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Biomedical subjects

S van der Geest

Publications and source records attributed to S van der Geest.

At least 19 recordsLinked to original sources
PubMed2004

[The hot summer of 2003: heat stroke in Maastricht].

Two male patients, 46 and 62 years of age, were brought to the emergency department on a hot summer's day. Both wore excessive clothing. The first patient had a temperature of 43 degrees C and was comatose. Heteroanamnesis indicated that he was suffering from schizophrenia. Although the prognosis seemed to be poor, his condition improved after treatment in intensive care, consisting of cooling and supportive treatment, but the patient had considerable permanent neurological impairment. The second patient had a temperature of 40.3 degrees C, was confused and had an atactic gait. He was cooled immediately and recovered swiftly without complications. Heat stroke is a life-threatening illness, which is defined as a body temperature above 40 degrees C and central nervous-system dysfunction. Heat stroke may be attended by many serious complications, including multi-organ failure and residual brain damage. Prompt recognition and rapid treatment, consisting of adequate cooling, are required.

Body Temperature↗
PubMed2004

Successful treatment of severe bleeding with recombinant factor VIIa after kidney transplantation.

Recombinant factor VIIa (rFVIIa, NovoSeven) has been registered for the treatment of bleeding episodes in patients with inherited or acquired hemophilia A or B with inhibitors. Furthermore, rFVIIa has been used successfully for the treatment of bleeding in patients with thrombocytopenia, and acquired and congenital platelet dysfunction. The definite spectrum of indications for rFVIIa has not yet been established. We describe a case of severe intra-abdominal bleeding 3 days after non-heart beating kidney transplantation in a patient with severe coronary artery disease in which rFVIIa (a single intravenous bolus injection 70 microg/kg bodyweight) was successfully used. No thrombotic complications occurred. This report demonstrates that rFVIIa might be safe and effective after recent renal transplantation.

Factor VIIa↗
PubMed2001

Steady-state pharmacokinetics of twice-daily dosing of saquinavir plus ritonavir in HIV-1-infected individuals.

OBJECTIVE: To compare the steady state plasma pharmacokinetics of 1000 mg of saquinavir (SQV) in a soft-gel capsule (SGC) formulation in combination with 100 mg of ritonavir (RTV) (capsules) in a twice-daily dosing regimen in HIV-1-infected individuals with historical controls who used 400 mg of SQV in a hard-gel capsule (HGC) formulation in combination with 400 mg of RTV and to investigate the plasma pharmacokinetics of the 1000 mg/100 mg regimen after normal and high-fat breakfasts. DESIGN: Open-label, crossover, steady-state pharmacokinetic study. METHODS: Six HIV-1-infected individuals who used either 1200 mg of SQV (SGC or HGC) three times daily or 400 mg twice daily in combination with 400 mg of RTV twice daily were included. Each patient was switched to 1000 mg of SQV SGC twice daily in combination with 100 mg of RTV twice daily. After 14 days, the patients came to the hospital for assessment of a pharmacokinetic profile during 12 hours. Patients were randomized to receive a high-fat (+/-45 g of fat) or normal (+/-20 g of fat) breakfast. After 7 days, a second pharmacokinetic profile was assessed after ingestion of the drugs with the alternate breakfast. A noncompartmental pharmacokinetic method was used to calculate the area under the plasma concentration versus time curve (AUC0-12h), the maximum plasma concentration (Cmax), the plasma trough concentration (C12h), and the elimination half-life in plasma (t1/2). The obtained pharmacokinetic parameters were compared with those of 12 patients using SQV HGC (400 mg twice daily) in combination with RTV (400 mg twice daily). RESULTS: The median values of the pharmacokinetic parameters for SQV SGC (1000 mg twice daily, normal breakfast) were: AUC0-12h, 18.84 h*mg/L; Cmax, 3.66 mg/L; C12h, 0.40 mg/L; and t1/2, 3.0 hours. The median values of the pharmacokinetic parameters for SQV HGC (400 mg twice daily, normal breakfast) were: AUC0-12h, 6.99 h*mg/L; Cmax, 1.28 mg/L; C12h, 0.23 mg/L; and t1/2, 3.9 hours. The exposure to SQV in the dosing regimen of 1000 mg twice daily in combination with 100 mg of RTV twice daily was significantly higher than the exposure to SQV in a dosing regimen of 400 mg twice daily in combination with 400 mg of RTV twice daily. The pharmacokinetic parameters of SQV SGC in the dosing regimen of 1000 mg twice daily in combination with 100 mg of RTV twice daily were not significantly different after ingestion of a high-fat or normal breakfast (p >.35). CONCLUSIONS: The combination of 1000 mg of SQV SGC twice daily and 100 mg of RTV twice daily resulted in a higher exposure to SQV compared with the exposure to SQV obtained when SQV is used in the 400 mg/400 mg twice-daily combination with RTV. In this small number of patients, no significant differences in exposure were seen after ingestion of either a normal or high-fat breakfast. From a pharmacokinetic perspective, the combination of 1000 mg of SQV SGC twice daily and 100 mg of RTV twice daily seems to be a good option for further clinical evaluation.

