Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This paper describes work to develop a model-based system to support clinical decision-making. In previous articles, we have developed (from 695 measurement sets obtained from 148 patients) a physiologic state classification based on a set of 11 cardiovascular and metabolic measurements. There is an R or reference state, for stable ICU patients. Patients under (operative, traumatic, or compensated septic) stress, or with (septic or hepatic) metabolic, respiratory, or cardiac insufficiency are in the A, B, C, or D states, respectively. We wished to make the state easier to measure and eventually available continuously, automatically, and noninvasively, as well as reflecting a wider group of bodily systems. The 5 centers define a 4 dimensional affine subspace, designated the cardiovascular state space. Using eigenvector analysis, we have found four new derived physiologic variables CV1, CV2, CV3, and CV4 that span the state space. We have fit sets of linear regression equations that allow the patient's position in the state space, and therefore his state, to be determined from more easily obtainable sets of measurements. Further, we selected 1966 measurement sets from 512 patients at two hospitals. We used the data from 250 of these patients to define 13 prototypical types, namely survivors and deaths from various combinations of sepsis, cardiogenic decompensation, cirrhosis, and pneumonitis, following trauma or general surgery. For any future patient, the statistical theory of Bayesian inference allows one to infer back from the measurements observed to the probability of his being of any of these types and of surviving or dying. We used this method to predict the outcome of the other 262 patients, prospectively. Statistically, the predictions of survival or death were not significantly different from the actual. For individual patients, the method predicts a clinical course that closely follows the actual episodes in their history. These results confirm and explain the validity of the concept of the patient state and make the state easier to compute. The patient state and the probability plot together help to stage, select, and evaluate therapy. They do not replace the clinician's judgement, but rather are tools that help the clinician to exercise judgement.
Int J Clin Monit Comput 1990
PMID:Probability and the patient state space. 209 69

Aerosolized tobramycin was given to a 68-year-old man with resistant Pseudomonas aeruginosa pneumonitis at a dose of 100 mg every 8 h via a tracheostomy, after the patient failed to respond adequately to parenteral aminoglycoside and ticarcillin therapy. Minimum inhibitory concentration and minimum bactericidal concentration for tobramycin and gentamicin were 16 micrograms/ml and greater than 16 micrograms/ml, which necessitated aerosol administration. Tracheal concentrations 15 min and 4 h after a dose were 1,560 and 930 micrograms/ml. The patient responded and eventually was discharged from the hospital. Thus, monotherapy with an aerosolized aminoglycoside may be effective in some patients with resistant Pseudomonas aeruginosa pneumonitis.
Ther Drug Monit 1989 Nov
PMID:The use of aerosolized tobramycin in the treatment of a resistant pseudomonal pneumonitis. 259 51

The rate of elimination of theophylline varies widely from individual to individual depending on age, body weight, diet, history of smoking, presence of hepatic or cardiovascular dysfunction, pneumonia, chronic obstructive lung disease, pneumonia, and viral exanthems. As a result of the variability in theophylline clearance and a narrow toxic/therapeutic ratio of theophylline plasma concentrations, the use of plasma concentration monitoring can ensure adequate and safe dose schedules for most patients.
Ther Drug Monit 1980
PMID:Monitoring plasma theophylline concentrations. 676 6

Moraxella catarrhalis (M. catarrhalis) may normally be found in the upper respiratory tract. This bacterium, however, may cause infections such as acute otitis media, sinusitis, conjunctivitis, bronchitis chronica, pneumonia, endocarditis, septicaemia and meningitis. Haemophilus influenzae, Streptococcus pneumoniae and M. catarrhalis were the main causative agents responsible for respiratory tract infections. The major resistance problems associated with these species are those which cause resistance to beta-lactams. beta-lactamase was produced by > 80% M. catarrhalis strains. The susceptibility to ampicillin, amoxicillin/clavulanic acid, cefuroxime, erythromycin, ciprofloxacin was tested in 137 M. catarrhalis strains. All the strains resistant to ampicillin produced beta-lactamase and were sensitive to amoxicillin/clavulanic acid. For M. catarrhalis, the most active antimicrobials included cefuroxime (99%), ciprofloxacin (99%) and erythromycin (93%).
Med Sci Monit
PMID:Antibiotic-sensitivity of Moraxella catarrhalis isolated from clinical materials in 1997-1998. 1120 26

