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PubMedDate not supplied

[Strategies to reduce morbidity and mortality caused by acute diarrhea in Latin America].

Following the World Health Organization guidelines, the Latin American Diarrheal Disease Control Programs have directed its efforts towards the promotion of Oral Hydration Therapy (OHT) and appropriate dietary management during the diarrheal episode and convalescent period, aimed at diminishing the mortality secondary to diarrhea. In developing countries, OHT is preventing, annually, one million of childhood deaths due to dehydration. Yet, only one fourth of the total population of children suffering diarrhea are being treated with this therapy. Among the strategies to decrease diarrhea morbidity, breast-feeding and hand washing are top priorities. The fundamental strategy has been to promote educational programs to train health personnel and community members. To continue these actions, we suggested the creation of more secondary and tertiary level hospitals and the installation of community units of OHT. They should become self-sufficient and self-manageable and include other programs of primary health care, such as immunization, growth and development surveillance, family planning and pregnancy control.

Acute Disease↗
PubMed1998

Technical aspects of minimally invasive abdominal surgery performed with needlescopic instruments.

Interest has grown in reducing the size of laparoscopic instruments. We define as "needlescopic" those instruments that have a diameter of < or =3 mm. We compared data from 60 needlescopic cholecystectomies with a matched group of laparoscopic procedures. No intraoperative complications occurred in either group. Operative time was 20% longer for the needlescopic operations. Hospital stay was similar for both groups. Postoperative analgesia requirements for the needlescopic group were 70% lower than for the laparoscopic group. From a scale (0, no scar visible, to 10, worst scar), patients scored their scars as 1 for the needlescopic cases and 5 for the laparoscopic group. Likewise, we have used needlescopic instruments to perform appendectomy, inguinal herniorrhaphy, adrenalectomy, splenectomy, and fundoplication. In conclusion, needlescopic procedures are safe and efficient. While they result in longer operative times, they decrease the need for postoperative analgesia, which may shorten convalescence and improve the cosmetic result.

Abdomen↗
PubMed1993

Long-term psychological and physiological effects of heat stroke.

Heat stroke leads only rarely to permanent neurological deficits and the convalescence is almost complete. There are, however, some sporadic descriptions of disturbances that lasted for up to 4 months. Little has been mentioned in the literature on residual changes in personality and late neurological side effects. The present study was conducted to follow systematically late personality and behavioral abnormalities in a population of heat stroke victims. This study analyzed 21 young subjects (age: 21 +/- 2 years), who were inflicted by heat stroke. They were invited for a physiological and psychological follow-up examination at least 6 months post-hospitalization. The psychological assessment was comprised of the self-report symptom checklist-90R (SCL-90R), which inquires about symptoms during the 2 weeks preceding the interview. The results indicated that the subjects are psychologically healthy because their scores fell within the normal range. Comparison with a carefully matched control group strengthened this finding. The conclusion was that prominent neurological or behavioral sequelae in heat stroke victims are rare. The psychological assessments clearly indicate that heat stroke did not leave long-term adverse residues. However, one should be aware of the possible complications and follow the patient for several months after the event.

Adult↗
PubMed1990

[A case report of spotted fever group rickettsiosis first encountered in Shimane Prefecture, Japan].

Rickettsial infections of a spotted fever group have recently been experience in Japan. Although there have been 50 cases reported by this time, they were exclusively distributed in the areas along the Pacific coast. We report in this paper the first case of spotted fever group rickettsiosis in Shimane prefecture, an area faced to the Japan Sea. A 57 year-old man with high fever, general fatigue and rash was admitted to the hospital of Shimane Medical University at the end of September 1987, who had been treated with cefaclor for a few days without effect before his visit to the University Hospital. Physical examination revealed erythematous eruption, eschar on the left side of the abdomen, and generalized lymphadenopathy. Hepatosplenomegaly was not detected. Laboratory studies showed normal leukocyte counts with relative lymphopenia, high ESR and increased CRP. Transaminase levels were slightly elevated. Paul-Bunnel and Weil-Felix tests resulted in negative. Specific immunofluorescence tests demonstrated that IgG and IgM antibodies of acute-phase serum to Rickettsia japonica, a spotted fever group rickettsia isolated from patients in Japan, were not detected, while both IgG and IgM antibody titers of convalescent-phase serum increased to 1:320. Convalescent-phase serum reacted at significantly lower titers with R.typhi as well as other pathogenic spotted fever group rickettsiae. The patient was treated with ofloxacin for six days and then with combination of ofloxacin and minocycline. It should be noted that clinical symptoms such as high fever and general fatigue disappeared during a single therapy with ofloxacin.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibodies, Bacterial↗
PubMed2003

Total artificial hearts: bridge to transplantation.