Adult↗
PubMed2001

Prevention of ventilator-associated pneumonia by oral decontamination: a prospective, randomized, double-blind, placebo-controlled study.

UNLABELLED: Colonization of the intestinal tract has been assumed to be important in the pathogenesis of ventilator-associated pneumonia (VAP), but relative impacts of oropharyngeal, gastric, or intestinal colonization have not been elucidated. Our aim was to prevent VAP by modulation of oropharyngeal colonization, without influencing gastric and intestinal colonization and without systemic prophylaxis. In a prospective, randomized, placebo-controlled, double-blind study, 87 patients received topical antimicrobial prophylaxis (gentamicin/ colistin/vancomycin 2% in Orabase, every 6 h) in the oropharynx and 139 patients, divided over two control groups, received placebo (78 patients were studied in the presence of patients receiving topical prophylaxis [control group A] and 61 patients were studied in an intensive care unit where no topical prophylaxis was used [control group B]). Baseline characteristics were comparable in all three groups. Topical prophylaxis eradicated colonization present on admission in oropharynx (75% in study group versus 0% in control group A [p < 0.00001] and 9% in control group B patients [p < 0.00001]) and in trachea (52% versus 22% in A [p = 0.03] and 7% in B [p = 0.004]). Moreover, topical prophylaxis prevented acquired oropharyngeal colonization (10% versus 59% in A [p < 0.00001] and 63% in B [p < 0.00001]). Colonization rates in stomach and intestine were not affected. Incidences of VAP were 10% in study patients, 31% in Group A, and 23% in Group B patients (p = 0.001 and p = 0.04, respectively). This was not associated with shorter durations of ventilation or ICU stay or better survival. Oropharyngeal colonization is of paramount importance in the pathogenesis of VAP, and a targeted approach to prevent colonization at this site is a very effective method of infection prevention. KEYWORDS: cross infection, prevention and control; respiration, artificial, adverse effects; antibiotics, administration and dosage infection control methods; pneumonia, etiology, prevention and control; intubation, intratracheal, adverse effects

Administration, Topical↗
PubMed2001

"No strength": sex and old age in a rural town in Ghana.

This article is part of a larger project on social and cultural meanings of growing old in a rural community of Ghana, the fieldwork for which was carried out between 1994 and 2000. It deals with ideas and practices concerning sex among the elderly. Informal conversations were held with individual elders and with groups of people that were, middle-aged and young. Sex was generally regarded as a matter of "strength", which was diminishing at old age. For men the concept of strength specifically referred to sexual potency, whereas for women "strength" was part of a more general feeling of physical power and the ability to perform the many activities expected from being a man's sexual partner. Sex at old age is looked at with a considerable amount of ambivalence. On the one hand, it is something that the elderly should have left behind them. On the other hand, sex confirms the vitality and status of the elder. If sex is practised at old age, it should be orderly and restrained, "respectful".

Aged↗
PubMed2000

User fees and drugs: what did the health reforms in Zambia achieve?

The article reports on exploratory research into the effects and prospects of health reforms in Zambia. The research, which was qualitative, was carried out in two rural and two urban health centres and their surrounding catchment populations. The authors focus on four principles of health reform: community involvement (including cost sharing), prevention, equity and quality of care. One of their main conclusions is that many people criticize the introduction of cost sharing because it does not improve the quality of care, by which they first of all mean the availability of drugs. The authors plead for a humane implementation of user fees in public health care that is directly linked to a more efficient provision of essential medicines.

Community Participation↗
PubMed1998

Yebisa Wo Fie: growing old and building a house in the Akan Culture of Ghana.

'House' (ofie) in the Akan culture of Ghana is the most common metonym for people living together. Mefie (my house) means 'my family'. A house is someone's identity, it is a sign of security and happiness. A house is the concretisation of social relations and the sentiments accompanying them. A house, not least of all, is a status symbol. Building a house is building a powerful symbol. A house is something to which people attach some of the most cherished virtues of their culture: respect, love, memory, 'home' and beauty. In this article, building a house is seen as one of the most important achievements in a person's life. It provides elderly people with respect and security. The article is based on anthropological research in the rural Ghanaian town of Kwahu-Tafo.

Journal Article↗
PubMed1998

Colonization with Pseudomonas aeruginosa in patients developing ventilator-associated pneumonia.

