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Sample records for aids patients treated

  1. The changing face of HIV/AIDS in treated patients.

    PubMed

    Llibre, Josep M; Falco, Vicenç; Tural, Cristina; Negredo, Eugenia; Pineda, Juan A; Muñoz, Jose; Ortega, Enrique; Videla, Sebastia; Sirera, Guillem; Martinez, Esteban; Miralles, Celia; Iribarren, Josean; Galindo, Maria J; Domingo, Pere; d'Arminio-Monforte, Antonella; Miro, Jose M; Clotet, Bonaventura

    2009-07-01

    The spectrum of complications emerging in successfully treated HIV-infected patients has dramatically changed since the advent of HAART. Typical AIDS-defining illnesses have been substituted by new comorbid conditions that threaten even those patients who maintain virologic suppression. Proper management of cardiovascular risk, and early diagnosis of AIDS-related and, particularly, non-AIDS-related malignancies (including papilomavirus-related neoplasms) must be introduced into the routine of care. Hot areas of investigation include HIV-associated neurocognitive disorders, hepatitis B and C coinfection, non-alcoholic fatty liver disease, progressive multifocal leukoencephalopathy and tuberculosis. Bone and kidney long-term toxicities and lipoatrophy remain as issues of paramount importance. The identification and early treatment of immune reconstitution disease is also of major interest, specially in those patients starting their antiretroviral treatment with severe CD4 cell depletion. The present review focuses on these twelve areas of increasing interest for physicians currently facing successfully treated HIV+ patients.

  2. Willingness of Health-Professions Students to Treat Patients with AIDS.

    ERIC Educational Resources Information Center

    Currey, Charles J.; And Others

    1990-01-01

    This 1988-89 survey of 319 students in the medical, dental, nursing, and allied health-care professions revealed that over one-third had reservations about treating AIDS (Acquired Immune Deficiency Syndrome) patients. Unwillingness to treat AIDS patients was strongly associated with homophobic attitudes. Education should emphasize methods for the…

  3. Long-Term Survival of AIDS Patients Treated with Only Traditional Chinese Medicine

    PubMed Central

    Wang, Yifei; Jin, Fujun; Wang, Qiaoli

    2017-01-01

    Abstract Traditional Chinese herbal medicine (TCM) has been used in Chinese society for more than 5,000 years to treat diseases from inflammation to cancer. Here, we report the case of nine living AIDS patients in the age range of 51 to 67 who were treated with either a unique formula of TCM alone from 2001 to 2009 or the TCM from 2001 to 2006 and then switched to occasional antiretroviral therapy. Surprisingly, the viral loads of eight patients were at undetectable levels on June 28, 2016, while the remaining patient had a low viral load of 29 copies/ml. The CD4+ counts (170–592 cells/μl) and CD4+/CD8+ ratios (0.21–0.90) of the nine patients are excellent, contributing to their current good health. Thus, the case study suggests that the TCM has the potential to become a functional cure for HIV/AIDS. PMID:28067535

  4. Electromagnetic detection of HIV DNA in the blood of AIDS patients treated by antiretroviral therapy.

    PubMed

    Montagnier, Luc; Aïssa, Jamal; Lavallée, Claude; Mbamy, Mireille; Varon, Joseph; Chenal, Henri

    2009-12-01

    Electromagnetic signals of low frequency have been shown to be durably produced in aqueous dilutions of the Human Imunodeficiency Virus DNA. In vivo, HIV DNA signals are detected only in patients previously treated by antiretroviral therapy and having no detectable viral RNA copies in their blood. We suggest that the treatment of AIDS patients pushes the virus towards a new mode of replication implying only DNA, thus forming a reservoir insensitive to retroviral inhibitors. Implications for new approaches aimed at eradicating HIV infection are discussed.

  5. Ergotism related to a single dose of ergotamine tartrate in an AIDS patient treated with ritonavir.

    PubMed

    Blanche, P; Rigolet, A; Gombert, B; Ginsburg, C; Salmon, D; Sicard, D

    1999-09-01

    We report a rare case of ergotism related to a single dose of ergotamine tartrate in a man with AIDS being treated with ritonavir. He was treated with a prostacyclin analogue and made a complete recovery.

