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Biomedical subjects

I Beyer

Publications and source records attributed to I Beyer.

15 recordsLinked to original sources
PubMed2006

Management of an outbreak of Clostridium difficile-associated disease among geriatric patients.

OBJECTIVE: To describe a nosocomial outbreak of Clostridium difficile-associated disease (CDAD). DESIGN: A traditional outbreak investigation. SETTING: Geriatric department of a tertiary care teaching hospital from March through April 2003. METHODS: The outbreak was detected by the C. difficile surveillance program of the infection control unit. CDAD was diagnosed by stool culture and fecal toxin A detection with a qualitative rapid immunoassay. Isolates of C. difficile were serotyped and genotyped using pulsed-field gel electrophoresis. RESULTS: The incidence of CDAD increased from 27 cases per 100,000 patient-days in the 6-month period before the outbreak to 99 cases per 100,000 patient-days during the outbreak. This outbreak involved 21 of 92 patients in 4 geriatric wards, which were located at 2 geographically distinct sites and staffed by the same medical team. The mean age of patients was 83 years (range, 71-100 years). Five (24%) of the 21 patients had community-acquired diarrhea, and secondary hospital transmission resulted in 3 clusters involving 16 patients. Serotyping and genotyping were performed on isolates in stool specimens from 19 different patients; 16 of these isolates were serotype A1, whereas 3 displayed profiles different from the outbreak strain. Management of this outbreak consisted in reinforcement of contact isolation precautions for patients with diarrhea, cohorting of infected patients in the same ward, and promotion of hand hygiene. Relapses occurred in 6 (29%) of 21 patients. CONCLUSION: Control of this rapidly developing outbreak of CDAD was obtained with early implementation of cohorting and ward closure and reinforcement of environmental disinfection, hand hygiene, and enteric isolation precautions.

Aged↗
PubMed2002

Examining the effect of intervention to nutritional problems of hospitalised elderly: a pilot project.

BACKGROUND: Up to 65% of elderly patients are protein-energy undernourished at admission or acquire nutritional deficits while hospitalised. OBJECTIVES: The aims of this project were: 1) to assess the quality of care concerning nutrition among geriatric units; 2) to assess the impact of implementive nutritional interventions on nutritional status and on the length of hospitalisation. DESIGN: Two hundred and six patients consecutively admitted in a geriatric unit of a general hospital were studied prospectively for 6 months (from January to June 2001). All patients underwent a comprehensive geriatric assessment. For the first 3 months the nutritional status of the patients on admission and at discharge were assessed without particular recommendations for nutritional intervention. A standardised nutritional intervention was proposed for the last 3 months. RESULTS: Median value of Mini-Nutritional Assessment was 19 points (ranged from 9 to 29), mean admission s prealbumin concentration (PAB) was 0.179 g/l, and C-reactive protein 5.9 2.8 mg/100ml. Hospitalisation stay was significantly lower during the interventional period than during the observational period. A higher mean PAB variation was observed during the interventional period as compared to the observational period. CONCLUSIONS: Nutritional assessment should be part of routine clinical practice in elderly hospitalized patients. A comprehensive screening tool for assessment of nutritional status is needed that is clinically relevant and cost-effective to perform. If malnutrition is suggested by such screening tests, implementations of nutritional intervention allow to ameliorate discharge nutritional status and to reduce hospitalization stay.

Journal Article↗
PubMed2001

Management of urinary tract infections in the elderly.

Urinary tract infection (UTI) is the most common infection and the first cause of bacteremia in the elderly. With increasing age the female to male ratio decreases and UTI becomes almost half as frequent in men compared to women. Significant bacteriuria exists in about 40% of institutionalized women. But asymptomatic bacteriuria is neither the cause of morbidity nor associated with a higher mortality rate and thus should not be treated. Symptomatic infection in women without complicating factors is most often caused by E. coli and may be treated with 3 or 7 day regimens of trimethoprim-sulfamethoxazole or fluoroquinolones (FQ). In the presence of symptoms of upper tract infection or complicating factors, urine culture is mandatory and will detect multiple and/or resistant microorganisms in most cases. Empirical treatment has to be adapted according to the sensitivity once established and should be administered for at least 10 days. Most of the patients above 65 and virtually all patients above 80 present either with general debility or diabetes or other factors such as bladder outflow obstruction or abnormal bladder function and have to be considered as presenting with complicated UTI. Indwelling catheters should be removed if possible, otherwise be changed.

