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At least 19 recordsLinked to original sources
PubMed1992

Domestic animal models of severe combined immunodeficiency: canine X-linked severe combined immunodeficiency and severe combined immunodeficiency in horses.

This review describes the clinical, immunologic and pathologic features of two naturally-occurring models of severe combined immunodeficiency (SCID) in domestic animals that represent different forms of human SCID. Canine X-linked SCID (XSCID) has an X-linked recessive mode of inheritance and, as such, represents a model for the most common form of human SCID in the United States. Affected dogs have normal percentages of circulating B cells and low to normal percentages of phenotypically mature, but nonfunctional T cells. Severe combined immunodeficiency in the horse is an autosomal recessive form of SCID that is characterized by a profound lymphopenia affecting both the B and T cell lineage most likely due to a lymphoid stem cell defect. Since these diseases are naturally-occurring in an outbred species, like man, they represent unique animal models of their respective human counterparts in which to determine the underlying immunologic defect(s), to evaluate novel approaches to immunotherapy or gene therapy, and to evaluate therapeutic regimens for opportunistic infections associated with SCID.

Animals↗
PubMed1986

Domiciliary comparison of terbutaline treatment by metered dose inhaler with and without conical spacer in severe and moderately severe chronic asthma.

The bronchodilator response to cumulative doses of terbutaline administered by metered dose inhaler with and without a conical spacer device and by Acorn nebuliser has been compared in groups of patients with chronic severe and moderately severe asthma. After laboratory studies the patients undertook a randomised domiciliary crossover comparison of bronchodilator response to terbutaline given by metered dose inhaler with and without a spacer device, during which the severity of asthma was assessed by thrice daily recordings of peak expiratory flow (PEF) and symptom score. Improvement in FEV1 produced in the laboratory by the metered dose inhaler with spacer device was significantly greater than by metered dose inhaler alone (p less than 0.001) and similar to that from the nebuliser in both asthmatic groups throughout a range of terbutaline doses. In the domiciliary comparison mean midday and evening PEF rates were significantly higher with the use of the spacer device both in those with severe (p less than 0.01) and in those with moderately severe (p less than 0.05) asthma, and mean morning PEF was significantly higher in the severe group (p less than 0.05). The spacer device also produced a significant improvement in symptom score in both the severe and the moderately severe groups (p less than 0.05). Regular domiciliary use of the spacer device with the metered dose inhaler improves bronchodilator response, particularly in patients with chronic severe asthma, and may be a useful alternative to nebuliser treatment.

Administration, Inhalation↗
PubMed1992

The severity of herpes simplex viral keratitis in mice does not reflect the severity of disease in humans.

Four herpes simplex type 1 virus (HSV) isolates were selected from patients with mild ocular disease and four from patients with severe ocular disease on the basis of the number of epithelial recurrences, presence or absence of stromal disease, visual acuity, and the need for corneal transplantation. The scarified right corneas of 20 BALB/c mice were inoculated with each low-passage HSV isolate (1.0 x 10(7) plaque-forming units/ml) and examined three times per week for 2 weeks for the presence and severity of epithelial and stromal disease. The eight individual virus isolates differed with respect to the incidence of dendritic disease (P less than 0.001), the severity of dendritic disease (P less than 0.001), the incidence of stromal disease (P = 0.002), and the severity of stromal disease (P = 0.001) they produced in the mouse. The severity of disease was compared for the two groups of viruses: (1) those that had caused mild disease in their human hosts and (2) those that had caused severe disease. There were no statistically significant differences in the severity or incidence (44 versus 43 animals, respectively) of dendritic disease or stromal disease (27 of 80 animals in each group) between the two groups. These data suggest that the naive BALB/c mouse model of acute HSV keratitis after topical ocular inoculation does not reflect clinically significant differences in the severity of human HSV keratitis that might be caused by variations in the virus genome.

Animals↗
PubMedDate not supplied

Status asthmaticus, severe acute asthma or severe exacerbation of asthma.