The CardioWest TAH was created and initially tested at the same time as the Thoratec, Novacor, and HeartMate devices. It was designed as a permanent artificial heart and was the first-ever mechanical circulatory device to be used as destination therapy. Twenty years have passed since that early experience. Pneumatic technology is still current and being developed as in existing or new implantable Thoratec VADs the pneumatic HeartMate, and the Abiomed BVS 5000 pumps. Portable pneumatic drivers have been available since 1982, and in recent times have allowed discharge to home of substantial numbers of patients, thus reducing the length of hospital stays and making mechanical device support less expensive to society and more tolerable to patients. Within months, a portable driver for the CardioWest will be available. The documented benefits of the CardioWest TAH include rescue of: critically ill patients with advanced heart failure; patients with biventricular failure especially those with significant right heart failure, elevated pulmonary vascular resistance, or pulmonary edema; patients with renal or hepatic failure secondary to low cardiac output; patients with massive myocardial damage such as those with post-\infarction VSD or irreversible cardiac graft rejection; patients with mechanical valves or native valve disease; and patients with intractable arrhythmias and heart failure. High device outputs with restoration of normal filling pressures result in high perfusion pressures that have led to dramatic recoveries, convalescence, and return to levels of activity compatible with normal life. The average device output with the CardioWest TAH is higher than any other approved or investigational device. The reason for this resides in design simplicity this device has the shortest and largest inflow pathway. Stroke, in the authors' own series, is rare with a linearized rate of 0.068 events per patient year. If the experiences of La Pitie and the University of Arizona are combined, there has been one stroke in 25 patient years (0.04 events/patient year). Serious infections have been rare (12% of patients). No clinical mediastinitis has occurred. Drivelines have healed in tightly and never caused an "ascending" infection. There has not been a case of device endocarditis. Using a broad definition of bleeding, including takeback reoperation for bleeding, bleeding more than 8 units in the first postoperative 24 hours or 5 units over any other 48-hour period, a 25% to 36% incidence has been documented. No cases of fatal exsanguination have resulted, as there have been with the HeartMate. The incidence of bleeding as an adverse event is about 17% lower than the rate reported for the HeartMate VE LVAD, and it is about the same as that reported for Novacor and for Thoratec. Implantation of this device is relatively easy and often done (with attending help) by the authors' residents. If one follows the guidelines for fitting the device, and takes the recommended advice for implantation, hemostasis is excellent and restoration of immediate cardiac function with high flows is nearly automatic. Use of a neopericardium of 0.1 mm EPTFE at the time of implantation assures atraumatic and relatively quick re-entry for transplantation and prevents the normal inflammatory mediastinal reaction that might be desirable in a destination application. In selected patients the CardioWest TAH is the device of choice for bridge to transplantation. When a portable driver becomes available, out of hospital management of CardioWest TAH patients will be feasible and consideration of use of this device for longer term applications, (e.g., "destination therapy,") will be reasonable. A wearable driver, even smaller than a portable, will improve quality of life and expand the patient population that may be therapeutically served with this system. In short, the CardioWest TAH has come nearly full circle. It was first used as a destination device. It has since been used as a bridge to transplantation in nearly 200 patients as the Jarvik-7/Symbion TAH and, since 1993, in over 225 patients as CardioWest. The results have improved with time. Thromboembolism and infection rates have been competitive with currently available devices. Device reliability and durability have been excellent. Survival rates have been very high in a group of perhaps the sickest patients to be supported with any pulsatile device. Pneumatic technology has improved with portability and miniaturization, and there is reason to believe that it will become even better. Application of modern manufacturing techniques to this very simple device raises the possibility of significant manufacturing cost reduction, in an era of prohibitive cost for other devices. All of this establishes the CardioWest as a valuable device for any program that is seriously interested in end-stage heart disease and a likely device for permanent use in appropriately selected patients.

