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Biomedical subjects

J Hedlund

Publications and source records attributed to J Hedlund.

29 records · Page 2Linked to original sources
PubMed1995

Incidence, capsular types, and antibiotic susceptibility of invasive Streptococcus pneumoniae in Sweden.

The number of reported cases of invasive pneumococcal infections in Sweden increased more than threefold from 1988 through 1992. We studied the capsular types and the antibiotic susceptibility of 619 pneumococcal strains isolated from blood or CSF at 18 Swedish microbiological laboratories in 1987 and in 1992. These strains belonged to 35 of the 84 recognized capsular types. We noted a remarkable increase in the prevalence of invasive infections with type 14 from 1987 (8.2%) to 1992 (18%) (P = .001), which correspond to a sevenfold increase in absolute numbers. The most prominent increase in infections was seen among elderly people; in 1992, type 14 accounted for 22.5% of the isolates from infected persons who were >64 years of age. The majority of the strains were susceptible to all antibiotics tested. However, there was a significant increase in trimethoprim-sulfamethoxazole resistance from 1.4% in 1987 to 7.1% in 1992. Nine multiresistant isolates (1.5%) were found.

Adolescent↗
PubMed1995

Short- and long-term prognosis for middle-aged and elderly patients hospitalized with community-acquired pneumonia: impact of nutritional and inflammatory factors.

To investigate the impact of nutritional and inflammatory factors on short- and long-term prognosis for patients hospitalized for community-acquired pneumonia (CAP), 97 patients, 50-85 years old, admitted to the Department of Infectious Diseases at Danderyd Hospital were enrolled in a prospective study. 13 enrolment variables were examined for association with 6 outcome variables. Serum orosomucoid concentration, acute physiology and chronic health evaluation (APACHE) II score, body mass index (BMI) and triceps skinfold (TSF) were each associated with duration of hospital stay. A low TSF and BMI, and a high APACHE II score were all associated with death. A high APACHE II score and a high TSF were both associated with readmission within 6 months of discharge. The alfa-1-antitrypsin concentration was the most closely correlated with duration of fever. We conclude that the admission concentrations of alfa-1-antitrypsin and orosomucoid are better predictors of hospital morbidity than the more commonly used albumin and C-reactive protein (CRP) levels. Measurement of APACHE II and TSF on admission may give additional prognostic information on the interval from admission to 6 months after discharge.

APACHE↗
PubMed1995

Diagnostic and prognostic value of interleukin-6 and C-reactive protein in community-acquired pneumonia.

The diagnostic and prognostic value of admission serum levels of interleukin-6 (IL-6) and C-reactive protein (CRP) was investigated in 203 hospital-treated patients with community-acquired pneumonia (CAP). In serum samples obtained during the first 24 h after admission, IL-6 was detectable in 198 patients (98%), with a median value of 50 ng/l. Ten % of the patients had IL-6 values of 1000 ng/l. A clear positive correlation between IL-6 and CRP was found (r = 0.29, p < 0.0001). Patients with high IL-6 or CRP levels had longer duration of fever, longer hospital stay, and had less often recovered clinically or radiographically on follow-up weeks after discharge. A high IL-6, but not a high CRP, also seemed to be associated with a higher mortality. Bacteremic pneumococcal pneumonia had the highest levels of IL-6 (mean 2852 and median 420 ng/l) and CRP (mean 292 and median 285 mg/l). High IL-6 values were also seen in patients with non-bacteremic pneumococcal pneumonia, while all patients with pneumonia due to other bacterial, or viral, aetiology had IL-6 levels of < or = 300 ng/l. In conclusion, IL-6 and CRP are promising diagnostic and prognostic tools in the management of CAP. Further studies are needed to establish the usefulness of repeated measurements early in the hospital course of the disease.

Bacteremia↗
PubMed1995

Community-acquired pneumonia requiring hospitalisation. Factors of importance for the short-and long term prognosis.

