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PubMed1983

[Comparative study of various methods for the determination of the IgM or IgG class of antibodies, applied to the diagnosis of hepatitis A].

We report herein results of comparative study of different methods for determination of M or G classes of antibodies applied to serodiagnosis of type A hepatitis. We have examined retrospectively 259 sera with a technique employing protein A and 2 kits, HAVAB-M (RIA-M) and Hepanostika anti-HAV-IgM (ELISA-M). Some sera were studied after treatment by 2-mercapto-ethanol. We have obtained the same results with RIA-M and ELISA-M: 119 sera contain Ac anti-HAV of M class and 116 of G class, 24 sera non classified with protein A owing to their low level of Ac anti-HAV, are all but one of G class. We have observed 23 discrepancies between protein A or RIA-M and ELISA-M. A first group is constituted by 15 sera obtained during late convalescence and containing rates of Ac anti-HAV-M too low to be determined with protein A or 2-mercapto-ethanol so they are classified G, while RIA-M and ELISA-M, more sensitive, could detect such antibodies. Another group is constituted by 8 sera containing low rates of anti-HAV antibodies so we could not dilute them for reaction, and IgG were not adsorbed entirely on protein A while 2-mercapto-ethanol, RIA-M and ELISA-M led them being classified Ac anti-HAV-G. RIA-M and ELISA-M are useful tools particularly for sera obtained during late convalescence while protein A and 2-mercapto-ethanol are effective for diagnosis during 1 month after acute phase.

Acute Disease↗
PubMed1991

Cardio-respiratory responses to exercise following treatment of acute severe asthma.

Asthmatic patients are encouraged to adopt a normal and active life-style. However, following treatment of acute severe asthma, patients may ask for advice about taking exercise. Serial measurements of the cardio-respiratory responses to continuous work load exercise, were made in asthmatic patients convalescing following hospital treatment of an acute exacerbation. Eighteen asymptomatic patients, (seven male) aged 18-48 years, were studied. The first test was performed within 1 week of admission, when the mean (SD) peak expiratory flow rate (PEFR) was 88 (20)% predicted normal and the arterial oxygen tension (PaO2) was 13.1 (1.4) kPa. No significant differences in the mean cardio-respiratory responses, from the last minute of exercise, were found during the 4-week study. There were no significant differences in the four tests, between the resting PEFR, lowest post-exercise PEFR or % change in PEFR. Also, there were no significant differences in the pre-exercise, end of exercise and recovery (10 min after exercise) PaO2, between the four tests. However, taking the four tests as a whole, significant relationships were found between the recovery PaO2 and the lowest post-exercise PEFR, expressed in absolute terms (r = 0.515, P less than 0.001), and as a percentage of predicted normal (r = 0.533, P less than 0.001); and also between the recovery PaO2 and the % change in PEFR after exercise (r = 0.299, P less than 0.05). It is suggested that a formal exercise test should be performed in convalescent asthmatics wishing to participate in active sports. Patients with exercise-induced asthma may then be identified and treated appropriately.

Acute Disease↗
PubMed1996

Differing antibody responses to Haemophilus influenzae type b after meningitis or epiglottitis.

Two common forms of invasive disease due to Haemophilus influenzae type b (Hib) are epiglottitis and meningitis. It is not known why some children develop epiglottitis and others meningitis. To examine the hypothesis that epiglottitis occurs in children who may have been previously exposed to Hib, and who would therefore exhibit a more vigorous antibody response in convalescence, we measured levels of antibody to Hib capsule in 92 children. Geometric mean convalescent-phase IgG, IgA, IgM and total antibody levels were significantly higher in 45 children with epiglottitis than in 47 with meningitis, even after adjustment for age differences (mean total antibody, 95% confidence intervals: meningitis 0.38, 0.34-0.43; epiglottitis: 2.25, 2.0-2.54 micrograms/ml). However, contrary to previous reports, a poor antibody response was only observed in a minority of children with meningitis; the antibody response of the majority was indistinguishable from that observed in children with epiglottitis.

Acute-Phase Reaction↗
PubMed2005

Effect of short-term erythropoietin therapy in anemic premature infants.