To determine routes of colonization and genotypic variation of Pseudomonas aeruginosa leading to ventilator-associated pneumonia, colonization of the rectum, stomach, oropharynx, and trachea was studied chronologically in 10 patients. Ninety-one isolates of P aeruginosa were genotyped; seven different genotypes were identified. Patients developing ventilator-associated pneumonia caused by P aeruginosa were colonized at multiple body sites and may be colonized with multiple genotypes. The upper respiratory tract is the predominant initial site of colonization with P aeruginosa.

Humans↗
PubMed1998

Cross-colonisation with Pseudomonas aeruginosa of patients in an intensive care unit.

BACKGROUND: Ventilator-associated pneumonia (VAP) caused by Pseudomonas aeruginosa is usually preceded by colonisation of the respiratory tract. During outbreaks, colonisation with P aeruginosa is mainly derived from exogenous sources. The relative importance of different pathways of colonisation of P aeruginosa has rarely been determined in non-epidemic settings. METHODS: In order to determine the importance of exogenous colonisation, all isolates of P aeruginosa obtained by surveillance and clinical cultures from two identical intensive care units (ICUs) were genotyped with pulsed field gel electrophoresis. RESULTS: A total of 100 patients were studied, 44 in ICU 1 and 56 in ICU 2. Twenty three patients were colonised with P aeruginosa, seven at the start of the study or on admission and 16 of the remaining 93 patients became colonised during the study. Eight patients developed VAP due to P aeruginosa. The incidence of respiratory tract colonisation and VAP with P aeruginosa in our ICU was similar to that before and after the study period, and therefore represents an endemic situation. Genotyping of 118 isolates yielded 11 strain types: eight in one patient each, two in three patients each, and one type in eight patients. Based on chronological evaluation and genotypical identity of isolates, eight cases of cross-colonisation were identified. Eight (50%) of 16 episodes of acquired colonisation and two (25%) of eight cases of VAP due to P aeruginosa seemed to be the result of cross-colonisation. CONCLUSIONS: Even in non-epidemic settings cross-colonisation seems to play an important part in the epidemiology of colonisation and infection with P aeruginosa.

Adolescent↗
PubMed1998

[Reciprocity and care of the elderly. An anthropologic comparison between Ghana and the Netherlands].

The author compares the lives of elderly people in Ghana and the Netherlands from the perspective of reciprocity. As a rule, the Ghanaian government does not provide social security for the elderly. Their security is entirely in the hands of their relatives and depends on reciprocity. As a result, some elderly find themselves in a stressful situation, both in material and in emotional terms. A remarkable similarity is that the principle of reciprocity is applied in both societies; in Ghana openly, in the Netherlands in a more subtle and concealed way.

Aged↗
PubMed1997

Is there a role for traditional medicine in basic health services in Africa? A plea for a community perspective.

Traditional medicine in Africa is contrasted with biomedicine. Most traditional medical theories have a social and religious character and emphasize prevention and holistic features. Traditional medical practices are usually characterized by the healer's personal involvement, by secrecy and a reward system. Biomedical theory and practice show an almost opposite picture: asocial, irreligious, curative and organ-directed; professional detachment, public knowledge and-until recently-'free of charge'. It is suggested that local communities do not expect that basic health care will improve when traditional healers become integrated into the service. They ask instead for improvement of basic health care itself: more services with better access, more dedication and respect from doctors and nurses, more medicines and personnel. Fieldwork needs to be done at the community level to arrive at a better understanding and assessment of the community's opinion concerning a possible role of traditional medicine in basic health care.

Community Networks↗
PubMed1997

Indications for antibiotic use in ICU patients: a one-year prospective surveillance.

The high prevalence of nosocomial infections in critically ill ICU patients is associated with high antibiotic consumption. Besides its economic impact, there is the constant threat of selection and induction of antibiotic resistance. Surveillance studies recording the incidence of infections, antibiotic use, and antimicrobial susceptibilities of pathogens supply vital information regarding infection control and prevention of antibiotic resistance. In order to analyse antibiotic consumption we recorded antibiotic use in a general ICU during one year by categorizing the indications for antibiotic use into three groups; (i) prophylaxis; (ii) therapy for a bacteriologically proven infection (BPI); (iii) therapy for a non-bacteriologically proven infection (non-BPI). Bronchoscopic techniques were used to diagnose pneumonia. In practice, BPI must be treated, but a proportion of antibiotics prescribed for non-BPI may be unnecessary. The subdivision in BPI and non-BPI may help to identify these cases. In all, 515 patients were admitted to ICU and 36% of these had at least one infection. Of all infections, 53% were ICU-acquired and 99% of these occurred in intubated patients. Antibiotics were prescribed in 61% of admissions. Of all antibiotics prescribed for therapy, 49% were for respiratory tract infections, 19% for abdominal infections and 13% for sepsis eci. Categorized by indication, 59% of all antibiotic prescriptions were for BPI, 28% for non-BPI and 13% for prophylaxis. A theoretical reduction of 25% in the number of non-BPI prescriptions would result only in a 7% decrease of total antibiotic use. We conclude that almost all antibiotics prescribed were for intubated patients and for BPI. Respiratory infections were the single most common infection and accounted for 49% of all antibiotics used. Therefore, in our setting, prevention of respiratory tract infections is probably the most effective mode to reduce antibiotic use.