The report describes a case of a four-month-old infant, who developed acute gastric ulcer while being hospitalised because of pneumonia. One year's observation of the patient, additional tests, especially gastroscopy with histopathological evaluation of biopsy specimen, determination of gastrin level in blood serum, and therapy analysis allow to establish a diagnosis of pseudo Zollinger-Ellison syndrome.
Med Sci Monit
PMID:Bleeding from alimentary tract in pseudo Zollinger-Ellison syndrome. 1120 77

In November 1992 in Bangladesh, the community medicine and pharmacology departments of medical colleges in Chittagong, Khulna, Mymensingh, and Rajshahi conducted a survey of 40 thana health complexes (THCs) and 40 union subcenters (USCs) nationwide to examine patterns of drug use at the primary health care level. They focused on those drugs used to treat watery diarrhea, dysentery with blood, helminthiasis, pneumonia, acute respiratory tract infections, and scabies. Physicians provided medical care and prescriptions at THCs while medical assistants did at USCs. The average consultation time was only 54 seconds (60 seconds for THCs vs. 48 seconds for USCs). Adequate examinations were conducted only on 37% of patients (41% vs. 32%). Adequate treatment as defined by standard treatment guidelines was accorded to only 41% of patients (43% vs. 39%). The average number of drugs prescribed was acceptable (1.44). 25% of patients received antibiotics (25% at THCs and 24% at USCs). Use rates of metronidazole were 25% for THCs and 18% for USCs. 17% of tracer diagnoses received metronidazole, even though none of them needed it for treatment. 85% and 78% of drugs prescribed were from the essential drugs list and prescribed by generic name, respectively, indicating adequate implementation of the National Drug Policy. Only 54% of the 12 essential drugs were available (63% vs. 46%). This low availability affected prescribing patterns. Financial constraints limited the drug supply. It took only 23 seconds to dispense the drugs. The short dispensing and consultation times may have accounted for the low level (55%) of patients knowing how and when to take the drugs. 81% of drugs prescribed were dispensed according to the prescription. These findings will be used to target and evaluate future interventions by the Improvement of Drug Management Project.
Essent Drugs Monit 1993
PMID:Results of drug use survey in Bangladesh. 1231 52

The mysterious severe acute respiratory syndrome (SARS) that has originated from the southern Chinese province of Guangdong appears to be a major public health threat and medical challenge. Laboratory studies of SARS patients in a number of countries identified the etiologic agent being a novel member of coronaviridae. High RNA concentrations of this virus in sputum make it as a highly infectious agent. Low concentrations of viral genome are also detectable in feces. Coronaviruses are ubiquitos. They cause disease in many animals including pigs, cattle, dogs, cats, and chickens. These viruses have been associated with upper respiratory infections and sometimes pneumonia in humans. SARS presents with fever, cough, malaise, dyspnea, and hypoxemia. Chest radiographs from affected regions are associated with progressive airway disease. Clinical laboratory features of SARS include lymphopenia, thrombocytopenia, and elevated lactate dehydrogenase levels. Currently, there is no FDA approved pharmacologic treatment for SARS. To date, no convincing clinical data is available for treatment of SARS with ribavirin. While there are some controversies about the use of systemic corticosteroids, Martin et al, in this issue of MSM, present their views on the use of pentoxyfylline (PTX) as a potential agent to be considered for SARS treatment. Finally, our analytical approach to the risks of SARS will certainly enable us to
Med Sci Monit 2003 Jun
PMID:Severe acute respiratory syndrome. 1282 56