OBJECTIVE: To determine the effectiveness of a 10-day subcutaneous erythropoietin (rHuEpo) course of 300 units per kg per dose plus oral iron compared to oral iron alone in anemic infants during their convalescent phase of illness. STUDY DESIGN: Prospective, randomized trial performed at a 40-bed, teaching, referral, level III, neonatal intensive care unit. Infants with a gestational age at birth of less than 32 weeks, hematocrit of less than or equal to 28% with a corrected reticulocyte count of less than or equal to 5%, postconceptual age of less than 48 weeks or 5 months chronological age, and a diagnosis of anemia of prematurity were considered for inclusion. Major outcome parameters included hematocrit, corrected reticulocyte count and red cell transfusion requirements. RESULTS: A total of 60 infants were enrolled (n=30 per group). Infants randomized to rHuEpo had a significantly higher post-treatment hematocrit and corrected reticulocyte count than infants in the iron only group (p<0.001). There was a trend towards fewer red cell requirements in the rHuEpo group. CONCLUSIONS: The rHuEpo regimen studied here was associated with an acute improvement in hematocrit and corrected reticulocyte counts. This study did not demonstrate a statistically significant decrease in transfusion therapy, in part related to increased subsequent use of rHuEpo in the control group. Taken together, these data demonstrate that this regimen can effectively treat anemia in convalescent premature infants.

Anemia, Neonatal↗
PubMed2005

Back transport of neonates: effect on hospital length of stay.

INTRODUCTION: In a regionalized perinatal system, recovering neonates may be back transported from a regional Neonatal Intensive Care Unit (NICU) to community hospitals closer to their residence to convalesce prior to hospital discharge. OBJECTIVE: This study evaluates the practice of neonatal back transport for growth and the duration of total hospitalization. METHODS: We conducted a retrospective study comparing length of stay (LOS) for infants back transported from a regional NICU to a level II nursery for convalescent care (BT), with LOS for infants eligible for back transport discharged home from the Regional Center (RC). RESULTS: A total of 221 infants were studied. BT infants (n=104) had lower birth weights (median; 1955 vs 2700 g, p=0.001), more frequently needed mechanical ventilation (84 vs 65%, p=0.002) and parenteral nutrition (71 vs 55%, p=0.013), less frequently were evaluated by subspecialists (20 vs 59% p=0.0001), and had longer total LOS (median; 20 vs 11 days, p<0.0001) compared to infants discharged home from the RC (n=117). However, in the subgroup with birth weights <or=1500 g (very low birth weight (VLBW)), BT (n=25) infants had similar birth weight (median; 1160 vs 1215 g, p=0.9) compared to those discharged home from the RC (n=24) and did not have a statistically different total LOS (median; 50 vs 56 days, p=0.1). Almost all infants who had major surgeries, treatment for retinopathy of prematurity, seizures, or had severe intra-ventricular hemorrhages were discharged home from the RC. The rates of hospital readmissions or emergency room visits acutely after their discharge to home from the RC or the community hospital were similar. CONCLUSIONS: BT Infants differed based on clinical features compared to premature infants discharged from the RC. VLBW infants, back transported for growth, had similar total LOS compared to similar weight infants discharged home from the RC.

Birth Weight↗
PubMed2002

Thrombocytopenia in patients with malaria: automated analysis of optical platelet counts and platelet clumps with the Cell Dyn CD4000 analyser.