Adolescent↗
PubMed1997

Implementation of bronchoscopic techniques in the diagnosis of ventilator-associated pneumonia to reduce antibiotic use.

In intensive care units, a large proportion of antibiotics are prescribed for presumed episodes of ventilator-associated pneumonia (VAP). VAP is usually diagnosed on a combination of clinical, radiographic, and microbiologic criteria with a high sensitivity but low specificity for VAP. As a result, patients may receive antibiotics unnecessarily. Specificity can be increased by the addition of quantitative cultures of samples of protected specimen brush (PSB) and bronchoalveolar lavage (BAL) to the diagnostic criteria. We prospectively analyzed the effects of implementation of PSB and BAL in the diagnosis of VAP on antibiotic prescription. PSB and/or BAL were performed in patients who fulfilled the clinical, radiographic, and microbiologic criteria for VAP. Based on quantitative cultures of PSB and/or BAL, patients were categorized into three groups: VAP microbiologically proven (Group 1; n = 72); clinical suspicion of VAP not confirmed microbiologically (Group 2; n = 66); and patients in whom bronchoscopy could not be performed (Group 3; n = 17). In Group 1, antibiotic therapy was instituted empirically in 40 patients (56%) (Group 1a) and after obtaining culture results in the other 32 patients (Group lb). Adjustment of therapy, based on culture results, occurred in 14 (35%) patients in Group la. In Group 2 empiric therapy was instituted in 34 (52%) patients (Group 2a) and dIscontinued within 48 h in 17 of them (50%). In Group 3, 17 (100%) patients were treated with antibiotics. Among the 66 patients in whom a clinical suspicion of VAP was not confirmed, only 18 (27%) were treated with antibiotics, and antibiotic therapy was withheld in 48 (35%) of 138 patients who underwent bronchoscopy. Withholding of antibiotic therapy had no negative effect on the recurrence of a clinical suspicion of VAP or on mortality rates. We conclude that addition of bronchoscopic techniques to the criteria for VAP may help to reduce antibiotic use. However, the definite benefits and cost-effectiveness of these techniques should be analyzed in a randomized study.

Anti-Bacterial Agents↗
PubMed1996

Clinical spectrum of ventilator-associated pneumonia caused by methicillin-sensitive Staphylococcus aureus.

The incidence of tracheal colonization and its association with ventilator-associated pneumonia caused by methicillin-sensitive Staphylococcus aureus (MSSA) was studied prospectively in 530 consecutively admitted mechanically ventilated patients in a general intensive care unit. Furthermore, the clinical spectrum, outcome, and microbiological results of 27 cases of staphylococcal ventilator-associated pneumonia (SVAP) were examined. Ventilator-associated pneumonia was diagnosed by protected specimen brush and/or bronchoalveolar lavage. On admission, 7% of the patients were colonized with MSSA in the trachea. Acquired tracheal colonization was demonstrated in 10% of the patients and occurred less frequently in patients with a hospital stay of > 48 h before ICU admission compared to patients admitted directly to the ICU (6% vs. 15%, p < 0.001). Moreover, colonization was acquired more frequently among trauma and neurological/neurosurgical patients (22%) as compared to surgical and medical patients (7%) (p < 0.0001). Twenty-one patients (4%) developed SVAP, the incident being higher in patients colonized in the trachea with MSSA than in those not colonized (21% vs. 1%), p < 0.00001). Staphylococcal ventilator-associated pneumonia developed more often in trauma and neurological/neurosurgical patients as compared to surgical and medical patients (8% vs. 3%, p < 0.05). Moreover, patients with a hospital stay of < 48 h before admission to the ICU had a higher incidence of SVAP as compared to those with a longer hospital stay before ICU admission (7% vs. 2%, p < 0.01). Crude infection-related mortality was 26%. Preceding colonization with MSSA in the trachea appears to be an important risk factor for the development of SVAP, and patients with a short duration of hospitalization before intensive care unit admission have the highest incidence of ventilator-associated pneumonia caused by MSSA.

Adolescent↗