Delayed infectious

Opiates and opioid derivatives delay the transit of intraluminal content or increase gut capacity, prolonging contact and absorption. The limitations of the opiates are addiction potential (a real concern with long-term use) and worsening of diarrhea in selected infectious diarrheas. 

The optimal time to initiate EN is controversial. Early initiation within 24 to 48 hours of hospitalization is recommended for critically ill patients because this approach appears to decrease infectious complications and reduce mortality. If patients are only mildly to moderately stressed and well nourished, initiation can be delayed until oral intake is inadequate for 7 to 14 days. 

For keyhole limpet hemocyanine (KLH) both antibody responses and delayed type hypersensitivity (DTH) reactions can be determined [43—45]. In addition several infectious models, including bacterial, viral and parasitic infections may be used to challenge the immune system [18,46]. As survival and eradication of the infections is the primary function of the immune system, these models provide direct information on the functional status of the immune system. Direct immunotoxic compounds will induce immunosuppression and thus an increase in infection rate and/or severity of the infection. The number of infectious agents (bacteria, parasites, or viral colonyforming units), increased morbidity and mortality are indications for an immunotoxic effect. Also a reduction in specific antibody levels in animals treated with the test compound compared to nontreated controls indicates immunosuppression. 

Benzene also affects functional immune responses, as indicated by decreased resistance to infectious agents. Pre-exposure to benzene at >30 ppm for 5-12 days increased the bacterial counts in mice on day 4 of infection with Listeria monocytogenes (Rosenthal and Snyder 1985). Recovery of the immune system was noted on day 7. The effects did not occur at 10 ppm. In addition, a concentration-dependent statistically significant depression was noted in T- and B-lymphocyte populations from day 1 through day 7 at 30 ppm and above. B-cells were more sensitive to benzene than were T-cells on a percentage-of-control basis. This indicates a benzene-induced delay in immune response to L. monocytogenes. Concentrations of 200 or 400 ppm for 4-5 weeks (5 days per week) suppressed the primary antibody response to tetanus toxin in mice, but there was no effect at 50 ppm (Stoner et al. 1981). In another intermediate-duration exposure study, no changes were noted in the numbers of splenic B-cells, T-cells, or... 

Deaths and injuries from earthquakes vary according to the type of housing available, time of day of occurrence, and population density. Common injuries include cuts, broken bones, crush injuries, and dehydration from being trapped in rubble. Stress reactions are also common. Morbidity and mortality can occur during the actual quake, the delayed collapse of unsound structures, or cleanup activity. Disruption of the earth may release pathogens that when inhaled can lead to increased reports of infectious disease (see Case Study 17.3). 

The duration of neutropenia is usually brief and treatment delays for unresolved adverse hematological effects at day 21 are rare. Paclitaxel-induced neutropenia does not always lead to infectious complications, and therefore... 

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