Specialized ambulatory dementia clinic. Arkansas: diagnostic & treatment services for patients and families.
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Biomedical subjects
Publications and source records attributed to T May.
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The aim of this study was to assess the clinical efficacy of a combination of penicillin G and ofloxacin in the treatment of community acquired pneumonia. Thirty eight patients (23 males, 15 females, mean age 62.8 years +/- 19.6) were included. They presented a CAP with the following criteria: fever, abnormal chest X-ray pattern. They received the combination of IV penicillin 12 x 10(6) U daily and IV ofloxacin 200 mg bid. After 48 hours of apyrexia, this treatment was followed by oral ofloxacin alone 200 mg bid. In six cases, the etiologic agent was identified: 2 S. pneumoniae, 1 Chlamydiae psittaci, 2 Staphylococcus aureus, 1 Mycoplasma. In 32 cases, the bacteriological investigation was negative. Five patients were excluded: 2 deaths due to heart failure, 3 alterations of treatment. Twenty eight patients recovered: apyrexia was obtained in 3.5 days. Penicillin G was prescribed for 7.5 days +/- 2.65, followed by ofloxacin alone for 11.43 +/- 3 days. Five patients were considered as clinical failures: 2 deaths due to extensive pneumonia, 3 recoveries after alteration of treatment. Side effects were rare: 1 confusion, 2 skin rashes. As a conclusion: penicillin G and ofloxacin in combination for the initial therapy of CAP, rapidly relayed by ofloxacin alone, permitted 84.3% of recovery in our patients.
HPA-23 is a competitive inhibitor of the RNA-dependent DNA polymerase (reverse transcriptase) of the human immunodeficiency virus (HIV). It may therefore potentially benefit patients with HIV infection. This study aimed at defining the haematopoietic toxicity of this drug and particularly its effects on the normal human granulocyte-macrophage progenitor cells (GM-CFU). Our in vitro studies, in semi-solid agar, have shown an inhibitory effect of increasing concentrations of HPA-23 on colony and cluster formation. This effect is probably dose-dependent. An almost complete inhibition of colony formation was observed at doses of more than 20 micrograms/ml. Regarding cluster formation, a similar although much more progressive inhibitory effect was found. Our experimental data should be extrapolated with caution to clinical situations. However, they must be kept in mind for optimal design of HPA-23 therapy in HIV infected patients.
Fluctuations in the carbamazepine (CBZ) concentration during the day were studied using the profiles of 88 patients on slow release CBZ preparations. Blood was taken at 800, 1100, 1400, 1700, 2000, 2200 and 800 hr of the following day. The CBZ dosage was divided into two equal doses and administered at 800 and 2000 h. The influence of different factors on the fluctuations in the CBZ concentration during the day was studied. The fluctuation correlated negatively (r = -0.51, p less than 0.001) with the level-dose ratio LDR (CBZ morning concentration-CBZ dose per body weight ratio). The co-medication and preparation had no additional significant influence on fluctuations in the CBZ concentration during the day. The maximal CBZ serum concentration during the day can be described for most patients as a function of the CBZ morning concentration and the level-dose ratio using a suitable regression equation (r = 0.93, standard error of estimate = 1.2 mg/L).
Using a new promoter analysis transformation vector for Dictyostelium discoideum (PAV-CAT), we have defined cis-acting elements in the promoter of the cyclic AMP-induced early-expressed gene A11H2, which encodes an alpha-fucosidase-related protein (A. Müller-Taubenberger, M. Westphal, A. Noegel, and G. Gerisch, FEBS Lett. 246:185-192, 1989). Sequences responsible for developmentally regulated gene induction could be separated from the basal promoter that conferred low levels of transcriptional activity. By gel shift experiments, we present evidence that the cis-acting element is the target of a trans-acting factor that by itself is subject to developmental regulation.
We report a case of amodiaquine-induced agranulocytosis in a 60-year-old woman. Four months after the agranulocytosis episode we investigated the effect of the drug using in vitro agar culture techniques. Amodiaquine at increasing concentrations (0.005, 0.05 and 0.5 microgram/ml) displayed an inhibitory effect, probably dose-dependent, on the growth of the patient's bone marrow GM-CFU colonies in the absence of autologous serum. In contrast, no effect was found on the colony and cluster growth of bone marrow samples from 13 healthy controls. Though it has been shown in several cases that amodiaquine-induced agranulocytosis occurs via immune-mediated mechanisms, our data are in support of a direct toxic effect of the drug on abnormally sensitive myeloid progenitor cells.
