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Biomedical subjects

J Pape

Publications and source records attributed to J Pape.

At least 19 recordsLinked to original sources
PubMed2005

CSF findings in 250 patients with serologically confirmed West Nile virus meningitis and encephalitis.

OBJECTIVE: To provide a large, comprehensive evaluation of the CSF findings in patients with serologically confirmed West Nile virus (WNV), CNS disease, and their correlation with outcome. METHODS: CSF samples from 334 WNV-infected hospitalized patients were analyzed. Information was available and extracted from the medical records of 250 of these patients, and CSF parameters correlated with clinical and epidemiologic features of disease (e.g., patient age, sex, outcome). RESULTS: Patients with meningitis had a mean of 226 cells/mm3, and those with encephalitis had a mean of 227 cells/mm3. Three percent of meningitis patients and 5% of encephalitis patients had fewer than 5 cells/mm3, and approximately 8% of both groups had more than 500 cells/mm3. Patients with meningitis had a mean of 41% neutrophils, and those with encephalitis had 45%. Forty-five percent of meningitis patients and 37% of encephalitis patients had at least 50% neutrophils in their initial CSF specimen. Neither the mean percent neutrophils nor their distribution differed significantly between groups. Forty-seven percent of encephalitis patients and 16% of meningitis patients had CSF protein of 100 mg/dL or greater (p < 0.01). Although specific CSF parameters, including nucleated cell count and protein concentration, correlated significantly with outcome, multivariate analysis suggested that their total predictive value was modest. Age was an additional predictor of outcome independent of CSF variables in all patients. CONCLUSIONS: Serologically confirmed West Nile virus meningitis and encephalitis produce similar degrees of CSF pleocytosis and are frequently associated with substantial CSF neutrophilia. Patients with encephalitis have higher CSF protein concentrations and are more likely to have adverse outcomes, including admission to long-term care facilities or even death after their acute illness. CSF findings were only a modest predictor of disease outcome, with patient age adding important independent prognostic information.

Adult↗
PubMed1999

Comparison of three commercial systems for identification of yeasts commonly isolated in the clinical microbiology laboratory.

We evaluated three commercial systems (RapID Yeast Plus System; Innovative Diagnostic Systems, Norcross, Ga.; API 20C Aux; bioMerieux-Vitek, Hazelwood, Mo.; and Vitek Yeast Biochemical Card, bioMerieux-Vitek) against an auxinographic and microscopic morphologic reference method for the ability to identify yeasts commonly isolated in our clinical microbiology laboratory. Two-hundred one yeast isolates were compared in the study. The RapID Yeast Plus System was significantly better than either API 20C Aux (193 versus 167 correct identifications; P < 0.0001) or the Vitek Yeast Biochemical Card (193 versus 173 correct identifications; P = 0.003) for obtaining correct identifications to the species level without additional testing. There was no significant difference between results obtained with API 20C Aux and the Vitek Yeast Biochemical Card system (P = 0.39). The API 20C Aux system did not correctly identify any of the Candida krusei isolates (n = 23) without supplemental testing and accounted for the major differences between the API 20C Aux and RapID Yeast Plus systems. Overall, the RapID Yeast Plus System was easy to use and is a good system for the routine identification of clinically relevant yeasts.

Candida↗
PubMed1993

AIDS in Haiti: 1982-1992.

Haiti was one of the first countries where AIDS was recognized, a burden that led to the stigmatization of an entire nation resulting in serious long-term economic, social, and psychological consequences. Sixty percent of urban hospital beds are now occupied by patients infected with human immunodeficiency virus (HIV). AIDS is the leading cause of death in sexually active adults and increasingly has become a disease of women and children. AIDS threatens to reverse the decrease in infant mortality achieved during the past decade. In spite of educational efforts, the "silent epidemic" continues in all parts of the country and within all strata of society. The current HIV seroprevalence is 10% in urban areas and 5% in rural areas. AIDS is known but not understood; counseling modifies behavior in only 10%-20% of at-risk persons. This distressing situation is likely to worsen in view of the ongoing political crisis since almost all AIDS-education programs are dependent on foreign support.

