The effect of pneumonia on mortality among patients hospitalized for acute stroke.

OBJECTIVE: To determine the effect of pneumonia on 30-day mortality in patients hospitalized for acute stroke. METHODS: Subjects in the initial cohort were 14,293 Medicare patients admitted for stroke to 29 greater Cleveland hospitals between 1991 and 1997. The relative risk (RR) of pneumonia for 30-day mortality was determined in a final cohort (n = 11,286) that excluded patients dying or having a do not resuscitate order within 3 days of admission. Clinical data were obtained from chart abstraction and were merged with Medicare Provider Analysis and Review files to obtain deaths within 30 days. A predicted-mortality model (c-statistic = 0.78) and propensity score for pneumonia (c-statistic = 0.83) were used for risk adjustment in logistic regression analyses. RESULTS: Pneumonia was identified in 6.9% (n = 985) of all patients and in 5.6% (n = 635) of the final cohort. The rates of pneumonia were higher in patients with greater stroke severity and features indicating general frailty. Unadjusted 30-day mortality rates were six times higher for patients with pneumonia than for those without (26.9% vs 4.4%, p < 0.001). After adjusting for admission severity and propensity for pneumonia, RR of pneumonia for 30-day death was 2.99 (95% CI 2.44 to 3.66), and population attributable risk was 10.0%. CONCLUSION: In this large community-wide study of stroke outcomes, pneumonia conferred a threefold increased risk of 30-day death, adding impetus to efforts to identify and reduce the risk of pneumonia in patients with stroke.

Thymic size on chest radiograph and rapid disease progression in human immunodeficiency virus 1-infected children.

BACKGROUND: Early infection of the thymus, an organ central to the ontogeny of the immune system, has been proposed as a cause of rapid progression in pediatric HIV disease. OBJECTIVE: To test the hypothesis that small thymic volume is associated with rapid disease progression in HIV-infected children. DESIGN: Three pediatric radiologists established criteria for rating the size of the thymic profile on chest radiographs. All available baseline chest radiographs were reviewed in a random sequence, with radiologists blinded to study subjects' clinical status. A consensus was reached on whether the thymus was normal or small for age. SETTING: A prospective multicenter study of the natural history of HIV-1 infection in children, the Pediatric Pulmonary and Cardiovascular Complications of Vertically Transmitted Human Immunodeficiency Virus Infection (P2C2) Study. PATIENTS: Fifty-eight HIV-infected children and 38 control children (uninfected but born to HIV-infected women) for whom chest radiographs in the first year of life were available. MAIN OUTCOME MEASURE: Rapid progression of HIV disease, defined as CDC Clinical Category C (severely symptomatic) or Immunologic Category 3 (severe immunosuppression) by 1 year of age. RESULTS: The mean age at the time of chest radiography was 3.5 months. Ten (17%) HIV-infected children had reduced thymic profile size, whereas no controls did (P = 0.006). Of the 58 (59%) HIV-infected children 34 were classified as rapid progressors, and 9 (26%) of them had reduced thymus size, compared with 1 (4%) of the non-rapid progressor children [odds ratio, 8.28; 95% confidence interval (CI), 1.0, 70.5; P = 0.035]. Baseline mean CD4+ count was 1642 (95% CI 1322 to 2009) cells/microl for those with normal thymus and 740 (95% CI 380 to 1275) cells/microl for those with reduced thymus (P = 0.007). CONCLUSION: Early thymic involution is associated with rapidly progressive disease in HIV-infected children.

Human immunodeficiency virus-related mortality in infants and children: data from the pediatric pulmonary and cardiovascular complications of vertically transmitted HIV (P(2)C(2)) Study.

OBJECTIVES: To identify the causes of mortality in children with vertically transmitted human immunodeficiency virus (HIV) infection and to study age-related mortality trends. METHODS: In the multicenter P(2)C(2) HIV Study, 816 children born to HIV-infected mothers were followed for a median of 3.6 years. Two hundred five study participants with HIV infection were enrolled at a median age of 23 months; 611 were enrolled either prenatally or in the neonatal period before their HIV infection status was known. There were 121 deaths in study patients. The cause of death for all patients, its relationship to HIV infection, and pulmonary or cardiac involvement were determined. Age trends in disease-specific mortality were summarized for the HIV-related deaths. RESULTS: Ninety-three children died of HIV-related conditions. Infection was the most prevalent cause of death for children under 6 years of age with 32.3% caused by pulmonary infection and another 16.9% caused by nonpulmonary infection. The frequency of pulmonary disease as the underlying cause of death decreased significantly with increasing age: 5/9 (55.6%) by age 1, 1/12 (8.3%) after age 10 years. The frequency of chronic cardiac disease as the underlying cause increased with age-0% by age 1 year, 3/12 (25.0%) after age 10 years, as did the frequency of wasting syndrome with disseminated Mycobacterium avium complex-0% by age 1 year, 6/12 (50.0%) after age 10 years. CONCLUSIONS: Children with HIV who survive longer are less likely to die of pulmonary disease or infection and more likely to die of cardiac causes or with wasting syndrome.pediatric acquired immunodeficiency syndrome, mortality, human immunodeficiency virus.