"Status Asthmaticus" is an old term which has been defined in many different ways. Two distinctive features are usually used to identify "Status Asthmaticus": severity and lack of response to bronchodilators. However, the latter condition is not always observed and thus the term "Status Asthmaticus" basically implies severity. "Severe acute asthma" is a new term which has replaced "Status Asthmaticus". Nevertheless, a severe attack of asthma may occur suddenly or can take place after days or weeks of a progressive deterioration. A "Status Asthmaticus" can be "acute" or "subacute" according to the rate of deterioration; therefore the term "Severe acute asthma" is misleading. Since the term "Status Asthmaticus" essentially implies severity, severe attacks would be better described as "Severe exacerbation of asthma" (SEA). Classification of the SEA into two types (acute and subacute), could help to reveal the etiology of the attack and might also be relevant to the management of the patient. For instance an acute SEA can be seen in brittle asthma and in patients with aspirin intolerance. On the other hand, patients with the subacute form are refractory to bronchodilators and must be treated with corticosteroids.

Acute Disease↗
PubMed1989

Using severity information for quality assessment: a review of three cases by five severity measures.

Five severity measurement systems--APACHE II, Computerized Severity Index, Disease Staging (both Q-Scale and clinical criteria version), MedisGroups, and Patient Management Categories--were applied to three clinical cases. Severity results and recommendations for quality review were then compared and contrasted. Systems that define severity based on resource need produce different impressions than those that define severity in more clinical terms. In-depth quality review is generally suggested when severity scores later in the hospital stay are higher than at admission. Recommendations for review may be automatic or tied to other factors. Some systems use normative data, based on observed severity patterns and patient outcomes, to guide decisions about quality reviews.

Adolescent↗
PubMed1992

Predictors of survival and severity of disability after severe brain injury in children.

Seventy-five children, 16 years of age or younger, consecutively admitted to a level I trauma center over a 2-year period with severe nonpenetrating traumatic brain injuries were studied to assess factors predictive of survival and level of disability. The mortality rate was 33%; 31% had good recovery, 12% had moderate disability, 19% had severe disability, and 5% remained in a vegetative state. Factors were analyzed separately for potential effects on survival and, with fatalities excluded, for potential effects on the level of disability in survivors. Clinical status in the field and emergency room, although highly associated with survival, was less predictive of the level of disability in survivors. Glasgow Coma Scale scores 72 hours after injury, especially the motor component, were significantly better predictors of quality of survival. The severity of the brain injury and the presence and severity of extracranial injuries were strongly related both to survival and quality of survival. Chest injuries, in particular, were associated with increased mortality and morbidity, as was level of oxygenation; these factors were highly correlated. Factors most significantly predictive of survival were severity of total injuries as assessed with the Injury Severity Score and pupillary responses in the emergency room; factors most predictive of disability were Glasgow Coma Scale motor responses 72 hours after injury and level of oxygenation in the emergency room. These findings of differential predictive factors for outcomes of survival versus quality of survival have implications relevant both to clinical care and to research involving severely brain-injured children.

Adolescent↗
PubMed1992

Development and validation of the Nursing Severity Index. A new method for measuring severity of illness using nursing diagnoses. Nurses of University Hospitals of Cleveland.

The purpose of this study was to develop and validate the Nursing Severity Index, a new method used to measure the admission severity of illness of hospital patients using nursing diagnoses, which categorize biologic, functional, cognitive, and psychosocial abnormalities. This retrospective cohort study with independent development and testing phases was conducted at a U.S. academic medical center. In the development phase, data regarding 14,183 adult medical-surgical patients admitted to the medical center in 1985 and 1986 was used. In the testing phase, data regarding 7,302 patients admitted in 1987 and 1988 was used. Primary nurses prospectively recorded the presence or absence of 61 nursing diagnoses on admission. Demographic and clinical data were obtained from hospital data bases. In the development phase, the number of admission nursing diagnoses was highly related (P < 0.001) to in-hospital mortality. Using multiple logistic regression, 34 nursing diagnoses were identified as independent predictors of mortality; the Nursing Severity Index equals the number of these 34 diagnoses. In the testing phase of 7,302 patients, the Nursing Severity Index was related (P < 0.001) to mortality rates, which were 0.5%, 1%, 2%, 6%, 13%, 22%, and 31% in seven hierarchical strata defined by the Index. The Index was as accurate in predicting mortality as MedisGroups (receiver-operating-characteristic curve areas, 0.814 +/- 0.016 vs. 0.845 +/- 0.015, respectively, P = 0.12). Furthermore, the Nursing Severity Index and MedisGroups together (receiver operating characteristic curve area 0.880 +/- 0.014), were more accurate (P < 0.01) than either measure alone. The Nursing Severity Index assesses multiple dimensions of illness, can be easily measured during routine patient care, accurately predicts the risk of in-hospital death, and has similar prognostic accuracy as MedisGroups. Its usefulness in outcomes assessment, quality assurance, and case management merits further study.