AIDS-Related Opportunistic Infections↗
PubMed1991

Forces acting during air and ground transport on patients stabilized by standard immobilization techniques.

OBJECTIVE: Transportation, whether by air or ground, exposes the injured patient to mechanical shocks and vibrations. These forces and their hazardous potential remain largely unknown. The purpose of this study was to identify, characterize, and compare the forces generated during patient transport in helicopter and ground ambulances. METHODS: Forces generated during transport were measured using an instrumented, low mass triaxial accelerometer fixed to a standard backboard. Measurements were recorded in three axes with an adult subject immobilized on the board during experimental ambulance and helicopter trials. Acceleration waveforms were analyzed in each mode of transport. RESULTS: Forces for both ground and air transport ranged 0.07g to 0.19g root mean square, and 0.32g to 0.83g mean peak. The vibrational forces in the helicopter were fairly discrete, located at 6.6, 19.5, and 39 Hz, and axis dependent. Ground ambulance vibrations were more diffuse, occurring below 1 Hz and between 10 and 15 Hz. Crest factor analysis shows that shocks were more uniform in the helicopter than on the ground, especially in the anterior-posterior axis. CONCLUSION: These data suggest that transportation by helicopter subjects supine patients to greater lateral and vertical forces, but smaller head to toe forces, than ground transportation (P less than .05). In general, the forces to which a backboarded subject is subjected during transport range from 0.32g to 0.83g, vary by direction, and are more predictable for air than for ground transport. The clinical significance of these measurements requires further study.

Acceleration↗
PubMed1984

Meningococcal septicaemia treated with combined plasmapheresis and leucapheresis or with blood exchange.

Mortality among patients suffering from meningococcal septicaemia has reached nearly 50% in parts of northern Norway despite intensive care. The activation of complement and blood cells by endotoxin is assumed to be the cause of most of the associated pathophysiological changes. Consequently, it would seem logical to remove such constituents either by combined plasmapheresis and leucapheresis or by blood exchange in patients with a fatal prognosis. Three patients were treated with plasmapheresis and leucapheresis and one with blood exchange. All recovered without sequelae, and no complications or serious problems caused by these procedures were observed. It is concluded that either combined leucapheresis and plasmapheresis or blood exchange is well tolerated and a valuable supplement to conventional intensive care in fulminant meningococcal septicaemia.

Adolescent↗
PubMed1983

Effect of posture on ampicillin pharmacokinetics, glomerular filtration rate and renal plasma flow in resting subjects.

Differences in drug kinetics between supine rest and ambulation have been reported, but the relative contribution of postural changes and changes in the level of physical activity has not been evaluated. Ampicillin pharmacokinetics, glomerular filtration rate (GFR) and renal plasma flow (RPF) were studied in six male volunteers at rest in the sitting and lying position with an interval of 1 week. After intravenous administration ampicillin kinetics, analyzed according to a two-compartment open model, demonstrated significant changes in drug distribution when the position was changed from lying to sitting: alpha-increased by 50%, V1 and V beta increased by 19% and 22% respectively. Ampicillin clearance, the fraction of dose recovered from urine, GFR and RPF were, however, not influenced by the change in posture. Our data on effects of posture in resting subjects suggest that previously reported differences in drug elimination and RPF between lying and ambulatory subjects are largely due to differences in the level of physical activity.

Adult↗
PubMed1981

Blood pressure and pulse response to insulin-induced hypoglycemia during non-selective and selective beta-blockade.

Hypoglycemia was induced in ten healthy male volunteers during medication with atenolol, metoprolol and propranolol. The beta-blockers abolished the tachycardia during hypoglycemia. In some subjects bradycardia, and in two nodal bradycardia was observed on propranol. The physiologic blood pressure responses were dampend during the beta1-selective blockade. With propranolol a rise in blood pressure was recorded, in two subjects up to 160/105. The blockers had no effect on degree of hypoglycemia or glucose recovery.