Anticoagulants↗
PubMed1999

Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery.

BACKGROUND: Continuous passive motion after major knee surgery optimizes the functional prognosis but causes severe pain. The authors tested the hypothesis that postoperative analgesic techniques influence surgical outcome and the duration of convalescence. METHODS: Before standardized general anesthesia, 56 adult scheduled for major knee surgery were randomly assigned to one of three groups, each to receive a different postoperative analgesic technique for 72 h: continuous epidural infusion, continuous femoral block, or intravenous patient-controlled morphine (dose, 1 mg; lockout interval, 7 min; maximum dose, 30 mg/4 h). The first two techniques were performed using a solution of 1% lidocaine, 0.03 mg/ml morphine, and 2 microg/ml clonidine administered at 0.1 ml x kg(-1) x h(-1). Pain was assessed at rest and during continuous passive motion using a visual analog scale. The early postoperative maximal amplitude of knee flexion was measured during continuous passive motion at 24 h and 48 h and compared with the target levels prescribed by the surgeon. To evaluate functional outcome, the maximal amplitudes were measured again on postoperative day 5, at hospital discharge (day 7), and at 1- and 3-month follow-up examinations. When the patients left the surgical ward, they were admitted to a rehabilitation center, where their length of stay depended on prospectively determined discharge criteria RESULTS: The continuous epidural infusion and continuous femoral block groups showed significantly lower visual analog scale scores at rest and during continuous passive motion compared with the patient-controlled morphine group. The early postoperative knee mobilization levels in both continuous epidural infusion and continuous femoral block groups were significantly closer to the target levels prescribed by the surgeon than in the patient-controlled morphine group. On postoperative day 7, these values were 90 degrees (60-100 degrees)(median and 25th-75th percentiles) in the continuous epidural infusion group, 90 degrees (60-100 degrees) in the continuous femoral block group, and 80 degrees (60-100 degrees) in the patient-controlled morphine group (P < 0.05). The durations of stay in the rehabilitation center were significantly shorter: 37 days (range, 30-45 days) in the continuous epidural infusion group, 40 days (range, 31-60 days) in the continuous femoral block group, and 50 days (range, 30-80 days) in the patient-controlled morphine group (P < 0.05). Side effects were encountered more frequently in the continuous epidural infusion group. CONCLUSION: Regional analgesic techniques improve early rehabilitation after major knee surgery by effectively controlling pain during continuous passive motion, thereby hastening convalescence.

Adolescent↗
PubMed2003

Eosinophil activation and preschool viral wheeze.

BACKGROUND: A study was undertaken to ascertain whether systemic eosinophil activation is associated with preschool viral wheeze (PVW). METHODS: Urinary eosinophil protein X (uEPX) and serum total IgE (IgE) levels were measured in children admitted to hospital with PVW, and uEPX was measured 6 weeks after discharge. Two years after admission, current wheeze in children aged > or =5 years was determined by questionnaire. Controls were recruited from children undergoing elective surgery (normal controls) and from those with skin prick test reactivity to foods (atopic controls). RESULTS: There was no difference in uEPX levels between normal controls (n=15) and atopic controls (n=8). uEPX levels were increased in children with acute PVW (n=84; p<0.001 v normal controls, p<0.01 v atopic controls) and fell on convalescence (n=20, 95% CI -217 to -31 microg/mmol creatinine, p<0.05). In children with acute PVW there was no association between uEPX and serum IgE levels or markers of clinical severity. Respiratory questionnaires were returned for 25/55 eligible children. There was no difference in uEPX level during acute PVW when stratified by "current wheeze" (n=18) or "no wheeze" (n=7) 2 years later. CONCLUSIONS: Systemic eosinophil activation is associated with PVW but is not associated with serum IgE, clinical severity, or persistence of wheeze into the early school age period.

Child, Preschool↗
PubMed1997

Laparoscopic adrenalectomy for solitary metachronous contralateral adrenal metastasis from renal cell carcinoma.