Academic Medical Centers↗
PubMed1992

Disease severity in rheumatoid arthritis: relationships of plasma tumor necrosis factor-alpha, soluble interleukin 2-receptor, soluble CD4/CD8 ratio, neopterin, and fibrin D-dimer to traditional severity and functional measures.

Rheumatoid arthritis is a complex inflammatory disease of unknown cause. Although various laboratory and clinical measurements are useful in managing these patients, there is a need for better tests to quantitatively assess disease activity. The purpose of this study was to investigate the association of certain immune and inflammation (I-I) parameters with four traditional disease severity measures and a functional measure in rheumatoid arthritis patients. A single set of patient blood samples was analyzed, and four traditional disease severity measures and patient functional statuses were determined from 64 consecutive outpatients with rheumatoid arthritis. Plasma tumor necrosis factor-alpha (TNF), soluble interleukin-2 receptor (sIL-2R), sCD4 and sCD8 (and the sCD4/sCD8 ratio), neopterin, and fibrin D-dimer were analyzed in relationship to Westergren erythrocyte sedimentation rate (ESR), physician assessment of disease activity, joint pain count, grip strength, and Arthritis Impact Measurement Scale (AIMS) scores. Rheumatoid arthritis patients had higher mean levels of all I-I measures (except sCD4) compared to healthy subjects. Initial significant correlations between TNF, sIL-2R, and D-dimer and several disease severity and functional measures were detected. When we controlled for the covariates age, gender, race, and medications, regression analyses indicated that, as a group, the I-I measures were significantly related to grip strength, physician disease severity rating, ESR, and total joint pain. When the predictive values of the I-I measures were tested controlling for the covariates and ESR, D-dimer was independently and significantly associated with variability in grip strength, physician disease severity, and AIMS physical disability, while TNF was associated with a significant amount of variability in total joint pain.(ABSTRACT TRUNCATED AT 250 WORDS)

Antifibrinolytic Agents↗
PubMed1991

Reversible T-wave abnormality in severe acute asthma: an electrocardiographic sign of severity.

Reversible electrocardiographic (ECG) abnormalities are well recognized in severe acute asthma. Inferior lead T-wave abnormalities have only rarely been reported, and their frequency and significance have not been well documented. We studied 70 consecutive patients with severe acute asthma on admission to hospital and during recovery, in order to examine the frequency and natural history of such changes and to document their relationship to the severity of the attack. Twenty-two patients (34%) had inferior lead T-wave inversion on ECGs performed within 1 h of admission (group 1), whereas the rest did not (group 2). Apart from sinus tachycardia this was the most common ECG abnormality. Patients with inferior T-wave inversion were found to have more severe asthma in terms of degree of pulsus paradoxus, peak expiratory flow rate, forced expiratory volume in 1 s and arterial blood oxygen tension. Ten group 1 and ten group 2 patients underwent two-dimensional echocardiography during the acute phase of their illness and during recovery. Six (60%) group 1 patients showed echocardiographic evidence of right ventricular pressure overload compared with only one (10%) patient in group 2 (P less than 0.02). Following recovery, voluntary hyperventilation and exercise testing in ten group 1 patients failed to reproduce the ECG changes seen on admission. Reversible inferior lead T-wave abnormalities may occur in the severe acute asthma and appear to be related to the severity of the attack.

Acute Disease↗
PubMed1986

Severe measles in Sunderland, 1885: a European-African comparison of causes of severe infection.

On the basis of research in Guinea-Bissau, this paper re-analyses a severe measles epidemic which occurred in 1885 in Sunderland (England). In both England and Guinea-Bissau, acute measles mortality was higher in households with multiple cases than in families with only a single case of measles. Secondary cases (infected in the house) had higher mortality and higher frequency of severe complications than index and single cases. In Sunderland, severe complications were associated with a history of previous respiratory infection and with greater number of siblings. Since cases with severe complications had significantly prolonged prodromal symptoms and shorter periods of incubation, it is suggested that high dose of infection may be an essential mechanism in the pathogenesis of severe disease. Overcrowding may be a major determinant of severe measles because it increases the risks of intensive exposure, intercurrent infections, and previous respiratory infection.

