Monoclonal antibodies in the treatment of rheumatoid arthritis.
Explore the source record for details and available documents.
Adrenal Cortex Hormones↗
Biomedical subjects
J C Delafuente
Publications and source records attributed to J C Delafuente.
Health status of the aged: medical profile of a group of functional elderly.
By studying a group of very elderly but generally functional people, we have compiled a medical profile that helps describe health-related characteristics of effective aging. We obtained functional, nutritional, and biochemical information regarding 61 men and women (mean age 86.8 years) attending a veterans' convention. Twenty-three out of 60 (38%) reported a fall in the previous year, with those who were less physically active falling more than the most active. Many of the men were thin or had lost weight, but at most 3 of the 25 male subjects were clinically malnourished. Many of the women were heavy but were otherwise healthy. Of the 36 women, 6 (17%) had an elevated level of thyroid-stimulating hormone (TSH). Five of 58 (9%) had low vitamin B12 levels. Even in the older old who seem to be aging well, falling is relatively common, and screening for certain laboratory abnormalities has a reasonably high yield.
Accidental Falls↗
Drug use among functionally active, aged, ambulatory people.
BACKGROUND AND METHODS: Only a few pharmacoepidemiology studies have included very old subjects and most studies included both healthy and very ill people. Interpretation of data from these investigations is limited because of the mix of health status in the populations studied. We examined drug use in a group of active, relatively healthy, older people. Sixty-one attendees at a national convention, aged 76-96 years, volunteered to participate in a study on health status in a very old, ambulatory population. Medication histories, selected blood biochemistry analyses, a mental status examination, and other data were collected. RESULTS: The mean number of prescription and nonprescription drugs used per person was 2.02 and 1.85, respectively. More than a quarter of the sample population took no prescription medications and two-thirds used two or fewer prescription drugs. Sixteen percent of those taking prescription medications experienced adverse effects from their current drug regimens. Although falling was prevalent among our study subjects, there were similar drug-use patterns in those who did and who did not fall. CONCLUSIONS: In a group of relatively healthy and functional very old people, we found that drug use was not excessive, although adverse effects were still prevalent. In addition, most subjects were knowledgeable about their medications. These studies demonstrate that extreme age alone does not always result in sickness, frailty, and overuse of medications.
Aged↗
Immunologic effects of cocaine and related alkaloids.
Because of the national epidemic of cocaine abuse and the increasing prevalence of infectious diseases among drug abusers, we investigated the effects of cocaine and cocaine metabolites on human cellular immune functions. Mononuclear cells (MNC) were isolated from blood of healthy adult volunteers. MNC were stimulated in vitro with mitogens with and without various concentrations of cocaine. Because of cocaine's poor stability in vitro, we found it necessary to replenish cocaine daily to MNC cultures. Under these conditions, cocaine, in a dose response fashion, significantly inhibited MNC proliferation. Metabolites of cocaine did not alter MNC proliferative responses significantly from control cultures. Polymorphonuclear leukocyte chemotaxis was also significantly impaired by cocaine. Our data demonstrate that cocaine is immunosuppressive and that it acts on human MNC during early stages of cellular activation. These data further suggest that illicit cocaine use may compromise the integrity of the immune system.
Chemotaxis, Leukocyte↗
Perspectives on geriatric pharmacotherapy.
In the United States the population over 85 years of age use a disproportionately large percentage of health care resources, including drugs. The elderly take approximately one-third of all medications. Among other factors, the need for several agents predisposes them to adverse drug reactions and drug interactions. Sequelae from drug usage in the elderly are more common than in younger patient populations, and often result in hospitalization. Careful patient monitoring is imperative for optimum pharmacotherapy in elderly patients.
Age Factors↗
Nutrients and immune responses.
A wide spectrum of nutritional deficiencies, ranging from trace elements to protein, can impair normal immunologic functions. Repletion of deficient nutrients generally will restore the immune response. Under some experimental conditions, single nutrient supplementation boosts immunity; however, some mega-dose therapies have been shown to suppress the immune response. Adequate nutrition is essential for maintaining the integrity of the immune system.
Animal Nutritional Physiological Phenomena↗
Orthostatic hypotension: therapeutic alternatives for geriatric patients.