PURPOSE: We report our experience with laparoscopic adrenalectomy for malignant adrenal disease. MATERIALS AND METHODS: Between June 1995 and January 1996, 2 patients with a solitary metachronous contralateral adrenal metastasis from renal cell cancer were evaluated. Both patients had undergone radical nephrectomy for localized renal cancer 5 years previously. Laparoscopic transperitoneal adrenalectomy was performed. RESULTS: The laparoscopic procedures required 2.5 and 4.3 hours. Hospital stay was 3 and 4 days. The specimens weighed 98 and 81 gm. All surgical margins were free of metastatic clear cell cancer. Both patients were begun on prednisone and fludrocortisone replacement therapy. One patient experienced an increase in creatinine, which has since stabilized at 3.0 mg/dl. Neither patient had recurrent cancer at 11 and 16 months of followup. CONCLUSIONS: Laparoscopic adrenalectomy for metastatic renal cell cancer was performed successfully in 2 patients. However, the short-term benefits to the patient of earlier ambulation, decreased pain, minimal incisions and shortened convalescence must be weighted against the as yet unknown long-term (5 years) results.

Adrenal Gland Neoplasms↗
PubMed2002

An outbreak of eosinophilic meningitis caused by Angiostrongylus cantonensis in travelers returning from the Caribbean.

BACKGROUND: Outbreaks of eosinophilic meningitis caused by the roundworm Angiostrongylus cantonensis are rarely reported, even in regions of endemic infection such as Southeast Asia and the Pacific Basin. We report an outbreak of A. cantonensis meningitis among travelers returning from the Caribbean. METHODS: We conducted a retrospective cohort study among 23 young adults who had traveled to Jamaica. We used a clinical definition of eosinophilic meningitis that included headache that began within 35 days after the trip plus at least one of the following: neck pain, nuchal rigidity, altered cutaneous sensations, photophobia, or visual disturbances. RESULTS: Twelve travelers met the case definition for eosinophilic meningitis. The symptoms began a median of 11 days (range, 6 to 31) after their return to the United States. Eosinophilia was eventually documented in all nine patients who were hospitalized, although on initial evaluation, it was present in the peripheral blood of only four of the nine (44 percent) and in the cerebrospinal fluid of five (56 percent). Repeated lumbar punctures and corticosteroid therapy led to improvement in symptoms in two of three patients with severe headache, and intracranial pressure decreased during corticosteroid therapy in all three. Consumption of one meal (P=0.001) and of a Caesar salad at that meal (P=0.007) were strongly associated with eosinophilic meningitis. Antibodies against an A. cantonensis--specific 31-kD antigen were detected in convalescent-phase serum samples from 11 patients. CONCLUSIONS: Among travelers at risk, the presence of headache, elevated intracranial pressure, and pleocytosis, with or without eosinophilia, particularly in association with paresthesias or hyperesthesias, should alert clinicians to the possibility of A. cantonensis infection.

Adrenal Cortex Hormones↗
PubMed2005

Seroprevalence of hepatitis D virus in patients with hepatitis B virus-related liver diseases.

BACKGROUND AND OBJECTIVE: Several reports indicated a declining trend in the occurrence of hepatitis D virus (HDV) infection in some geographical areas. However, no study has been conducted in India to evaluate whether a similar epidemiological change is occurring in this part of the world. The present study was undertaken to evaluate the seroprevalence of HDV in patients with hepatitis B virus (HBV) related liver diseases attending a Government hospital in New Delhi, and to assess any change in its epidemiology by comparing the results with seroprevalence figures reported in the past. METHODS: A total of 123 patients with HBV-related liver diseases comprising 32 cases of acute viral hepatitis (AVH), 5 of fulminant hepatic failure (FHF), 37 of chronic hepatitis (CH), 46 of cirrhosis and 3 of hepatocellular carcinoma (HCC). All patients were evaluated for the presence of delta antibodies using commercially available ELISA kits. Both IgM and IgG anti-delta assays were performed to differentiate between active and convalescent infection. RESULTS: The mean age of the patients was 35.6 +/- 3.3 yr with a male : female ratio of 11:5. Of the 123 patients, serological evidence of delta virus infection was seen in 13 subjects (10.6%); 9 (7.3%) had evidence of past infection (IgG positive, IgM negative) and the remaining 4 (3.3%) recent infection (IgM anti-delta antibody positive). Evidence of HDV infection in acute viral hepatitis, fulminant hepatitis, chronic hepatitis, cirrhosis and hepatocellular carcinoma groups was found in 3.1, 20, 8.1, 15.2 and 33.3 patients, respectively. INTERPRETATION AND CONCLUSION: Our results suggest that delta infection may not be very common in Indian patients with HBV-related liver diseases. It is also possible that HDV epidemiology in this part of the world may be undergoing a transition towards decreasing prevalence.