Adolescent↗
PubMed1992

Correlation between injury severity scores and subjective ratings of injury severity: a basis for trauma audit.

A retrospective review of 1900 road accident victims attending the emergency departments of two Melbourne hospitals was undertaken to identify Injury Severity Score levels which could distinguish between minor, moderate, severe and critical injury. Injuries scoring ISS 6 or below were designated 'minor' because they were associated with a low risk of requiring admission to hospital. Case notes of patients scoring above ISS 6 were then reviewed by a panel of clinicians, who independently rated each patient's overall injury severity as moderate, severe or critical according to what was recorded in the notes and their 'clinical' judgement. ISS values were compared with clinicians' ratings. Measures of each clinician's individual rating consistency, and correlation between pairs of clinicians with respect to inter-rater consistency, were made. By combining data from both hospitals it emerged that 'moderate' injury corresponded to ISS 8-13, 'severe' to ISS 14-20 and 'critical' to ISS 21 and above. These ISS breakpoints will be useful in selecting groups of injured patients for future trauma audit studies.

Accidents, Traffic↗
PubMed1991

Measuring severity of illness: six severity systems and their ability to explain cost variations.

This paper presents results from a study that used a common set of patient records to compared how well different severity measurement systems are able to explain the variations in estimated costs among hospital patients. The systems examined were: APACHE II, MedisGroups, Computerized Severity Index (CSI), Disease Staging, Patient Management Categories (PMCs), and Acuity Index Method. In regressions on costs, all of the measures were found to improve upon DRGs for some types of cases but to offer little or no improvement for others. Indicators of maximum severity, especially Max CSI, explained greater proportions of cost variation than measures of admission severity and measures based on discharge abstracts. In most of the analyses, PMCs and Disease Staging yielded somewhat higher R2 values than the measures of admission severity.

Abstracting and Indexing↗
PubMed1987

[Obstetric management in severe fetal growth retardation. Report of experiences based on 278 newborn infants with severe dystrophy 1970-1985].

The article discusses and reviews the obstetrical modalities in confirmed severe growth retardation and the effects exercised by marked dystrophy of newborn (less than or equal to 3rd percentile of weight) at the Department of Gynaecology of the University of Cologne between 1970 and 1985 on perinatal mortality, rate of asphyxiation and neonatal complications. In view of the optimal diagnostic possibilities available during the past decade, the examinations were subdivided into two groups (1970-1975 and 1976-1985). In severe foetal growth retardation-mainly confirmed sonographically-the proportion of primary Caesarean sections increased from 10% to 38%, whereas indication for inducing labour clearly dropped from 25% to 6%. The desired slight reduction in incidence of prenatally severely dystrophic newborn from 1.6% to 1.2% is regarded as the beginning of the effect of ultrasound screening during pregnancy. The higher perinatal mortality of the severely dystrophic newborn of the years 1976-1985 is explained by the increased incidence of dystrophic newborn who are considerably underweight (less than 1000 g) from 1.3% (1970-1985) to 10.4% (1976-1985). If perinatal mortality rate is corrected accordingly, perinatal mortality for both groups is about equal, namely, 3.3% and 3.2% respectively. Among the severely dystrophic newborn there were distinct differences on comparing the two groups in respect of the degree of maturity depending on the pregnancy period, and of the weight at birth. In 1970-75 85% of the dystrophic children were born after the 37th pregnancy week, i.e. mature-dystrophic, and only 15% showed in addition the signs of immaturity.(ABSTRACT TRUNCATED AT 250 WORDS)

Apgar Score↗
PubMed1990

CD4 T-lymphocyte activation in acute severe asthma. Relationship to disease severity and atopic status.