Platelet counts and automated detection of platelet clumps were evaluated by optical analysis with the Abbott CD4000 analyser (Abbott Diagnostics, Santa Clara, CA, USA) in this South African study of 828 samples referred for malaria investigations. Based on microscopy (Micro) and rapid tests (RT) for HRP2 protein and parasite-associated LDH, malaria negative samples (n = 417) were defined as Micro-, RT-. Convalescent cases (n = 64) were Micro-, RT+ and had a recent record of positive microscopy. Malaria positive cases were subdivided into Micro+ (n = 315) and Micro-, RT+, PCR+ (polymerase chain reaction) (n = 32) subgroups. The mean platelet count for Micro+ cases (89.7 x 10(9)/l) was significantly lower than both the malaria negative (mean 212.6 x 10(9)/l) and convalescent malaria (mean 152.8 x 10(9)/l) groups; 89% of microscopy positive cases were thrombocytopenic (< 150 x 10(9)/l) and 30% had severe thrombocytopenia (< 50 x 10(9)/l). For comparison, 32% of the 417 malaria negative samples were thrombocytopenic and 6% of these were severe. Two thirds of samples with parasitaemia above 10% had platelet counts of < 50 x 10(9)/l while the counts were largely independent of parasite numbers when the parasitaemia was below 10%. Thirty percent of samples with microscopically detectable parasites had a PltClmp flag compared to 13% of the malaria negative group but, when the actual platelet count was taken into account, it became apparent that appearance of the flag was primarily associated with thrombocytopenia per se rather than malaria status. In most samples with a PltClmp flag, the CD4000 optical platelet clump 'signature' was indicative of small platelet aggregates and giant platelets. Morphological examination confirmed the presence of varying numbers of small platelet aggregates (3-12 individual platelets), often together with increased giant platelets, in many samples with a PltClmp flag. The observations suggest that while patients with malaria may be predisposed to the development of thrombocytopenia, a reduced platelet count in some patients may also be due in part to pseudo-thrombocytopenia.

Artifacts↗
PubMed2000

Clinical pathway management of total knee arthroplasty: a retrospective comparative study.

BACKGROUND: Clinical pathways facilitate the management of defined patient groups using interdisciplinary plans of care. The aim of the present study was to evaluate the effectiveness of a clinical pathway in improving a range of selected outcome measures in patients who have undergone total knee arthroplasty (TKA). METHODS: The present study was conducted at Queen Elizabeth Hospital, Adelaide. Using a retrospective comparative study design, 119 TKA patients who were managed on a clinical pathway from July 1997 to January 1998 (group 2) were compared with a retrospective group of 58 patients who underwent the same procedure from July 1996 to January 1997 (group 1) prior to the pathway's implementation. The following outcomes were measured: length of hospital stay; postoperative complications; readmissions and emergency service visits within 6 months of discharge; day of transfer to the convalescent unit; convalescent unit utilization and admission and discharge times. RESULTS: There was a significant reduction in the median length of stay in group 2 patients (9 vs 7 days; P < 0.0001). In addition there was a 66% increase in the proportion of patients in group 2 who were admitted on the day of surgery (P < 0.0001) and a 19.6% increase in the number of patients discharged within 8 postoperative days (P < 0.01). There were no significant differences between the groups with respect to the occurrence of postoperative complications. Although there was a trend toward a reduction in emergency service utilization and readmissions within 6 months of discharge for patients managed on the pathway, this was not significant. CONCLUSIONS: The development and implementation of a TKA clinical pathway resulted in a significant reduction in length of stay and improved streamlining of admission, discharge and transfer processes without adversely affecting patient outcomes.

Aged↗
PubMed2003

Morbidity of laparoscopic radical prostatectomy: summary of early multi-institutional experience in Japan.

AIM: Laparoscopic radical prostatectomy is being evaluated throughout the world. The aim of the present study is to report early multi-institutional experience of the procedure in Japan. METHODS: A total of 148 men who were diagnosed with clinically localized prostate cancer underwent laparoscopic radical prostatectomy at seven different institutions in Japan. Early complications (within 30 days postoperatively) and postoperative convalescence were reviewed retrospectively. The median age of patients was 68.0 years (range, 51-80). RESULTS: The median operative time was 403 minutes (range, 167-925; average, 427). Blood loss ranged from 50 to 5000 mL (median, 540; average, 856). A total of 66 complications were reported in 55 patients (37.2%). Intraoperative complications were noted in 25 of 148 patients (16.9%): 10 rectal injuries (6.8%); five bladder injuries (3.4%); five cases of subcutaneous emphysema (3.4%); two intestinal injuries (1.4%); one major vessel injury (0.7%); one ureteral injury (0.7%); and one obturator nerve injury (0.7%). Overall, 16 of 148 patients (10.8%) required open conversion or postoperative open surgical repair. The most common postoperative complications were anastomotic leakage (6.8%), wound-related complications (4.7%) and perineal pain (4.7%). The bladder catheter was removed on day 7 or earlier in 73 cases (49.3%). The median time to ambulation was 1 day (mean 1.4, range 1-5). Oral intake was started on postoperative day 1 in 67 patients (45.2%) and on postoperative day 2 in 65 (43.9%). CONCLUSION: Although laparoscopic radical prostatectomy is technically demanding, reduced blood loss and shorter convalescence periods can be expected from the procedure. Surgeons should be aware of the disturbingly high morbidity rate related to early experience. By mastering laparoscopic skills and sharing knowledge, surgeons could reduce the impact of the learning curve required to complete this procedure competently.