In 277 patients admitted to hospital for community-acquired pneumonia (CAP) an aetiologic diagnosis was established in 68% with S. pneumoniae being the predominating agent. Four percent of the patients (12/277) died during their hospital stay, and only one of these patients was below 60 years of age. On admission, the most important factor, independently associated with fatal disease was a low serum albumin concentration, which was also a negative prognostic factor for the course of the survivors. In patients admitted to hospital for CAP, the finding of a low serum albumin level should therefore lead to intensified observation and treatment. Of 241 patients discharged after treatment for CAP, 50 patients were readmitted to hospital with recurrence of pneumonia during a 31 month follow-up period. This pneumonia incidence rate was more than five times that in a control population. Fifty-one of the patients (21%) died during follow-up, with 13 (25%) of the deaths directly associated with pneumonia. Systemic treatment with corticosteroids was associated with a higher risk of recurrence of pneumonia and death, while airway colonisation with Gram-negative enteric bacteria and a serum albumin below 30 g/l during hospital treatment of the initial pneumonia were associated with death from pneumonia after discharge. In 97 middle-aged and elderly patients admitted to hospital for CAP, malnutrition reflected by low triceps skinfold (TSF) and body mass index (BMI) values was associated with death during a six-month follow-up period, as was severity of disease on admission classified according to acute physiology and chronic health evaluation (APACHE II). Admission serum concentrations of orosomucoid and alpha-1-antitrypsin were most closely correlated with in-hospital morbidity measured as days spent in hospital and duration of fever. The risk of readmission within six months of discharge was higher in patients with high admission levels of APACHE II and TSF. Measurement of serum concentrations of alpha-1-antitrypsin and orosomucoid on admission should be considered in order to better predict hospital morbidity in these patients. Measurements of APACHE II and TSF on admission may give additional prognostic information on the interval from admission to six months after discharge. On admission 64% of the patients were hypoalbuminaemic, but only 6-10% were so at follow-up visits. Admission serum albumin concentration correlated negatively with investigated acute-phase proteins, and positively with other serum transport proteins, but no association with investigated nutritional measurements was found. The main reason for depressed serum albumin in elderly patients with pneumonia thus seems to be not malnutrition, but the inflammatory reaction per se. In 203 hospital-treated patients with CAP, the diagnostic and prognostic value of admission serum levels of interleukin-6 (IL-6) and C-reactive protein was investigated. The highest levels of IL-6 and CRP were found in patients with pneumococcal pneumonia, especially when bacteraemic. Patients with high IL-6- or CRP levels had longer duration of fever, longer hospital stay, and fewer had recovered clinically or radiographically at follow-up eight weeks after discharge. A high IL-6, but not a high CRP, also seemed to be associated with a higher mortality. The type-specific antibody responses to six pneumococcal capsular polysaccharide antigens included in the 23-valent vaccine as well as antibodies against the vaccine were measured by use of an enzyme-linked immunosorbent assay in 65 middle-aged and elderly individuals treated in hospital for pneumonia eight weeks prior to vaccination. The antibody concentrations before and after the vaccination were comparable with those in a vaccinated age-matched control group who had not recently been treated for pneumonia...

Adult↗
PubMed1990

Recurrent encephalitis due to trimethoprim intake.

We wish to report a 76-year-old woman with 2 episodes of meningitis related to the intake of trimethoprim. On both occasions the patient demonstrated encephalitic symptoms and a pathological electroencephalogram with cerebral function disturbances. A similar case with encephalitic symptoms due to trimethoprim has not been reported earlier.

Aged↗
PubMed1990

Aetiology, outcome and prognostic factors in community-acquired pneumonia requiring hospitalization.

Outcome and prognostic factors were prospectively studied in 277 adult patients (average age 62 yrs) with community-acquired pneumonia requiring hospitalization. The aetiology was established in 68%, with S. pneumoniae as the predominating agent. Mortality was 4% (12 of 277), and all but one who died were greater than or equal to 60 yrs of age. Features associated with high mortality included greater age, absence of chills and chest pain, high respiratory rate (greater than 30 breaths.min-1) and low serum albumin on admission, and the occurrence of airway colonization and secondary infection during hospital stay. Multivariate analysis showed that low serum albumin and the occurrence of secondary infection, but also absence of chills and airway colonization, were correlated to a higher mortality. In patients who survived, the median length of hospital stay was seven days, and at follow-up, about eight weeks after admission, 81% had recovered and chest X-ray was normal in 84%. In conclusion, we believe that the outcome of community-acquired pneumonia can be influenced by prophylactic measures against pneumococcal infection, and an increased surveillance of risk patients.