  6. Gene Therapy and Combination Chemotherapy in Treating Patients With AIDS-Related Non-Hodgkin Lymphoma

    ClinicalTrials.gov

    2017-02-23

    AIDS-Related Burkitt Lymphoma; AIDS-Related Diffuse Large B-cell Lymphoma; AIDS-Related Plasmablastic Lymphoma; AIDS-Related Primary Effusion Lymphoma; HIV Infection; AIDS Related Non-Hodgkin Lymphoma

  7. BK virus associated meningoencephalitis in an AIDS patient treated with HAART

    PubMed Central

    Vidal, José E; Fink, Maria C; Cedeno-Laurent, Filiberto; Delbue, Serena; Ferrante, Pasquale; Dauar, Rafi F; Filho, Francisco Bonasser; Nogueira, Roberta Schiavon; Calore, Eduardo E; Pannuti, Claudio S; Trujillo, J Roberto; de Oliveira, Augusto C Penalva

    2007-01-01

    A severely immune-suppressed AIDS patient was suspected of suffering from BK virus (BKV) meningoencephalitis, after being studied for common causes of neurological complications of co-infectious origin. Polymerase chain reaction (PCR) and sequence analysis of cerebrospinal fluid and brain samples, confirmed the presence of BKV. His clinical condition improved along with the regression of brain lesions, after modifications on his antiretroviral regime. Five months after discharge, the patient was readmitted because of frequent headaches, and a marked inflammatory reaction was evidenced by a new magnetic resonance imaging (MRI). The symptoms paralleled a rising CD4+ lymphocyte count, and immune reconstitution syndrome was suspected. This is the first non-postmortem report of BKV meningoencephalitis in an AIDS patient, showing clinical and radiographic improvement solely under HAART. PMID:17559655

  8. A Theoretical Model for Understanding Dentists' Behavior in Treating Patients with AIDS.

    ERIC Educational Resources Information Center

    Chen, Meei-shia

    1991-01-01

    The theory of reasoned action is applied to dentists' behaviors toward and treatment of patients with or at risk for Acquired Immune Deficiency Syndrome. Two belief components are seen as critical: (1) beliefs about consequences of treating these patients; and (2) perceptions of how his reference groups view such treatment. (MSE)

  9. [The use of growth hormone to treat endocrine-metabolic disturbances in acquired immunodeficiency syndrome (AIDS) patients].

    PubMed

    Spinola-Castro, Angela Maria; Siviero-Miachon, Adriana A; da Silva, Marcos Tadeu Nolasco; Guerra-Junior, Gil

    2008-07-01

    Acquired Immunodeficiency Syndrome (Aids) was initially related to HIV-associated wasting syndrome, and its metabolic disturbances to altered body composition. After Highly Active Antiretroviral Therapy (HAART) was started, malnutrition has declined and HIV-associated lipodystrophy syndrome has emerged as an important metabolic disorder. Aids is also characterized by hormonal disturbances, principally in growth hormone/insulin-like growth factor 1 (GH/IGF-1) axis. The use of recombinant human GH (hrGH) was formerly indicated to treat wasting syndrome, in order to increase lean body mass. Even though the use of hrGH in lipodystrophy syndrome has been considered, the decrease in insulin sensitivity is a limitation for its use, which has not been officially approved yet. Diversity in therapeutic regimen is another limitation to its use in Aids patients. The present study has reviewed the main HIV-related endocrine-metabolic disorders as well as the use of hrGH in such conditions.