Symptomatic orthostatic hypotension is a serious problem in the elderly because it can precipitate falls and fractures, myocardial infarctions, and strokes. Several disorders may cause symptomatic orthostatic hypotension including age-related changes in physiology, disorders of the autonomic nervous system, drugs, and a decrease in circulating blood volume. Orthostatic hypotension is defined as a fall in systolic pressure of at least 20-30 mm Hg and a fall in diastolic pressure of at least 10-15 mm Hg upon rising, with symptoms of cerebral ischemia. Management includes a search for reversible causes as well as nonpharmacologic and pharmacologic therapies. No single agent has been universally successful in relieving the symptoms of orthostatic hypotension. Trials of single agents or combinations of agents are needed to identify the most appropriate therapy for individual patients.
Aged↗
Pharmacotherapy of allergic rhinitis.
The pathophysiology, clinical manifestations and diagnosis, and pharmacotherapy of allergic rhinitis are reviewed. Allergic rhinitis is an immunologically mediated disease initiated by an antigen-antibody reaction in sensitized persons. Clinical manifestations include nasal obstruction, rhinorrhea, itching of the nose and eyes, coughing, and sneezing and may be perennial or seasonal. Diagnosis is confirmed by challenging the patient with suspected allergens in skin-prick tests. Avoidance of offending allergens is the cornerstone of therapy. Antihistamines and decongestants provides only minimal relief when used alone and are more effective when combined with other agents. Two newer antihistamines, astemizole and terfenadine, lack the sedative and anticholinergic properties of older antihistamines. Intranasal corticosteroids are particularly effective in relieving symptoms; beclomethasone diproprionate and flunisolide do so without producing systemic adverse effects. Cromolyn sodium is effective in relieving nasal symptoms and is the prototype of a new noncorticosteroidal class of compounds termed antiallergy drugs. Drugs under investigation for the treatment of allergic rhinitis include histamine H2-receptor antagonists, nonsteroidal anti-inflammatory agents, anticholinergic agents, and beta-adrenergic receptor agonists. Immunotherapy is a helpful adjunctive treatment. Treatment with drugs may be necessary for those patients with allergic rhinitis who find it difficult or impossible to avoid the offending allergen. The severity of symptoms and the adverse effects of agents should be considered when individual therapeutic plans are being established.
Humans↗
Profile of a meeting: how abstracts are written and reviewed.
We analyzed submissions to a recent scientific program to determine (1) how abstracts were reviewed and (2) what constituted a successful abstract. We found that (1) reviewers' gradings varied from 2-29%, in some instances differing significantly; (2) many (<74%) abstracts had inadequacies in form, title, introduction, aims, methods, results, and conclusions(collectively termed "content") or lacked numerical or statistical data; (3) accepted abstracts had fewer inadequacies and better "content"; and (4) abstract grades correlated closely with "content". The quality of preparation and of individual features of abstracts led to favorable review. This information is of potential value to scientists preparing and reviewing abstracts and planning programs.
Abstracting and Indexing↗
Pharmacologic immunoenhancement in the elderly: in vitro effects of isoprinosine.
The loss of immune competence that occurs with aging may be responsible for increased morbidity and mortality in elderly individuals. Pharmacologic modulation of the immune response might reverse the immunologic aberrations associated with aging. We, therefore, investigated the effects of isoprinosine, an immunoenhancing drug, on selected in vitro immune responses in elderly subjects. Subjects studied were 65 years of age or older, and all had chronic diseases. We chose this population since they were at greatest risk for morbid events. Isoprinosine significantly enhanced mitogen-stimulated mononuclear cell proliferation, did not affect unstimulated cell growth, and needed to be present for the entire culture period for maximum effect. Isoprinosine is a potent in vitro immunoenhancing agent in aged humans.
Aged↗
Anergy testing in nursing home residents.
Delayed cutaneous hypersensitivity (DCH) testing is commonly used to determine exposure to Mycobacterium tuberculosis and in the evaluation of cellular-mediated immunity. Many reports indicate that anergy to ubiquitous antigens is common in the elderly. Recent studies suggest that anergy in the aged is not common when five or more antigens are used. Because it is often difficult to purchase singularly or apply a larger number of quality DCH antigens, we investigated the usefulness of the Multitest CMI in 29 nursing home residents with chronic diseases. This device simultaneously applies seven skin test antigens and a negative control. Ten young healthy subjects served as controls. DCH reactions were scored based on the sum of induration and total number of positive responses. Although elderly subjects had significantly lower scores than the young subjects, only 7% of elderly subjects were anergic. Our data indicate that the Multitest CMI is a highly effective device to test for DCH in geriatric subjects with chronic diseases. Although skin test responses in these subjects were blunted, in most residents cellular-mediated immunity remained intact.