Definitive chemoradiation (without surgery) is an accepted treatment for esophageal cancer. Persistent or recurrent local disease is not infrequent after chemoradiation, and this is its greatest drawback. Selected patients with isolated local failures of definitive chemoradiation can be salvaged by esophagectomy. However, salvage esophagectomy is a high-risk operation; operative mortality is higher than for standard esophagectomy. In contrast to planned esophagectomy after induction (neoadjuvant) therapy, salvage esophagectomy is often carried out months after completion of definitive chemoradiation. Previous thoracic radiotherapy contributes to the genesis of postoperative complications. Respiratory failure (ARDS, pneumonia) and septic complications of esophageal reconstruction (anastomotic leaks) are major causes of postoperative death. Gastric conduit necrosis, airway necrosis, and tracheogastric fistulae are infrequent but highly lethal complications. We propose modifications of surgical practice that may reduce complications. These include strict guidelines for patient selection, conservative mediastinal dissection, prevention of intraoperative lung injury (barotrauma and oxygen related toxicity), near total esophagectomy with cervical esophagogastric anastomosis, anterior mediastinal reconstruction, judicious use of staged reconstruction, perioperative enteral nutritional support, and aggressive detection and treatment of postoperative complications. By conceptually breaking the operation into component parts, such as resection and reconstruction, and then modifying each component to minimize complications, we believe that the operative mortality of salvage esophagectomy can
Med Sci Monit 2003 Jul
PMID:Complications of salvage esophagectomy. 1288 67

Antimicrobial resistance is increasing among bacterial pathogens. In particular, organisms producing extended spectrum beta-lactamase enzymes (ESBLs) and AmpC chromosomal beta-lactamase enzymes are resistant to third generation cephalosporins and pose a formidable challenge in the management of seriously ill patients. Carbapenems are a class of broad-spectrum antibiotics with stability against ESBL and AmpC chromosomal beta-lactamases. They are well tolerated by patients. This review will examine the pharmacokinetic and pharmacodynamic properties of two carbapenems imipenem and meropenem and discuss their clinical use in children. References are limited to the English language and extend back to 1980. Sources include computerized databases such as MEDLINE searched using PubMed, and bibliographies of recent articles and books. Approximately 50% of the articles initially reviewed are included in the bibliography. Carbapenems are efficacious in the treatment of a variety of bacterial infections including meningitis, pneumonia, intraabdominal infections, bone, joint and urinary tract infections. The broad spectrum activity and comparatively low toxicity of carbapenems make them valuable therapeutic agents in the treatment of seriously ill patients with bacterial infections. These agents should be used judiciously in order to minimize the risk for development of carbapenem-resistant pathogens.
Ther Drug Monit 2003 Oct
PMID:Carbapenems in pediatrics. 1450 83

Intranasal infection of BALB/c mice with the IHD strain of vaccinia virus was found to cause pneumonia, profound weight loss and death. Cidofovir, hexadecyloxypropyl-cidofovir (HDP-CDV), the diacetate ester prodrug of 2-amino-7-[(1,3-dihydroxy-2-propoxy)methyl]purine (HOE961), and ribavirin were used to treat the infections starting 24h after virus exposure. Single intraperitoneal (i.p.) cidofovir treatments of 100 and 30 mg/kg led to 90-100% survival compared with no survivors in the placebo group, whereas a 10 mg/kg dose was ineffective. The 100 mg/kg treatment reduced lung and snout virus titres on day 3 of the infection by 20- and 8-fold, respectively. Mean arterial oxygen saturation levels in these two cidofovir treatment groups were significantly higher than placebo on days 4 through 6 of the infection, indicating an improvement in lung function. Effects of cidofovir on viral pathogenesis were studied on days 1, 3 and 5 of the infection, and demonstrated statistically significant reductions in lung consolidation scores, lung weights, lung virus titre and snout virus titres on days 3 and 5. Cidofovir treatment also reduced virus titres in other tissues and body fluid, including blood, brain, heart, liver, salivary gland and spleen. HDP-CDV was given by oral gavage at 100, 50 and 25mg/kg doses one time only, resulting in 80-100% survival. Lower daily oral doses of 10 and 5mg/kg per day given for 5 days protected only 30% of animals from death. Oral doses (100, 50 and 25 mg/kg per day) of HOE961 for 5 days protected all animals, whereas equivalent oral doses of ribavirin were completely ineffective. The rapidity of recovery from weight loss during the infection was a function of dose of compound administered. These data indicate the utility of parenteral cidofovir, oral HDP-CDV and oral HOE961 in treating severe respiratory infections caused by this virus.
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PMID:Effects of four antiviral substances on lethal vaccinia virus (IHD strain) respiratory infections in mice. 1512 Jul 19


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