Aged↗
PubMed1999

1,25-dihydroxyvitamin D3 inhibits parathyroid hormone-related peptide mRNA expression in fetal rat long bones in culture.

When fetal rat long bones are incubated in the presence of 10(-8) M 1,25-dihydroxyvitamin D3 [1,25(OH)2D3], steady-state parathyroid hormone-related peptide (PTHrP) mRNA levels are decreased. This decrease is temporary: it is observed as soon as after 3 h of exposure and reaches a nadir after 6 h. At that time, PTHrP mRNA levels are significantly lower in the experimental than in the control bones. However the inhibitory effect vanishes after 24 h, despite continuous exposure to 1,25(OH)2D3 for even 48 h. This is the first report showing that PTHrP mRNA expression can be regulated in rat fetal long bones in vitro by 1,25(OH)2D3.

Animals↗
PubMed1999

Clinical relevance of thiamine status amongst hospitalized elderly patients.

BACKGROUND: The prevalence and the consequences of thiamine deficiency among elderly patients admitted to acute geriatric wards are not known. OBJECTIVES: (1) To assess the prevalence of thiamine deficiency in patients admitted to a geriatric ward compared to age-matched ambulatory outpatients; (2) to identify their diseases and problems associated with thiamine deficiency, and (3) to determine the relationship between the thiamine status and the cognitive and functional status of these patients. MATERIALS AND METHODS: 118 aged hospitalized patients (83 +/- 7 years; mean age +/- SD) were prospectively enrolled on admission to the geriatric ward. Their cognitive status was assessed using the Mini-Mental State Examination (MMSE) and their ability to perform their activities of daily living (ADL) using ADL scales. The effect of exogenous thiamine pyrophosphate (TPP) addition on the blood transketolase (TK) activity (TPP TK effect) served to estimate thiamine deficiency. Socioeconomic data, diseases and treatment were identified as potential associated risk factors. This group of hospitalized patients was divided according to their thiamine status to characterize the conditions associated with thiamine deficiency. Thirty-five outpatients without any functional or cognitive impairment served as a control group. RESULTS: Of 118 inpatients, 46 (39%) presented with a TPP TK effect of >15%, and 6 with values of >22%, indicating moderate and severe thiamine deficiency, respectively. Only 6 of 30 outpatients (20%) exhibited a TPP TK effect of >15% and none of them reached values of >18%. Although it tended to be lower in outpatients, the mean TPP TK effect did not statistically differ from the mean of inpatients. Thiamine-deficient inpatients comprised a larger proportion of institutionalized subjects than nondeficient inpatients (87 versus 47%, p < 0.001). Functional status, cognitive functions and the occurrence of delirium did not differ according to their thiamine status. By contrast, thiamine-deficient inpatients exhibited a higher proportion of Alzheimer's disease, depression, cardiac failure and falls. Furosemide was more frequently taken by thiamine-deficient patients. CONCLUSIONS: Severe thiamine deficiency remained quite low among the hospitalized elderly. The prevalence of moderate thiamine deficiency approached 40%. Institutionalized subjects were at particular risk of developing thiamine deficiency. Its clinical relevance on functional status and on cognitive function remained not significant. By contrast, a high proportion of falls, Alzheimer's disease, depression, cardiac failure and furosemide use could have been related to thiamine deficiency.

Activities of Daily Living↗
PubMed1996

[Subjective contrast evaluation by visually handicapped patients].