Adult↗
Treatment of systemic lupus erythematosus.
Systemic lupus erythematosus (SLE) is an autoimmune disease with clinical manifestations involving a multitude of tissue sites. This article describes the pathophysiology, etiology, clinical manifestations, and therapy of SLE, and focuses mainly on drugs used in SLE treatment. The reader will be able to identify which pharmacologic agents are used in SLE and list the drugs that are useful for specific clinical manifestations. The reader will also be able to describe the common adverse drug reactions seen from SLE treatment and the potential risks involved with these therapies. Information on expected outcomes from drug therapy that will aid in monitoring patients receiving treatment for SLE is provided.
Humans↗
Immunologic modulation by vitamin C in the elderly.
Aging is associated with a decline in both humoral-mediated and cellular-mediated immunity. These aberrations may contribute to morbidity and mortality in the elderly. Since we have previously shown that vitamin C enhances in vitro and in vivo immune functions in young healthy volunteers, we studied the effects of vitamin C on certain immunologic parameters in an elderly population. In vitro lymphocyte proliferation to the mitogen concanavalin-A was significantly less when compared to a young control group. When lymphocytes from the elderly were pre-incubated overnight and cultured in the presence of 10 micrograms/ml of vitamin C, mitogen-stimulated lymphocyte proliferation was similar to that from controls without vitamin C in culture. Having demonstrated significant in vitro immunoenhancement with vitamin C, we next studied the effects of oral ingestion of 2 g of vitamin C daily on certain in vitro and in vivo immunologic parameters in the elderly. When compared with a placebo-treated group, 3 weeks of vitamin C treatment did not effect in vitro mitogen-stimulated lymphocyte proliferation or in vivo reactivity to common skin test antigens. The augmenting effects of in vitro vitamin C suggest that this essential vitamin may be an effective agent in modulating aberrant immunologic functions in the elderly. The clinical significance of these findings requires further study.
Aged↗
Immunosenescence. Clinical and pharmacologic considerations.
The effect of aging on the immune response is highly variable. Many individuals appear to maintain adequate immunologic function throughout life, whereas others have severely depressed immunologic responses accounting for disease activity. Both cellular- and humoral-mediated responses may be abnormal in the elderly. Aberrant function of immunoregulatory cells, effector T cells, and antibody-producing B cells contribute to poor immunity in the aged. Immunoenhancement in the elderly by pharmacologic agents appears promising. Several agents have been demonstrated to improve immune responses when administered to aging animals and humans. Although these studies are encouraging, it is not known if enhancement of immune responses in the elderly will be associated with clinical benefits. This issue must still be examined.
Aged↗
Drug-induced erythema multiforme: a possible immunologic pathogenesis.
A 37-year-old female developed erythema multiforme 17 days after beginning carbamazepine for complex partial seizures. The carbamazepine was discontinued and phenytoin begun. A new rash developed and phenytoin therapy was stopped. In vitro immunologic studies were conducted in an effort to understand the pathogenesis of the rashes. Enhancement of stimulated in vitro lymphocyte proliferation from the patient occurred in the presence of carbamazepine and phenytoin. Neither drug had an enhancing effect on lymphocyte proliferation from a control subject. These data, together with clinical data, strongly suggest an immunologic pathogenesis for drug-induced erythema multiforme.
Adult↗
Vitamins and immunocompetence.
Explore the source record for details and available documents.
Animals↗
Tetanus toxoid as an antigen for delayed cutaneous hypersensitivity.
We studied the usefulness of tetanus toxoid (TT) as a skin test antigen in assessing cellular immune function. Hospitalized patients were skin tested with four antigens, and the response rates between these antigens were compared. Candida and mumps antigens resulted in significantly more positive responses than did TT or PPD. The response rate to the TT significantly declined in older patients, suggesting these persons may not be adequately immunized against tetanus. We found TT is not as useful as Candida or mumps antigens in the evaluation of cellular immune function in a hospitalized population but it may have some usefulness in the evaluation of energy. Negative skin test results may convert to positive after patients receive an immunizing dose of TT, as shown by our data. In addition, there were several patients with a positive response to TT and negative responses to the other common skin test antigens.
Adult↗
Ampicillin-specific antibody and delayed hypersensitivity skin tests to ampicillin in patients with acute infectious mononucleosis.
Explore the source record for details and available documents.
Ampicillin↗