Twelve ruminally and abomasally cannulated lambs (27 +/- 1.16 kg) and 16 intact lambs (28 +/- 1.49 kg) were used in two trials to study the influence of dairy biomass (a cheese processing wash water sludge) as a protein source in medium-concentrate diets. In Trials 1 and 2, lambs were assigned to one of three concentrate diets containing 0, 10 or 20% biomass with an additional positive control diet in Trial 2. Biomass provided 27.4 and 52.7% of the CP in 10 and 20% biomass treatments, respectively. Diets were similar in N content and were fed at 3.5% of initial BW (as fed). Apparent ruminal OM and N digestibilities were lower (P less than .10) in lambs receiving 20% biomass than in lambs fed 0 or 10% biomass. Postruminal N digestibility was higher (P less than .10) for lambs fed 20% biomass. Apparent OM and N digestibilities in both trials were reduced (P less than .10) in lambs fed 20% biomass. Apparent OM and N digestibilities in both trials were reduced (P less than .10) in lambs receiving 10% biomass compared to lambs fed other treatments. Plasma urea N concentration (mg/dl) was higher (P less than .10) at 3 and 9 h after feeding in lambs receiving 10 and 20% biomass compared with control lambs. Although N retention was unchanged, fecal N excretion was higher (P less than .10) and urinary N excretion was lower (P less than .10) in lambs consuming 10 and 20% biomass treatments. Non-ammonia N and feed N flow (g/d) were higher (P less than .10) in abomasal contents of lambs consuming 20% biomass vs other dietary treatments but N digestibility was decreased. In conclusion, digestibility was decreased and site of N digestion was altered by feeding biomass.
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The expression of the adhesion molecule LFA1 was investigated in mononuclear cells from 200 samples of peripheral blood obtained from asymptomatic HIV-infected individuals and AIDS patients. The numbers and percentages of LFAI-positive cells were established by indirect immunofluorescence. A significant decrease in the number of labelled cells was observed (mean percentage 68.9) while 100% of the cells were positive in controls. These data suggest that LFA1-mediated cell-cell cooperation might be impaired in HIV infection, adding to the immune deficiency related to the disappearance of CD4+ cells.
An early treatment and an adequate antimicrobial chemotherapy are major prognostic factors for bacterial meningitis, brain abscesses and related infections. The necessity of an early therapy requires to begin an empiric antibiotic treatment prior to obtain microbiological results. The principles that apply to empiric therapy of other types of infections are equally applicable to the treatment of central nervous system (CNS) infections and include: the capacity of achieving adequate levels of antibiotic in the CNS and for the brain (pharmacokinetic criteria), the knowledge of the most likely etiologic agents for central nervous system infections and their antibiotic susceptibility (bacteriological criteria). The main clinical types of CNS infection are reviewed for their usual etiologic agents, with a definition of an optimal "bacteriological deal" for each situation. Most studies emphasize the striking differences in the clinical features, etiologic agents and prognosis of spontaneously occurring (primary) meningitis, as opposed to post-traumatic or post-surgical, frequently Gram negative bacillary (secondary) meningitis and other CNS infections (brain abscesses and related infections). These studies, as our experience, suggest that the selection of an empiric therapy must be adapted for each clinical situation. Ampicillin still appears to be an ideal agent for empiric therapy for primary meningitis in older children and adults, in whom meningitis are usually caused by N. meningitidis and S. pneumoniae. In younger children (before 6 years), H. influenzae is more often implicated and the occurrence of beta lactamase mediated resistance to ampicillin in as high as 15% of isolates led to use a third generation cephalosporin as an empiric therapy. Neonatal meningitis, meningitis following trauma or surgery, brain abscess, subdural empyema, epidural abscess are caused by various etiologic agents including Streptococcus sp, Staphylococcus sp, Enterobacteriaceae, and for brain infections, anaerobic bacteria. Each situation led to specific recommendations by authors. Finally, miscellaneous aspects of therapy as the usefulness of intrathecal or intraventricular therapy, duration of treatment and place of the neuro-surgery during CNS infections are briefly reviewed.