Adult↗
PubMed1994

Respiratory syncytial virus infection in hospitalized patients and healthy children in El Salvador.

Nasopharyngeal specimens from 42 children less than one-year old hospitalized with bronchiolitis or pneumonia in El Salvador were analyzed for the presence of subgroup-specific respiratory syncytial virus (RSV) antigens by the indirect immunofluorescence technique. The antigen RSV-A was demonstrated in 28 children, RSV-B in three, and in one child subgroup, specificity could not be determined. The male:female ratio in the RSV-infected children was 1.9:1. The most severe disease, requiring intensive care, was observed in two infants with RSV-B infection. Determination of serum IgG, IgA, and IgM antibodies in acute and convalescent sera showed that none of the tests alone had sufficient sensitivity for routine diagnostic purposes, although, in combination, they provided a correct diagnosis in 86% of the RSV-infected children. A seroprevalence study of IgG, IgA, and IgM antibodies in 206 healthy children showed that a primary RSV infection is usually acquired during the first year of life in El Salvador. These results also indicated that reinfections with RSV frequently occur during the first 3-4 years of life and suggest that the occurrence of serum RSV IgA antibodies may be a marker of reinfection.

Age Factors↗
PubMed1994

Q fever in Taiwan.

BACKGROUND: Although Q fever, a rickettsial disease caused by Coxiella burnetii, is supposed to occur sporadically worldwide, there is only one case report of this disease in Taiwan. We examined the antibody of Q fever to evaluate the status of Q fever in Taiwan. METHODS: In total, 579 paired serum specimens of suspected febrile patients sent by several hospitals and sanitary stations to this Institute in 1991 and 1992 were tested according to the technique of indirect fluorescent antibody (IFA). RESULTS: In total 48 serologically acute Q fever cases were found, mostly from Tainan, Pingtung and Kaohsiung. There was only one female, and the age of most patients was 40-50 years. The high season is in June and July. CONCLUSIONS: The antibody titer of all 48 positive cases reached 1:320 or higher on the 13th day after onset of the disease. IFA as a diagnostic tool to detect acute and convalescent serum antibody titer is discussed.

Adult↗
PubMedDate not supplied

Peritoneal cytology for suspected acute appendicitis: an economic evaluation.

Suspected acute appendicitis is a common reason for surgery. Unfortunately, diagnosis is not always simple and, in recent years, considerable attention has been devoted to developing better diagnostic techniques. Peritoneal cytology is one such technique. It is simple, minimally invasive, and has been established as clinically effective. This paper reports on an economic evaluation of peritoneal cytology, carried out at Wellington Hospital, New Zealand. The analysis is based on two trials totalling 192 patients. The perspective taken initially is that of a hospital financial manager, seeking to minimise costs. In the first trial, there was a marginal increase in overall cost per person presenting with suspected acute appendicitis, from using the test. In the second, there was a reduction. In both trials there were significant health benefits--unnecessary operations were avoided, and necessary operations done more quickly. Also, the practice developed, in the second trial, of sending patients home immediately following a negative test result. This further increased savings. We then discuss the results from a broader perspective. We conclude that the additional personal benefits--less time convalescing, and lower mortality, on average--ensure that the benefits outweigh the costs of the test.

Acute Disease↗
PubMed2004

Laparoscopic repair of groin pain in athletes.