  10. Risk factors for intestinal parasitosis among antiretroviral-treated HIV/AIDS patients in Ethiopia.

    PubMed

    Mahmud, Mahmud Abdulkader; Bezabih, Afework Mulugeta; Gebru, Rezene Berhe

    2014-10-01

    Summary A cross-sectional survey was conducted to determine the risk factors associated with intestinal parasitosis in HIV/AIDS patients receiving antiretroviral therapy (ART). Socio-demographic information was collected and faecal samples were analysed from 384 randomly selected patients on ART. Data on CD4+ T-cell counts and World Health Organization clinical staging were obtained from the medical records at the hospital. The overall prevalence of intestinal parasitosis was 56% (95% confidence interval [CI]: 51% to 61%). No opportunistic intestinal parasites or Schistosoma haematobium eggs were detected. Unavailability of latrine and lack of hand washing with soap were associated with Entamoeba histolytica/dispar (adjusted odds ratio [AOR], 2.75; 95% CI: 1.77 to 4.27 and AOR, 2.67; 95% CI: 1.60 to 4.44, respectively) and Giardia lamblia (AOR, 2.08; 95% CI: 1.08 to 3.99 and AOR, 2.46; 95% CI: 1.06 to 5.75, respectively) infections. Intestinal parasitosis was significantly associated with low CD4 cell count (p = 0.002). In contrast, intestinal parasitic infections were not associated (p > 0.05) with the World Health Organization disease staging. In summary, poor personal hygiene and sanitation practice contributed to the high prevalence of intestinal parasitosis. Routine diagnosis for intestinal parasitic infections should be performed in patients attending ART clinics in this setting.

  11. Successfully treated HIV-infected patients have differential expression of NK cell receptors (NKp46 and NKp30) according to AIDS status at presentation.

    PubMed

    Bisio, Francesca; Bozzano, Federica; Marras, Francesco; Di Biagio, Antonio; Moretta, Lorenzo; De Maria, Andrea

    2013-04-01

    Differences in innate immune responses may be associated with different capabilities of controlling HIV infection, not necessarily reflected by CD4(+) T-cell counts alone. We investigated by cytofluorometry the expression of NK cell receptors and ligands in 19 treated HIV-infected patients with CD4(+)<220 ml(-1) at presentation (11 AIDS, 8 non-AIDS) and 10 healthy donors. Expression of NKp46 and NKp30 was significantly higher in non-AIDS vs. AIDS patients. Overall, the level of NKp46 expression directly correlated with the degree of NK cell cytotoxicity. As compared to healthy donors, in both groups, there was a similar increase of CD69 and HLA-DR expression in NK cells that directly correlated with the presence of activation markers (HLA-DR) on CD4(+) and CD8(+) T cells. As compared to AIDS, in non-AIDS patients in vitro activated CD4(+) showed higher expression of MIC-A (NKG2D ligand), with significantly higher Nectin-2/DNAM-1 and MIC-A/NKG2D ratios. Thus, NK cell responses in AIDS and non-AIDS patients with similar CD4(+) counts significantly differ despite similar treatment. This suggests an involvement of innate mechanisms, in preventing AIDS-defining opportunistic infections in HIV infection and further suggests, that CD4(+) absolute counts alone, may be inadequate to explain differences in the clinical outcome.

  12. Targeted therapies to treat Non-AIDS Defining Cancers in patients with HIV on HAART therapy – treatment considerations and research outlook

    PubMed Central

    Deeken, John F.; Pantanowitz, Liron; Dezube, Bruce J.

    2012-01-01

    Purpose of review Highly active antiretroviral therapy (HAART) has led to a dramatic improvement in the prognosis of patients diagnosed with HIV and AIDS. This includes a significant decline in the rates of AIDS-related cancers, including Kaposi Sarcoma and Non-Hodgkin's Lymphoma. Unfortunately, rates of Non-AIDS Defining Cancers (NADCs) are on the rise, and now exceed the rates of AIDS-related cancers in patients with HIV. Treating NADCs in patients who are on HAART therapy is an open and complicated clinical question. Recent findings Newer targeted therapies are now available to treat cancers which were historically refractory to traditional cytotoxic chemotherapy. HAART agents are notorious for causing drug-drug interactions. The co-administration of targeted chemotherapies with HAART could well impede the efficacy or increase the toxicity of these targeted therapies. Unfortunately little is known about possible drug-drug interactions because HIV patients are typically excluded from clinical trials. Summary We highlight what is known about how and why HAART agents can affect drug metabolism. We then present the clinical and pharmacological data for nine recently approved targeted therapies – imatinib, dasatinib, nilotinib, erlotinib, sunitinib, lapatinib, bortezomib, sorafenib, and temsirolimus. We conclude with considerations on how to use these new agents to treat NADCs, and discuss a future research agenda to better understand and predict potential HAART-targeted therapy interactions. PMID:19606034

  13. Treating an HIV/AIDS Patient's PTSD and Medication Nonadherence with Cognitive-Behavioral Therapy: A Principle-Based Approach

    ERIC Educational Resources Information Center

    Chernoff, Robert A.