Lymphocytes are prominent among the inflammatory cells infiltrating the asthmatic airways, and several studies have suggested that cell-mediated immunity may play a role in the pathogenesis of chronic asthma. We have measured (1) the expression of activation markers on the CD4+ and CD8+ T-lymphocyte phenotypic subsets in the peripheral blood of patients hospitalized with acute severe asthma ("status asthmaticus"), and (2) the serum concentrations of two proteins elaborated by activated T-lymphocytes (interferon-gamma and the soluble interleukin-2 receptor). The results were compared with those in control subjects (mild asthma, chronic obstructive airway disease, and normal). CD4+ lymphocytes from patients with acute severe asthma showed significant increases in the expression of three surface proteins associated with lymphocyte activation (interleukin-2 receptor [IL-2R], class II histocompatibility antigen [HLA-DR], and "very late activation" antigen [VLA-1]) as compared with those from normal control subjects. In contrast, CD8 cells were devoid of IL-2R and VLA-1, in both patients with acute severe asthma and control subjects, and the expression of HLA-DR on these cells was not increased above that of control subjects. The serum concentrations of interferon-gamma and soluble IL-2R were significantly elevated in patients with acute severe asthma as compared with all the control groups. Concentrations decreased as the patients improved clinically during the first 3-day period of hospital treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1978

Evidence that the severity of depletion of inorganic phosphate determines the severity of the disturbance of adenine nucleotide metabolism in the liver and renal cortex of the fructose-loaded rat.

To test the hypothesis that in both the liver and renal cortex of the fructose-loaded rat, severity of depletion of inorganic phosphate (P(i)), and not the magnitude of accumulation of fructose-1-phosphate (F-1-P), determines the severity of the dose-dependent reduction of ATP, we intraperitoneally injected fed rats with fructose, 20 and 40 mumol/g, alone, and at the higher load, in combination with (a) sodium phosphate, 20 mumol/g, administered shortly beforehand or subsequently or, (b) adenosine, 2 mumol/g, administered beforehand. The following observations were made: (a) With fructose loading alone, at the higher load, both P(i) and total adenine nucleotides (TAN) were reduced by one third in the renal cortex and (as previously observed) by two thirds in the liver; and at either load, the reduction of ATP (and TAN) and the accumulation of F-1-P were less severe in the renal cortex than in the liver. (b) Prior phosphate loading largely prevented the reductions of ATP and TAN in the renal cortex and significantly attenuated them in the liver, yet doubled the renal cortical accumulation of F-1-P. (c) Adenosine loading substantially attenuated the reductions of ATP, TAN, and P(i) only in the renal cortex. (d) ATP varied directly with P(i) (P < 0.001, r = 0.98) in the domain of control and reduced values of P(i) taken from both liver and renal cortex. (e) As judged from tissue and plasma concentrations of fructose and glucose, and tissue concentrations of fructose-6-phosphate and glucose-6-phosphate, the rate at which the renal cortex and liver converted fructose to glucose was much lower at the higher fructose load. (f) Prior phosphate loading prevented this decrease in rate in the renal cortex and attenuated it in the liver; adenosine loading attenuated it only in the renal cortex. We conclude that in both the renal cortex of the fructose-loaded rat: (a) Depletion of P(i) is critical to the causation of the reductions in both ATP and TAN and, at the higher fructose load, of a decrease in the rate at which ATP is regenerated. (b) The severity of depletion of P(i) determines the severity of these disturbances. (c) By differentially mitigating the depletion of P(i), prior phosphate loading largely prevents these disturbances in the renal cortex, and attenuates them in the liver; and adenosine loading attenuates them only in the renal cortex. The findings provide some basis for the observation that in patients with hereditary fructose intolerance experimentally exposed to fructose, prior loading with sodium phosphate substantially attenuates the renal but not hepatic dysfunction.

Adenine Nucleotides↗
PubMedDate not supplied

Predicting severity of cognitive impairment after severe head injury.

It is often assumed that age is an important variable in determining cognitive outcome following severe head injury. The present study was carried out to determine whether age at time of injury predicted severity of cognitive impairment. Our hypothesis was that the older the patient at time of head injury the worse should be the cognitive impairment. Cognitive impairment was assessed by scores on nine standardized tests. Scores were obtained from 144 consecutive referrals to a clinical psychologist; all subjects had sustained a severe head injury. Of these, 115 had suffered a closed head injury. Ages ranged from 13 to 65 years. Apart from Unusual Views and Verbal Fluency no significant correlations were found between age and test performance. Thus there was little evidence that age predicted performance on cognitive tests. A number of significant correlations were found between length of coma and cognitive performance. The findings would seem to confirm that cognitive outcome after severe head injury is predicted by length of coma (which reflects severity of brain damage) whilst age at time of injury does not appear to be a good predictor of outcome.

Activities of Daily Living↗