Aged↗
PubMedDate not supplied

[The microagglutination test--a simple and sensitive procedure for serodiagnosis of pertussis infections].

The microagglutination assay is a useful method for the diagnosis of B. pertussis infections. In a group of 30 patients with culture proven pertussis 27 (90%) had > or = fourfold increases in titers between acute and convalescent phase serum specimens. The microagglutination test offers several advantages over other more sophisticated B. pertussis antibody tests: only 50 microliters of serum is required, it is a standardized test, which doesn't require specialized technical expertise or equipment, it is easy to perform and good results are noted in a broad age range of patients. Disadvantages of the microagglutination test are: two separate serum specimens are necessary (acute and convalescent phase), the test does not differentiate IgA and IgG antibodies and the temporal association with recent immunization can lead to false positive results. In our opinion the microagglutination test is a useful method for the diagnosis of B. pertussis infections. This is especially true in cases where more sophisticated serologic tests such as ELISA can not be performed immediately but physicians and patients expect to get a result quickly.

Adolescent↗
PubMed1992

Primary human herpesvirus 6 infection in young children.

BACKGROUND: Human herpesvirus 6 (HHV-6) is a recently discovered virus that, on the basis of serologic evidence, appears to infect most children by the age of three years. However, the clinical manifestations of primary HHV-6 infection have not been well defined. METHODS: We studied consecutive children two years old or younger who presented to an emergency ward with febrile illnesses. Our evaluation included the isolation of HHV-6 from peripheral-blood mononuclear cells, an immunofluorescent-antibody assay, the detection of HHV-6 by the polymerase chain reaction (PCR), and restriction-endonuclease-fragment profiles of HHV-6 isolates. RESULTS: HHV-6 was isolated from 34 of 243 acutely ill children (14 percent). The children with viremia had irritability, high temperatures (mean, 39.7 degrees C), and inflammation of tympanic membranes (in 21), but few other localizing signs. Two children were hospitalized, but all 34 recovered after an average of four days of fever. The rash characteristic of roseola, which has been associated with HHV-6 infection, was noted in only three children. In 29 children (85 percent), serum samples obtained during convalescence had at least a fourfold increase in IgG antibody titers; 4 infants less than three months old who presumably had maternal antibody did not have this increase. HHV-6 was isolated from blood obtained during convalescence in only one child, but in two thirds of the children the virus could be detected by PCR. The isolates had genomic heterogeneity, indicating the presence of multiple strains. CONCLUSIONS: Primary infection with HHV-6 is a major cause of acute febrile illness in young children. Such infection is associated with varied clinical manifestations, viremia, and the frequent persistence of the viral genome in mononuclear cells.

Antibodies, Viral↗
PubMedDate not supplied

Plasma levels of matrix metalloproteinase-9 in Henoch-Schönlein purpura.

OBJECTIVE: To investigate the potential role of matrix metalloproteinase-9 (MMP-9) in Henoch-Schönlein purpura (HSP), an acute type of systemic vasculitis in children. METHODS: In this study, 24 children with HSP and ten healthy children (HC) were enrolled from February 2003 to July 2004. Blood samples were obtained from all the children. The total levels of MMP-9 in the plasma were detected by enzyme-linked immunosorbent assay (ELISA). The second blood samples were obtained from eight of the 24 HSP patients in the convalescent phase. MMP-9 of circulating white blood cells was detected by immunocytochemistry. RESULTS: Plasma MMP-9 levels in the acute phase of HSP (249.75 ng/mL) were significantly higher than in HC (191.00 ng/mL) (p = 0.034). Immunocytochemistry showed that MMP-9 was positive in the circulating white blood cells. The MMP-9 levels in the convalescent phases were lower than in the acute phase in six cases, but increased in the other two cases, and one of these two cases had recurrence of purpuric rashes in the lower extremities for 3 months. CONCLUSION: MMP-9 plays an important role in the vascular destruction of HSP, and circulating white blood cells may be a source of the MMP-9 secreted into the circulation.