Natural history of primary Epstein-Barr virus infection in children of mothers infected with human immunodeficiency virus type 1.

The natural history of Epstein-Barr virus (EBV) infection in 556 infants born to 517 human immunodeficiency virus (HIV) type 1-infected mothers was studied in a prospective, multicenter, cohort study. HIV-1-infected children had a cumulative EBV infection rate similar to HIV-1-uninfected children at age 3 years (77.8% vs. 84. 9%) but had more frequent oropharyngeal EBV shedding (50.4% vs. 28. 2%; P<.001). The probability of shedding decreased with longer time from EBV seroconversion and was similar to that of HIV-1-uninfected children 3 years after seroconversion. HIV-1-infected children identified as rapid progressors shed EBV more frequently than nonrapid progressors (69.4% vs.41.0%; P=.01). HIV-1-infected children with EBV infection had higher mean CD8 cell counts. EBV infection did not have an independent effect on mean CD4 cell counts, percent CD4, IgG levels, HIV-1 RNA levels, lymphadenopathy, hepatomegaly, or splenomegaly. Early EBV infection is common in children born to HIV-1-infected mothers. Children with rapidly progressive HIV-1 disease have more frequent EBV shedding.

[Acid-base equilibrium values in the blood of dogs during training and work stress]. / Hodnoty acidobazické rovnováhy krve psu v prubehu výcvikové a pracovní záteze.

Separate components of acid-base balance in blood (ABR)-pH, pCO2, BE, SB, BB-were studied during the long-term drill of service dogs of two age categories. These service dogs were included in two different work strain groups (patrol dogs and searching dogs). The results of long-term drill demonstrated, in particular, significant changes in dynamics of pH and pCO2. The pH values were permanently raised as compared with reduced pCO2 values during the whole period of 130-days exercise and as compared with the initial values. Other components of acid-base balance in blood do not show such variations (patrol and searching dogs) and these components justify that the adaptation of organism to the given strain gained suitable stabilisation. For studying the psychical and physical strain in service dogs it is recommended to include pH and pCO2 in the tests.

[Mineral metabolism in dogs during training and work stress]. / Metabolismus minerálií u psu v prubehu výcvikové a pracovní záteze.

The contents of basic mineral elements (Na, K, Mg, Ca, P, Cl) were investigated in service dogs during their long-term basic training; the dogs belonged to two age categories, and the influence of different work stress (sentry, tracker, watch dogs) on the changes in the contents of these elements was also studied. Great changes in the dynamics of individual elements were demonstrated during the long-term training, signalling the beginning of muscular insufficiency and fatigue in the course of training, as well as the onset of adaptation processes to the psychic and physical stress (Na, K, Mg). The increased contents of Ca and P at the beginning and during the intensive training with a risk of bone demineralization, indicate the beginning of osteopathy, disorders of muscular and nervous irritability and unbalanced feed rations. The satisfactory adaptation process with the stabilized internal environment in the sphere of minerals metabolism is documented in service dogs by the long-term and qualitatively different work stress. The results of our studies can be included into the tests of training and work stress in service dogs.

[The effect of training stress on enzyme activity in working dogs]. / Enzymová aktivita pod vlivem výcvikové záteze sluzebního psa.

The activities were studied in five kinds of enzymes (aspartate aminotransferase - AST, alanine aminotransferase - ALT, lactate dehydrogenase - LD, the thermally stable fraction of lactate dehydrogenase - LD-1, and alkaline phosphatase - ALP) of 30 male dogs. The dogs, divided into two age categories, were studied during a long-continued training (130 days). Both transaminases exhibit characteristic changes in the activity, with a depression at the beginning between the 30th and 40th days of training, followed by a slow increase in AST and by a rapid increase in ALT, continuing until the end of the training period. A statistically significant activity pattern was recorded in LD: the activity declined continuously in both age groups of dogs. LD-1 exhibited an activity depression continuing until the 70th day of training, followed by an increase which reached statistical significance towards the end of the training. ALP activity varied regularly, but always remained significantly below the starting values. The enzymatic activities can be used as partial tests during the scientific management of the training of dogs in relation to the physiological and pathophysiological processes in the bodies of the dogs subjected to the training stress.