BACKGROUND: There has been increasing interest regarding the cause and treatment of groin pain in athletes. The most common finding is a deficiency of the posterior wall of the inguinal canal, often repaired with bilateral inguinal myorrhaphy. HYPOTHESIS: Laparoscopic repair will offer a shorter convalescent period and better results as compared with open myorrhaphy. STUDY DESIGN: Retrospective review of prospectively collected data. METHODS: Between October 1993 and October 2002, 131 athletes with groin pain unrelieved after 2 to 8 months of conservative management underwent bilateral laparoscopic repair with the transabdominal preperitoneal technique for hernias. In 123 (94%) patients, physical examination revealed a dilated external ring, unilateral or bilateral, of the inguinal canal, and in 8 patients (6%) it was normal. RESULTS: During laparoscopy, a deficiency of the posterior inguinal wall was seen in all athletes. All patients left the hospital 24 hours after the procedure, discontinued oral analgesics within 72 hours of surgery, and were back to full sporting activities within 2 to 3 weeks. Four patients (3%) complained of thigh pain. After a mean follow-up of 5 years (range, 4 months to 10 years), there was 1 recurrence (0.76%). CONCLUSIONS: Laparoscopic repair is an efficient method for the treatment of groin pain originating from a deficiency of the posterior inguinal wall, having fast recovery and excellent long-term results.

Adolescent↗
PubMed2000

Toxic megacolon secondary to infective colitis in children.

BACKGROUND AND PURPOSE: Toxic megacolon is a fulminating and potentially lethal complication of severe colitis. Toxic megacolon secondary to infective colitis in children is rare. We analyzed the clinical course, pathology, treatment, and outcome of toxic megacolon secondary to infective colitis in children. METHODS: The medical records of all 20 children treated for infective colitis complicated with toxic megacolon during a 12-month (October 1997-October 1998) period were retrospectively reviewed. RESULTS: There were 10 boys and 10 girls, with a mean (+/- standard deviation, SD) age of 26.2 +/- 12.9 months (range, 6-57 mo). With an initial presentation of nonspecific gastroenteritis syndrome lasting several days, the disease progressed rapidly. In the acute stage, most patients developed toxic signs such as mental change, ranging from irritability to stupor (20, 100%), fever (19, 95%), tachycardia (20, 100%), abdominal distension (20, 100%), and abnormal stool pattern (19, 95%). Initial investigations revealed anemia (11, 55%), leukocytosis (11, 55%), and elevated levels of C-reactive protein ranging from 25.0 mg/L to 483.0 mg/L with a mean +/- SD of 185.7 +/- 129.1 mg/L (normal range, < 8 mg/L) (20, 100%). Salmonella enteritidis (12 patients, 60%) and Clostridium difficile (1, 5%) were isolated from stool samples in some cases. Plain abdominal x-rays revealed severe colonic dilatation. Prolonged hospitalization (mean, 33.6 d) and intensive therapy including a combination of broad-spectrum antibiotics, physical decompression, and total parenteral nutrition were necessary. Three patients (15%) underwent surgical management; the pathologic findings in these patients demonstrated severe transmural inflammation. We believe that bacterial and/or endotoxin translocation played an important role in gut failure. Three patients (15%) in the study died. CONCLUSION: Toxic megacolon in infective colitis is a fulminating illness that has a high mortality rate. The disease course can be divided into three stages: the acute toxic stage, the gut failure stage, and the convalescence or deterioration stage. Early diagnosis and aggressive management are important.

Bacterial Infections↗
PubMed2004

Evaluation of a safe and sensitive Spike protein-based immunofluorescence assay for the detection of antibody responses to SARS-CoV.

Previously, we have identified a truncated antigenic fragment named protein C [441 to 700 amino acids (a.a.)] as the immunodominant fragment of Spike (S) protein of severe acute respiratory syndrome (SARS) coronavirus (SARS-CoV). We have now successfully expressed protein C using the baculovirus system in S. frugiperda (Sf-9) cells. This recombinant baculovirus expressing protein C was first characterized using five SARS convalescent human sera and five normal human sera. The results showed that protein C is an authentic antigen against SARS-CoV antibody. Our Spike protein-based immunoflourescence assay (IFA) based on this recombinant baculovirus-Sf-9 system was further assessed with a panel of 163 clinical samples collected during the SARS epidemic in Singapore, which include samples from 21 clinically confirmed SARS, 42 non-SARS patient sera, and 100 normal sera. The results were compared to a commercial SARS IFA kit (EUROIMMUN, Germany) and a conventional IFA test performed in Singapore General Hospital. All of the 21 SARS-positive serum samples could be recognized by our IFA, giving a specificity and sensitivity of 100%, which was compatible with both whole virus-based IFA assays. No cross-reactivity with serum samples against infectious bronchitis virus (IBV) and transmissible gastroenteritis virus (TGEV) were detected in our assays. Thus, our Spike protein-based IFA could offer a safer procedure which can be performed in a BSL-2 laboratory as it could mimic the whole virus based-IFA without any loss of sensitivity and specificity. It is also more user-friendly and cost-effective than the whole virus-based IFA.