Acute Disease↗
PubMed1998

Bassini repair compared with laparoscopic repair for primary inguinal hernia: a randomised controlled trial.

OBJECTIVE: To compare the effectiveness of open and laparoscopic primary inguinal hernia repair. DESIGN: Randomised controlled trial. SETTING: University hospital, The Netherlands. SUBJECTS: 87 patients had 103 open repairs and 88 patients had 114 laparoscopic repairs between November 1993 and July 1995. INTERVENTIONS: Laparoscopic repair by the transabdominal preperitoneal (TAPP) technique and open repair by the Bassini technique. MAIN OUTCOME MEASURES: Recurrence, morbidity, pain, and duration of convalescence. RESULTS: Operating time was longer for laparoscopy (mean (SD): 82 (28) compared with 45 (15) minutes p < 0.001). Patients in the Bassini group had higher postoperative pain scores (mean (SD)VAS: 2.9 (1.6) compared with 2.0 (1.6) p=0.002), used more analgesics (median total intake: 2 (0-54) compared with 0 tablets (0-42) p=0.008), and needed a longer convalescence time (mean (SD) time to return to work: 22 (12.6) compared with 14 (10.1) days p < 0.001; mean (SD) time to return to physical activities: 27 (12.6) compared with 17 (12.2) days p < 0.001). Mean follow up was 24 months. Recurrence rates were 21% (22/ 103) after Bassini and 6% (7/114) after laparoscopic repair (p=0.001). CONCLUSION: Laparoscopic hernia repair is a safe operation, which has obvious advantages over the Bassini repair in terms of pain, use of analgesic drugs, resumption of activities, and recurrence. A disadvantage of the laparoscopic repair is the longer operating time.

Analgesics↗
PubMed2000

Immune response to surface protein A of Streptococcus pneumoniae and to high-molecular-weight outer membrane protein A of Moraxella catarrhalis in children with acute otitis media.

The immune response was evaluated in 11 children with Streptococcus pneumoniae and in 9 children with Moraxella catarrhalis otitis media. The age of the children had a range of 4-32 months. The mean IgG, IgM, and IgA antibody responses to surface protein A (PspA) of S. pneumoniae in sera from children at the acute and convalescent stages were 4864 versus 5831 ng/mL, P<.05, 1075 versus 3752 ng/mL, P<.05, and 67 versus 93 ng/mL, nonsignificant (NS), respectively. The mean IgG, IgM, and IgA antibody responses to the high-molecular-weight outer membrane protein (UspA) of M. catarrhalis in sera from children at acute and convalescent stages were 710 versus 935 mg/mL, NS; 1895 versus 2646 ng/mL, NS; and 121 versus 204 ng/mL, P<.05, respectively. These data show that PspA and UspA are immunogenic in children after otitis media.

Acute Disease↗
PubMed1997

Antibody response to Arcanobacterium haemolyticum infection in humans.

Arcanobacterium haemolyticum causes pharyngitis, exanthema, and other infections. The evidence of the pathogenicity of A. haemolyticum depends on clinical descriptions of culture-positive patients and a comparison of carrier rates of patients with pharyngitis and healthy, matched controls. In this investigation, the antibody response of the host was studied for the first time, using SDS-PAGE and Western blot analyses. Paired acute and convalescent sera showed development of antibodies to A. haemolyticum in 7 of 8 patients. The antibodies reacted primarily with four distinct cell wall-associated proteins with estimated molecular masses of 80, 60, 50, and 30 kDa. Moreover, the reactivity of convalescent sera from 19 patients was compared with that of sera from 19 controls. Antibodies to A. haemolyticum were found in sera from 16 patients and 6 controls (P < .005); the antibody response of the patients was strong compared with that of the controls. These results indicate that A. haemolyticum infection induces an antibody response in the host.

Acute Disease↗
PubMed1977

Bactericidal antibody in genital infection due to Neisseria gonorrhoeae.