Seventeen Caucasian patients with acquired immunodeficiency syndrome (AIDS) contracted after long stays in Africa are reported. Central Africa was concerned in all cases. Men are particularly exposed to AIDS whatever their occupation. This study suggests that the risk of contracting AIDS in Africa is high; the transmission of the virus was related to sexual contact, particularly with prostitutes, in Africa in most of the cases. It suggests also that Caucasians who travel in Africa spread the virus throughout the world by means of their heterosexual relations.
The influence of carbamazepine (CBZ) dose, CBZ preparation used, comedication (phenobarbital, phenytoin, primidone, valproate), and factors such as age, weight, and sex on the concentration of CBZ and its metabolites carbamazepine-10,11-epoxide (CBZ-epoxide) and 10,11-dihydro-10,11-dihydroxy-carbamazepine (CBZ-diol) in serum was investigated. A non-linear regression analysis using the data of 609 patients shows that other anti-epileptic drugs can influence the metabolism of CBZ in various ways. The mean serum concentration of CBZ is lower when the drug is given in combination with phenytoin (59.4%), primidone (58.2%), phenobarbital (65.7%), and valproate (83.0%) than when CBZ is given alone (100%), whereas the mean concentration of CBZ-epoxide is increased by valproate (144.8%), by primidone (118.5%), and by a combination of the latter (167.4%). The CBZ-diol concentrations are also increased during concomitant treatment with the other antiepileptic drugs. Our results indicate a nonlinear relationship between the CBZ dose and the CBZ concentration, but a linear relationship between the CBZ dose and the CBZ-diol concentration.
Two experiments were conducted with growing male rats to determine the effects of 120 ppm of dietary sarsaponin (S) on nitrogen (N) metabolism when urea or protein are added to the diet. Growth, feed efficiency, N digestibility and balance, urinary N and ammonia-N (NH3-N), and cecal urease and NH3-N were measured. Growth and feed utilization were unaffected by dietary S. Adding urea or protein to the diet increased apparent N digestibility and increased urinary-N excretion. Urea did not affect N balance, whereas growth, feed utilization and N balance were maximized with 22% compared with either 16 or 28% dietary protein. Urinary NH3-N excretion was decreased by S when urea was added to the diet but was not affected when fed with increasing dietary protein. Cecal urease was decreased by S when urea was added or when the protein level was increased in the diet; effects on cecal NH3-N varied between the two experiments. Plasma urea-N was decreased by S. It is concluded that S has minor effects on N metabolism in rats and that NH3-N formation or excretion is only marginally affected by dietary S. If S decreases NH3-N level in confinement facilities, it is concluded that the effect is after the waste material is excreted by the animal, perhaps through reduced urease activity.
From 1984 to 1986, 13 patients (10 adults, 3 children) with bacterial meningitis following neurosurgery or traumatism were given ceftriaxone alone 6 times at a dose of 40 mg/kg one IV injection per day, or in association 7 times with fosfomycin at a dose of 200 mg/kg/day, 3 IV perfusions every 4 h. The bacteriological diagnosis was confirmed in 9 cases (3 Staphylococcus aureus, 4 Streptococcus pneumoniae, 1 Klebsiella, 1 Peptococcus). In vitro neither synergy nor antagonism were observed between the two antimicrobial agents. The acute infections episode resolved in all patients except on who died with a negative CSF culture. One superinfection meningitis with Achromobacter was seen. CSF concentrations of ceftriaxone were assayed and found to be comparable with those reported by most authors. Tolerance was excellent for all our patients.
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The clinical activity of piperacillin was evaluated in 34 children (mean age: 8 years) presenting with severe infection (septicaemia, meningitis, bronchopneumonia, pyelonephritis). A bacteriological diagnosis was established in 24 cases. The mean duration of treatment was 11 days, and the mean dose 220 mg/kg/day administered in three injections. In 25 cases piperacillin was combined with another antibiotic, usually an aminoglycoside (20 cases). Clinical cure or improvement was obtained in 29 children (85%). Treatment was well tolerated, with only 2 cases of moderate blood eosinophilia. In view of these results the authors suggest that piperacillin could be used in children in two circumstances: severe infections caused by Gram-negative cocci or bacilli in children with cystic fibrosis or neutropenia, and against infections contracted in intensive care units, or in children with febrile leucopenia, combined with an aminoglycoside in the absence of, or pending bacteriological results.
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