[Dynamics of the white blood cell picture during prolonged stress of training in the dog]. / Dynamika bílého krevního obrazu v prubehu dlouhodobé výcvikové záteze u psa.

Thirty clinically healthy dogs of two age categories were studied for the effect of long-continued training load upon the pattern of the components of the white blood picture of dogs. There is a number of changes--leucocytosis, elevation of the neutrophil granulocytes, depression of lymphocytes and eosinophil granulocytes. These changes vary with the age of the dogs. They can be considered as manifestations of myogenic reaction under physical load and under stress, and as manifestations of a gradual adaptation in the course of training. The results can be included in the set of tests within the scientific system of dog training.

[The effects of the stress of long-term physical and psychological training on the red blood cell picture in dogs]. / Vliv dlouhodobé fyzické a psychické výcvikové záteze na cervený krevní obraz psa.

The effect of the physical and psychical load of long-continued training on the components of the red blood picture was studied in thirty clinically healthy dogs of two age categories. The values of erythrocytes were found to be increased whereas those of haemoglobin, haematocrit and other components (MCV, MCH, BI, MCHC) were depressed. The effects are discussed of training, adaptation process, parasympathicotonic form of overload, and qualitative nutrition deficiency as a reflection of the studied training load as exerted on certain insufficiency of the desired formation of the red blood picture, and thereby of a possible adverse impact on the performance of the trained dog.

[Experimental testing of a rodenticidal preparation, Pyriminyl (Vacor), in small animals]. / Experimentální overeni rodenticidního prípravku Pyriminyl (Vacor) u malých zvírat.

The toxicity of the rodenticidal product Pyriminyl (Vacor) was tested in 4 dogs, 9 cats, 11 coypus and 16 ducks. In the tested dogs the 1000mg dose per kg l. w. was lethal only in 17% of cases. The results demonstrate that the LD50 for the dog is higher than stated in the literature (1000 mg/kg l. w.). Dogs show a high variability in their sensitivity to the product, since some of them died at lower doses. It can be assumed that 1 to 2% field bait will not induce any lethal intoxication in dogs. Doses of 300 mg/kg l. w. and higher were lethal for cats. The dose of 200 mg/kg killed 66% of the cats tested. There is a high possibility of poisoning cats in field deratization campaigns with Vacor. Coypus show clinical symptoms of intoxication after ingesting a Vacor bait at a 100mg dose per kg l. w.; however, they remain alive. Doses of 300 mg/kg l. w. and higher kill all the animals tested. The high sensitivity of coypu to Vacor suggests that coypu can be poisoned during Vacor deratization of coypu farms. Ducks were highly resistant to Vacor. Doses from 710 to 3000 mg per kg l. w. were endured without clinical changes, and the same was the case when the birds were given a diet with a 2% concentration of Vacor for six days. The toxicological examination demonstrated the different amounts of Vacor in liver for different periods of time from the ingestion of the toxic agent, including the dependence on the animal species.

[Hematology of the clinically healthy dog]. / Hematologie klinicky zdravého psa.

Seventy-three healthy dogs of the German Shepherd breed were tested for working out broader haematological standards. The red and white blood picture includes 14 parameters on the whole, all of them being obtained from dogs aged 6.5 to 7 years. The statistically evaluated results are always processed for such a number of animals to secure 95% reliability and due accuracy and generalizing ability of the results. In the mentioned haematological values, no differences concerning the influence of age were demonstrated statistically. The haematological standards, worked out during the study, are regarded as fully applicable to clinical laboratory diagnostics and prognostics in veterinary cynology and for the clinical physiology of dogs.

[Selected biochemical values of clinically healthy dogs]. / Vybrané biochemické hodnoty klinicky zdravého psa.

Twenty-six parameters of clinical biochemical properties were determined in 72 clinically healthy German Shepherd dogs. The standard values were determined for total protein, protein spectrum, albuminoglobulin quotient, enzymic activities for AST, ALT, LD, LD-1, and ALP, for sodium, potassium, magnesium, calcium, inorganic phosphorus, and chlorides, complete prameters of the acid-base balance of the blood, and the values of glucose, urea, lactic acid, and creatinin. For determining these standards, dogs were selected at the age of 6.5 months to 7 years. All the statistically processed results are obtained from a number of animals which would secure 95% reliability and accuracy of the results, which would allow for sufficient generalization. Differences concerning the influence of age were not demonstrated in any of the determined biochemical values. The results are regarded as representative standards which can be used for clinical and laboratory diagnostics and prognostics in veterinary cynology and for clinical physiology of the German Shepherd dog breed.