    2007-01-01

    HIV/AIDS patients with medication adherence problems are vulnerable to developing drug resistance, immune system degradation, and opportunistic infections. Poor adherence to antiretroviral medication regimens can be aggravated by psychiatric problems, including depression and posttraumatic stress disorder. This article presents the case study of a…

  14. Telemedicine for AIDS patients accommodations.

    PubMed

    Kulik, J F; de la Tribonnière, X; Bricon-Souf, N; Beuscart, R J; Mouton, Y

    1997-01-01

    People suffering from AIDS are subject to frequent hospitalisations. In some cases, they cannot go back home after hospitalisations, due to severe illness, family or sociologic problems. This is the reason why some therapeutic flats are at their disposal to make easier their medical follow-up after the hospital's discharge. In these Therapy Accommodation, they are treated by trained GP who often suffer from lack of information and lack of expertise in difficult cases. For this purpose we included these flats in the regional Telemedicine AIDS network to give these physicians free access to the computerised multimedia medical record of their patients and to provide them with synchronous co-operation facilities.

  15. Empathy and avoidance in treating patients living with HIV/AIDS (PLWHA) among service providers in China.

    PubMed

    Lin, Chunqing; Li, Li; Wan, Dai; Wu, Zunyou; Yan, Zhihua

    2012-01-01

    This study aims to investigate health care providers' empathy levels and its association with avoidance in providing service to patients living with HIV/AIDS (PLWHA) in China. A total of 1760 health service providers were randomly sampled from 40 county hospitals in two provinces of China. Using a self-administered questionnaire, participants' demographic characteristics, work history, empathy level, and avoidance attitudes toward PLWHA were collected in a cross-sectional survey. Empathy was higher among participants aged 31-40 years, those who had an associated medical degree, and those who had served in the medical profession for less than 20 years. Nurses, younger providers, and providers with lower education tended to avoid contact with PLWHA. Multiple linear regression model showed that a higher level of empathic attitude toward patients was significantly negatively associated with avoidance attitude toward PLWHA. Service providers' empathy level plays an important role in providing quality care to HIV-infected patients. Future stigma reduction interventions should cultivate empathy as a platform for understanding, effective communication, and trusting provider-patient relationships. PLWHA could potentially benefit from attitudinal change in medical settings.

  16. Pharmacotherapeutics for the AIDS Patient.

    ERIC Educational Resources Information Center

    Fife, Kenneth H.

    1991-01-01

    Anticipated shifts in the demographics of the Acquired Immune Deficiency Syndrome (AIDS) epidemic are examined, current state-of-the-art AIDS patient management is summarized, and some unique facets of drug therapy in the AIDS patient are discussed, including adverse reactions, complex drug interactions, use of investigational drugs, and…

  17. [The AIDS patient in anesthesia].

    PubMed

    Jalowy, A; Flesche, C W; Lorenz, C

    1997-02-01

    Treatment of a patient with Acquired Immune Deficiency Syndrome (AIDS) is very challenging, and makes great demands on the anaesthesiologist. Any of an AIDS patient's vital organ systems may be compromised, either by the human immunodeficiency virus (HIV) itself, opportunistic infections, by tumours, or as a result of AIDS-related drug therapies. Infections of the lungs (e.g., Pneumocystis carinii pneumonia) are prevalent, and cardiac impairment can be found in as many as 50% of AIDS patients. In addition, disorders of the central and peripheral nervous system and water and electrolyte imbalances are often seen. Perioperatively, the AIDS patient is especially prone to infections as a result of a compromised immune system. The choice of anaesthetic procedure for the AIDS patient-aside from the type of operation-depends on the severity of the illness and progression of organ impairment. All anaesthesia personnel must be careful to avoid infection, as they frequently come in contact with the blood or body fluids of their patients. However, the risk of being infected by an AIDS patient is very low, provided hygiene regulations are followed strictly. The rate of seroconversion after accidental needle-stick injury is below 1%. If exposure does occur, regular serologic controls should be continued for one year. Prophylactic treatment with azidothymidine after exposition to HIV is recommended.

