and effective as conventional multidose therapy with amoxicillin.

Adult↗
PubMed1983

Aztreonam, cefoperazone, and gentamicin in the treatment of experimental Enterobacter aerogenes endocarditis in rabbits.

The effectiveness of aztreonam, cefoperazone, and gentamicin alone and in combination was evaluated in Enterobacter aerogenes endocarditis in rabbits. The minimal inhibitory concentration/minimal bactericidal concentration ratios for E. aerogenes were as follows: aztreonam, 0.4/0.4 microgram/ml; cefoperazone, 0.8/0.8 microgram/ml; and gentamicin, 3.1/3.1 micrograms/ml. With an inoculum of 10(9) organisms per ml, aztreonam and cefoperazone were equivalent in reducing titers of E. aerogenes in broth, and both drugs demonstrated an increased rate of reduction when gentamicin was added; gentamicin alone was least effective. E. aerogenes endocarditis in rabbits was treated intramuscularly with aztreonam (60 mg/kg) every 6 h, with cefoperazone (60 mg/kg) every 6 h, with gentamicin (1.7 mg/kg) every 8 h, and with aztreonam plus gentamicin or cefoperazone plus gentamicin for 5 and 10 days, respectively. All of the therapeutic regimens were effective in reducing vegetation titers as compared with untreated controls. Aztreonam plus gentamicin was more effective than either aztreonam or gentamicin alone. Cefoperazone plus gentamicin was more effective than cefoperazone alone but was not more effective than gentamicin alone. Neither aztreonam and cefoperazone nor aztreonam and gentamicin differed significantly, but gentamicin was significantly more effective than cefoperazone. Aztreonam plus gentamicin did not differ significantly in effectiveness from cefoperazone plus gentamicin. Aztreonam gave a peak level of about 135 micrograms/ml and a half-life of 0.7 h. Cefoperazone gave a peak level of about 155 micrograms/ml and a half-life of 1.1 h. Gentamicin gave a peak level of 7.4 micrograms/ml and a half-life of 1.3 h.

Animals↗