Animals↗
PubMed1996

Ambulatory patients with community-acquired pneumonia: the frequency of atypical agents and clinical course.

OBJECTIVES: To determine the etiology of community-acquired pneumonia in patients treated in an ambulatory setting, using serological methods, and to compare presenting symptoms, radiographic manifestations, and clinical outcomes of patients with pneumonia of "atypical" and undetermined etiology. PATIENTS AND METHODS: This prospective cohort study was conducted in emergency room and outpatient facilities of Victoria General Hospital, Halifax, Nova Scotia, and in offices of participating family doctors based in Halifax. One hundred forty-nine adults with acute onset of one or more symptoms or signs suggestive of pneumonia and radiographic evidence of pneumonia who provided informed consent were enrolled. Patients known to be HIV positive or who had been discharged from a hospital within the previous 10 days were ineligible for enrollment. Demographic features and clinical data were collected by direct patient interview and chart review by trained research nurses. Outcome measures included quantitative evaluation of pneumonia-specific symptoms, and responses to the Short Form 36 Health Survey at presentation and at 30 days after presentation. Information was also collected on each patient's health prior to pneumonia, as well as the time until each patient's self-reported return to work and to usual activities. The etiology of pneumonia was determined by testing acute and convalescent serum samples for antibodies to Legionella pneumophila serogroup 1, Mycoplasma pneumoniae, Chlamydia pneumoniae, Chlamydia psittaci, Coxiella burnetii, adenovirus, respiratory syncytia virus, influenza viruses A and B, and parainfluenza viruses 1, 2, 3. RESULTS: The study population consisted of 149 patients, 54 (36%) of whom were men, with a mean age (+/- SD) of 41 +/- 15 years. An etiological diagnosis was made in 74 (49.7%) patients using serological methods. Etiological agents included M pneumoniae 34 (22.8%); C pneumoniae 16 (10.7%); M pneumoniae and C pneumoniae 5 (3.4%); C burnetii 4 (2.7%); influenza A virus 4 (2.7%); and other agents 6% (7.4%). Three patients (2%) had a conventional bacterial etiology, and 72 patients (48.3%) had pneumonia of undetermined etiology. Patients with pneumonia of known (atypical) and undetermined etiology were similar in terms of age, gender, race, education, employment, and comorbidity. Despite a higher proportion of patients with pneumonia of known etiology reporting sweats, chills, and headache at presentation, the two groups were similar for symptom severity and bother. The patients with pneumonia of undetermined etiology were more likely to have multilobar pneumonia (P < 0.02). Both patients with atypical pneumonia and those with pneumonia of undetermined etiology suffered severe deterioration of physical functioning with a marked but incomplete recovery at 30 days. Those with atypical pneumonia had higher physical functioning and general mental health scores at 30 days. CONCLUSIONS: Nearly half the cases of ambulatory community-acquired pneumonia are due to "atypical" agents. It is not possible to reliably distinguish patients with atypical pneumonia from those with pneumonia of undetermined etiology by clinical features at baseline. The outcomes in terms of resolution of symptoms, functional status, return to work, and return to usual activities are essentially similar in the two groups.

Adult↗
PubMed2001

HeartCare: an Internet-based information and support system for patient home recovery after coronary artery bypass graft (CABG) surgery.

HeartCare is an Internet-based information and support service for patients recovering at home from coronary artery bypass graft (CABG) surgery. The system is designed to meet the nursing challenges in health information to support needs of CABG patients. HeartCare (a) provides information and support, tailored to patients' individual and changing recovery needs during CABG recovery, (b) makes recovery information more accessible for timely use by patients, and (c) extends the scope of nursing services to CABG patients from hospital through home. An ongoing randomized controlled study is underway to evaluate the clinical outcomes of patients' use of the HeartCare system and to examine its acceptance as a usable resource for postCABG patients who have limited previous computer experience.

Adult↗