Adrenergic beta-Antagonists↗
PubMed1980

Effect of blood transfusions on renal transplantation: study of 191 consecutive first transplants from living related donors.

One hundred ninety-one consecutive living related transplants performed from 1969 to the end of 1978 have been analyzed for the effect of pretransplant blood transfusions. Superior graft survival was observed in transfused patients transplanted with a one HLA haplotype-disparate kidney, whereas no effect of blood transfusions could be observed on the survival of HLA-identical transplants. The frequency of first rejection episodes was significantly reduced in transfused compared to nontransfused one haplotype-mismatched transplants, while no influence of blood transfusions was seen in patients with HLA-identical transplants. The survival of patients was, however, not influenced by previous transfusions. Pretransplant hemodialysis improved graft survival and patient survival; the difference was, however, only significant at 2 years in the one haplotype-mismatched group. When analyzed separately, both blood transfusions and hemodialysis had a beneficial effect on graft survival in one haplotype-mismatched transplants.

Adult↗
PubMed1980

The effect of blood transfusions on renal transplantation. Studies of 395 patients registered for transplantation with a first cadaveric kidney.

Three-hundred-and-ninety-five candidates registered for a first cadaveric renal transplant have been analyzed for the effect of pre-graft blood transfusions. Of these, 348 patients were transplanted, 45 died prior to transplantation and two patients have not yet received a transplant. Slightly less than half of the transplanted patients had been transfused, and those received five or more transfusions demonstrated a superior graft survival. This was pronounced in all HLA incompatible transplants who had received five or more transfusions. In patients who received less than five transfusions, only one-two HLA antigen incompatible transplants demonstrated increased graft survival. The frequency of rejection episodes was significantly decreased in all transfused compared to non-transfused groups. Among the patients dying while waiting for a transplant, the majority had been transfused, and a significantly higher proportion of them had cytotoxic HLA antibodies, compared to those who were transplanted.

Adult↗
PubMed1980

Effect of blood transfusions on first cadaveric graft and uremic patient survival.

The 404 cadaveric first transplant candidates registered in Norway at the end of 1977, have been analyzed for blood transfusions; 346 of these patients have been transplanted, 45 died prior to transplantation, while 4 patients have not yet received a transplant and 9 were excluded from the analysis. Slightly less than half of the transplanted patients had been transfused, and these demonstrated significantly better graft survival, most pronounced in those receiving 5 or more transfusions. The majority of the patients dying while waiting for a transplant had been transfused, and in these also a significantly higher frequency of cytotoxic HLA antibodies was observed. All 4 still waiting patients are transfused and have multispecific antibodies. The increase in graft survival after blood transfusions was most pronounced in 1-2 HLA incompatible transplants, less in 3 and 4 antigen incompatible transplants, and no increase was seen in compatible transplants. When analyzing for rejection episodes, however, significant decrease was seen in all transfused groups compared to non-transfused.

Adult↗
PubMed1980

Effect of pre-transplant blood transfusions and haemodialysis on the survival of first kidney grafts from living related donors.

The influence of pre-transplant blood transfusions and haemodialysis has been analyzed in 191 consecutive living related first transplants. A significantly increased graft survival was seen among patients having received blood transfusions and transplanted with a 1 haplotype disparate kidney, while no effect could be observed in HLA-identical transplantations. No significant effect could be detected on recipient survival. Four patients to receive 1 haplotype mis-matched grafts were sensitized against their potential donors by transfusions, and therefore not transplanted with living related donors. The frequency of first rejection episodes was highly significantly reduced in transfused compared to non-transfused 1 haplotype mis-matched transplanted patients while no influence was seen in identicals. Pretransplant haemodialysis improved graft survival, the difference was, however, only significant in the 1 haplotype mis-matched group. When analyzed for patient survival, the difference between the pre-dialytic patients and those on haemodialysis was even more pronounced. When analyzed separately, both blood transfusions and haemodialysis had a beneficial effect on graft survival.

Adult↗