Adolescent↗
PubMed1989

Replicated item level factor structure of the MMPI: racial and sexual differences.

Item-level factor studies of the MMPI date back to the work of Comrey (1957). Surprisingly, there are no extant studies of the items that clinicians use most in the course of daily MMPI interpretive reporting, namely, the 399 x 399 matrix that represents all of the items that comprise the traditional clinical and validity scales. Furthermore, there are no prior studies with adequate Ns that have examined the replicability of MMPI factor structure via available factor comparison techniques (Harman, 1976). In this study, 20,000 MMPIs were factored by the principal components method, followed by Varimax rotations of 6 through 25 factors. The coefficient of congruence was used to compare the factor structures of randomly divided subsamples, as well as males vs. females and Blacks vs. Whites. Differences in factor structure were found, and suggestions are made with regard to the significance of these findings in clinical and applied settings.

Adult↗
PubMed1983

Changes in simple and complex behaviors following kindled seizures in rats: opioid and nonopioid medication.

To learn more about postictal behaviors and their underlying mechanisms, five behaviors and EEG recordings were studied following fully generalized, kindled seizures in rats. The behaviors included bar pressing for food; tail withdrawal, squeak, and multiple squeak responses to painful tail shocks; consumption of freely available food; clinging to a vertical grid; and locomotion. Latencies from the end of a seizure afterdischarge until each behavior recovered were compared and were found to cluster in three distinct pairs. Locomotion and grid clinging recovered most quickly; consumption of freely available food and EEG postictal depression recovered next; and bar pressing for food and the multiple squeak response recovered most slowly. Naloxone pretreatment (10 mg/kg but not 1 mg/kg) shortened recovery to multiple squeak responses, grid clinging, and locomotion, without affecting recovery of bar pressing, food consumption, or EEG postictal depression. These results suggest that complex behaviors recover more slowly following a seizure than simple behaviors. It also appears that opioids are released by a kindled seizure and mediate certain postictal changes in motor- and pain-related behaviors.

Animals↗
PubMedDate not supplied

Nasopharyngeal culture in the pneumonia diagnosis.

The diagnostic value of bacterial cultures from nasopharynx (NPH) was prospectively studied in 261 patients with community-acquired pneumonia requiring hospitalization. NPH culture results were compared with those of other diagnostic methods: Culture from blood and sputum, pneumococcal antigen detection, enzyme immuno assay (EIA) for detection of antibodies against pneumococcal hemolysin and in selected cases bronchoscopy. Pneumococcal pneumonia was diagnosed by these other methods in 121 patients. Streptococcus pneumoniae was detected in NPH in 33 of these patients (27%, or 36% if only cultures obtained before start of antibiotics are considered), but in only four of the other 140 patients. For other species the relevance of NPH culture was uncertain. Because of its simplicity and high specificity NPH culture can be a valuable supplement to other diagnostic methods, particularly when sputum samples are difficult to obtain.

Adult↗
PubMedDate not supplied

Procalcitonin and C-reactive protein levels in community-acquired pneumonia: correlation with etiology and prognosis.

BACKGROUND: The diagnostic value of admission serum levels of procalcitonin (PCT) and C-reactive protein (CRP) as indicators of the etiology and prognosis was prospectively investigated. PATIENTS: 96 patients, 50-85 years of age, treated in the hospital for community-acquired pneumonia (CAP). RESULTS: On admission, all patients had elevated CRP levels (> 10 mg/l), but only 60 patients (54%) had elevated PCT levels (> 0.1 microgram/l). The severity of disease measured by APACHE II score was strongly associated with admission levels of PCT (p = 0.006), but not with CRP. Eight of nine patients with pneumonia caused by atypical agents had PCT levels < 0.5 microgram/l compared with 6/27 patients with pneumonia caused by classic bacterial pathogens, mainly Streptococcus pneumoniae (p = 0.03). No such correlation between CRP levels and etiology was found. CONCLUSION: Our data indicate that in patients admitted to the hospital with CAP, measurement of PCT gives information about the severity of the disease, and may aid the physician to differentiate typical bacterial etiology from atypical etiology, and thereby to choose appropriate initial antibiotic treatment.

APACHE↗