  18. [Comorbid autoimmune pathology in patients treated with disease modifying drugs].

    PubMed

    Goncharova, Z A; Sizyakina, L P; Belovolova, R A; Megeryan, V A

    2016-01-01

    Because of intensive growth of the prevalence of multiple sclerosis (MS) and other autoimmune diseases (AID) during the last years, the comorbidity of MS and AID is not a rarity. In this literature review, the development of comorbid AID in patients with MS is considered to be the probable complication of disease modifying therapy with drugs of different groups. The authors present the own data on the prevalence of comorbid autoimmune pathology in patients with MS treated with disease modifying drugs.

  19. "MedTRIS" (Medical Triage and Registration Informatics System): A Web-based Client Server System for the Registration of Patients Being Treated in First Aid Posts at Public Events and Mass Gatherings.

    PubMed

    Gogaert, Stefan; Vande Veegaete, Axel; Scholliers, Annelies; Vandekerckhove, Philippe

    2016-10-01

    First aid (FA) services are provisioned on-site as a preventive measure at most public events. In Flanders, Belgium, the Belgian Red Cross-Flanders (BRCF) is the major provider of these FA services with volunteers being deployed at approximately 10,000 public events annually. The BRCF has systematically registered information on the patients being treated in FA posts at major events and mass gatherings during the last 10 years. This information has been collected in a web-based client server system called "MedTRIS" (Medical Triage and Registration Informatics System). MedTRIS contains data on more than 200,000 patients at 335 mass events. This report describes the MedTRIS architecture, the data collected, and how the system operates in the field. This database consolidates different types of information with regards to FA interventions in a standardized way for a variety of public events. MedTRIS allows close monitoring in "real time" of the situation at mass gatherings and immediate intervention, when necessary; allows more accurate prediction of resources needed; allows to validate conceptual and predictive models for medical resources at (mass) public events; and can contribute to the definition of a standardized minimum data set (MDS) for mass-gathering health research and evaluation. Gogaert S , Vande veegaete A , Scholliers A , Vandekerckhove P . "MedTRIS" (Medical Triage and Registration Informatics System): a web-based client server system for the registration of patients being treated in first aid posts at public events and mass gatherings. Prehosp Disaster Med. 2016;31(5):557-562.

  20. Thailand's fear of AIDS patients.

    PubMed

    Sivaraman, S

    1995-07-01

    Because of a terrorist incident against Bangkok's Relief Center for HIV/AIDS Carriers, it is feared that a rising intolerance is occurring in Thailand. Such fears are damaging efforts to help those with HIV/AIDS. Misconceptions about the nature of HIV/AIDS continue to dominate Thai society. The Thai government is particularly worried that an overemphasis on HIV/AIDS will hurt tourism. According to the Population and Community Development Association, Thai people are infected with HIV at the rate of 500 per day and treatment costs may exceed $170 million a year by the year 2000. Unfortunately, the lack of nongovernmental institutions (other than Buddhist monasteries) and the lack of positive response from other Thai social institutions is driving relatives and friends to take care of the afflicted, and the terrorist attack shows that many Thai people are still unprepared for the challenge.

  1. [Vision aids for multiple sclerosis patients].

    PubMed

    Frieling, E; Kornhuber, H H; Nissl, K

    1986-02-07

    Optical or electronic vision aids enabled 35 of 39 visually handicapped multiple sclerosis patients to read. Six patients had an uncorrected ametropia. 15 could read again with the help of magnifying optical aids and 11 with the help of an electronic television system. An electronic television reader was useful when visual acuities were below 0.1 and in patients with oscillating nystagmus or tremor capitis. Contact lenses helped 3 patients who had a neurogenous visual defect and oscillating nystagmus. Although acquired oscillating nystagmus disappears on eyelid closure and only reappears again on fixation, its amplitude, when unable to read, is greater. On overcoming the neurogenous visual defect with vision aids it becomes smaller.