Personal optical and electronic devices are helpful to people with binocular vision of less than 0.3 or a substantially impaired visual field. Striking brightness and color contrast may help patients to orient themselves outdoors. This is particularly true for patients with age-related macular degeneration who have diminished contrast sensitivity as evaluated by the Vistech test and the low-contrast sensitivity test. In this study, the desired level or color combination of contrasts was assessed subjectively by a scaled estimate. The patients were required to assess a sample of 79 black-and-white and color contrasts according to a five-point scale comprising the ratings "much too low", "low", "optimal", "high", "much too high". The visual fields (outfield, infield) were either colorless or contained the colors yellow, green, red, purple or blue. The study involved 59 patients with age-related macular degeneration. Ninety percent of the patients were over 65 years old. There were twice as many women as men. The control group population consisted of 43 emmetropic subjects. In black or white infields on a colorless background (light gray to dark gray), a slight preference for positive (infield lighter than the background) contrast situations was found. The optimal contrasts were in the range of [K[ > 0.91. When colored infields were presented on a colorless background, the light infield colors yellow and green were preferred. The optimal contrast level was found to be [K[ > 0.85. Similarly, when colorless and colored infields were presented, light infield colors (white, yellow, green) on a dark background (purple, blue) were preferred. In selecting contrasts, subjects with impaired vision because of age-related macular degeneration preferred positive contrasts, i.e., mainly white, yellow and green on a colored or colorless background. These results provide information that can be used in designing orientation aids, e.g., road striping and lines, edges of stairs, handrails, timetables, etc. Conflicts of interest with emmetropic subjects is not to be expected. Subjects in the control group, while preferring similar contrasts, were ready to accept a wider range than the partially sighted.

Aged↗
PubMed1996

[Biliary ileus].

A case of gallstone ileus in an elderly woman is described and attention is drawn to the insidious clinical presentation and the significance of the often subtle radiological signs. The data from the literature specifies these aspects and allows a more complete review of this relatively rare pathology in order to remind its importance in differential diagnosis to emergency clinicians and radiologists.

Biliary Fistula↗
PubMed1990

The effect of abstinence in alcoholics of erythrocyte gangliosides.

The pattern of gangliosides in membranes of erythrocytes was examined in healthy and in alcoholic subjects on the second and on the 28th day of detoxification therapy. The GM3 and GD3 fraction were decreased significantly in alcoholics on the 2nd day. After 4 weeks of abstinence all changes had returned to the level of healthy subjects.

Adult↗
PubMed1988

[Abnormal erythrocyte membrane gangliosides in alcoholism].

The pattern of gangliosides in membranes of erythrocytes was examined in healthy donors and in alcoholic subjects. Seven different gangliosides could be detected. In healthy donors the following pattern was found: GM3 = 17.6%, SPG = 43.1%, GD3 = 9.1%, GD1a = 12.8%, FucGD1b = 5.2%, GT1b = 6.7% and GX = 5.7%. The GM3 and FucDG1b fraction were decreased statistically significantly in alcoholics.

Adult↗
PubMed1988

Abnormality of gangliosides in erythrocyte membranes of schizophrenic patients.

The pattern of gangliosides in membranes of erythrocytes was examined in healthy donors, in acute schizophrenics without neuroleptic treatment and in alcohol-dependent patients. 7 different gangliosides could be detected. Healthy donors were characterized by the following ganglioside pattern: GX = 5.8%; GT1b = 6.7%; FucGD1b = 5.2%; GD1a = 12.6%, GD3 = 9.2%, SPG = 43.5%, and GM3 = 17.0%. In schizophrenic patients the GM3 and GD3 fractions were increased. No difference was found between the control group and the alcoholics.

Adolescent↗
PubMed1987

[Changes in the gangliosides of erythrocyte membranes of schizophrenic patients].

The pattern of gangliosides in membranes of erythrocytes was examined in healthy donors, in acute schizophrenics without neuroleptic treatment and in alcohol-dependent patients. 7 different gangliosides could be detected after extraction, purification by column chromatography and fractionation by TLC. Healthy donors were characterized by the following pattern of gangliosides: GX = 5.8%, GT1b = 6.7%, FucGD1b = 5.2%, und GD1a = 12.6%, GD3 = 9.2%, SPG = 43.5% and GM3 = 17.0%. In schizophrenic patients the GM3- and GD3-fraction were increased. No difference was found between the control group and the alcoholics.

Adolescent↗