An assay of bactericidial antibody has been developed to study the host response to infection with Neisseria gonorrhoeae. This test for antibody was performed on the sera of women who were exposed to N. gonorrhoeae but who did not become infected, of patients with various types of genital infection with N. gonorrhoeae, and of a small number of individuals with no history of gonorrhea. Antibody was found in the sera of less than 31% of men and women with uncomplicated gonococcal infection. Prolonged mucosal infection with the gonococcus (greater than 33 days) correlated with the presence of bactericidal antibody. Bactericidal antibody was not detected in 95% of the specimens of acute-phase serum obtained from women with gonococcal pelvic inflammatory disease. The convalescent-phase sera of 70% of women with clinically severe pelvic inflammatory disease showed a rise in titer of bactericidal antibody to the infecting strain of N. gonorrhoeae, whereas only 11% of the convalescent-phase sera of women with mild or moderately severe disease showed a similar rise.

Antibodies, Bacterial↗
PubMed1977

Reovirus-like agent in acute epidemic gastroenteritis in Japanese infants: fecal shedding and serologic response.

The reovirus-like agent, sometimes referred to as duovirus or rotavirus, was visualized by electron microscopy in stool extracts from Japanese infants and young children with acute epidemic gastroenteritis. The virus particles measured 70 nm in diameter and had double-shelled capsids. One hundred ten (89%) of 124 patients with the gastroenteritis had such virus particles in stools obtained during the acute phase. The virus particles were excreted in the stools usually during the first eight days of illness. Agglutination of virus particles by antibody present in convalescent-phase sera was demonstrated by immune electron microscopy. Complement-fixing antibody was detected as early as day 3 of illness, and antibody titers peaked during the second and third weeks of the disease. The antibody appearing in the acute and early convalescent phases was sensitive to 2-mercaptoethanol. Antibody resistant to 2-mercaptoethanol was produced approximately 10 days after the onset of the symptoms. The serologic evidence suggests that a primary infection with the reovirus-like agent was responsible for the clinical attack of acute gastroenteritis.

Acute Disease↗
PubMed1978

Studies on the relationships between serum bactericidal activity and uncomplicated genital infections due to Neisseria gonorrhoeae.

This report concerns the relationships between patients' uncomplicated genital infections due to Neisseria gonorrhoeae and the bactericidal activity of their sera against their infecting organisms. Forty isolates of N. gonorrhoeae and 91 serum samples were obtained from 23 patients with their first or repeated gonococcal infections. Of 32 sera obtained at the time of infection, 14 (44%) were bactericidal for the infecting strains. Of convalescent-phase sera from 27 infections, 12 (44%) were bactericidal; 22%-33% of convalescent-phase sera had increased bactericidal activity when compared with acute-phase sera or sera obtained before infection. Eleven patients developed 17 new infections after sera and negative cultures were obtained; in six (35%) the previously obtained sera were bactericidal but did not prevent infection.

Bacteriological Techniques↗
PubMed1995

Interleukin-10 inhibits tumor necrosis factor production but not antigen-specific lymphoproliferation in acute Plasmodium falciparum malaria.

In vivo interleukin (IL)-2, IL-4, IL-10, and interferon (IFN)-gamma production was measured at the mRNA transcript and protein levels in patients acutely infected with Plasmodium falciparum and during convalescence. Both IL-10 and IFN-gamma but not IL-2 were produced regardless of the patients' clinical severity. IL-4 production was variable. Circulating IFN-gamma and IL-10 were significantly higher in patients with severe disease (P < .01 and .001, respectively). In vitro stimulation of peripheral blood mononuclear cells (PBMC) by malarial antigens during acute infection showed that although there was no lymphoproliferation, the cells could produce IL-10 and IFN-gamma. Recombinant human IL-10 completely abolished in vitro tumor necrosis factor (TNF)-alpha production in response to malarial antigens, as well as the antigen-specific proliferative response of convalescent patients. However, anti-IL-10 was insufficient to restore proliferation of PBMC from acutely infected patients. These findings suggest that IL-10 may have an important negative feedback action on the production of inflammatory cytokines in acute falciparum malaria without contributing to the defect in antigen-specific proliferation.

Adult↗