  2. Herpetic whitlow in an AIDS patient.

    PubMed

    García-Plata, M D; Moreno-Giménez, J C; Vélez García, A; Valverde Blanco, F; Fernandez Roldán, J C

    1999-05-01

    This case confirms that cutaneous herpes simplex virus (HSV) infections in many AIDS patients is important not only for the difficulty in diagnosis of herpetic lesions, but also for the possibility that co-infection by HSV and HIV can adversely affect prognosis in these patients.

  3. Psychotherapy with AIDS Patients: Countertransference Issues.

    ERIC Educational Resources Information Center

    Wilk, Carole A.

    This paper provides a personal account of the process of psychotherapy for Acquired Immune Deficiency Syndrome (AIDS) patients, as seen from both the client's and the psychotherapist's perspective, with a focus on countertransference issues found in the early phases of treatment. Based on case material, the discussion explores themes presented by…

  4. Enhanced mucosal reactions in AIDS patients receiving oropharyngeal irradiation

    SciTech Connect

    Watkins, E.B.; Findlay, P.; Gelmann, E.; Lane, H.C.; Zabell, A.

    1987-09-01

    The oropharynx and hypopharynx are common sites of involvement in AIDS patients with mucocutaneous Kaposi's sarcoma. The radiotherapist is often asked to intervene with these patients due to problems with pain, difficulty in swallowing, or impending airway obstruction. We have noted an unexpected decrease in normal tissue tolerance of the oropharyngeal mucosa to irradiation in AIDS patients treated in our department. Data on 12 patients with AIDS and Kaposi's sarcoma receiving oropharyngeal irradiation are presented here. Doses ranged from 1000 cGy to 1800 cGy delivered in 150-300 cGy fractions. Seven of eight patients receiving doses of 1200 cGy or more developed some degree of mucositis, four of these developed mucositis severe enough to require termination of treatment. All patients in this study received some form of systemic therapy during the course of their disease, but no influence on mucosal response to irradiation was noted. Four patients received total body skin electron treatments, but no effect on degree of mucositis was seen. Presence or absence of oral candidiasis was not an obvious factor in the radiation response of the oral mucosa in these patients. T4 counts were done on 9 of the 12 patients. Although the timing of the T4 counts was quite variable, no correlation with immune status and degree of mucositis was found. The degree of mucositis seen in these patients occurred at doses much lower than expected based on normal tissue tolerances seen in other patient populations receiving head and neck irradiations. We believe that the ability of the oral mucosa to repair radiation damage is somehow altered in patients with AIDS.

  5. Disseminated adiaspiromycosis in a patient with AIDS.

    PubMed

    Echavarria, E; Cano, E L; Restrepo, A

    1993-01-01

    A case of disseminated adiaspiromycosis in an AIDS patient is described. The most notable characteristic of the infection was the extensive osteomyelitis exhibited by the patient. Positive cultures for Chrysosporium parvum var. parvum were obtained from pus taken from a lesion of the wrist during surgery as well as from sputum samples and a bone marrow aspirate. Treatment with amphotericin B controlled the fungal infection.

  6. [Cavum lymphoma in a hemophilic patient with AIDS].

    PubMed

    Corti, M; Villafañe, M F; Cermelj, M; Candela, M; Pérez Blanco, R; Tezanos Pinto, M

    2000-01-01

    Intermediate and highly malignant non-Hodgkin and primary central nervous system lymphomas are marker diseases for AIDS. Cavum and oropharynx involvement by these tumors is uncommon. Although there are few cases reported in the literature, these may be primary localizations of the tumor. We present a hemophilic HIV+ patient with non-Hodgkin lymphoma of the cavum. The histologic diagnosis was high-grade, pleomorphic, centroblastic lymphoma. The patient was treated with chemotherapy plus intrathecal chemotherapy and highly active antiretroviral therapy (HAART). His evolution has been excellent. One year after diagnosis, the patient is asymptomatic with no evidence of residual tumor, and responding well to HAART.

  7. Progressive multifocal leukoencephalopathy in an AIDS patient.

    PubMed

    Lee, Ming-Hsing; Chen, Yan-Zhong; Wang, Lih-Shinn; Yen, Pao-Sheng; Hsu, Yung-Hsiang

    2007-03-01

    Progressive multifocal leukoencephalopathy (PML) is a demyelinating brain disease caused by Jamestown Canyon virus (JCV). This disease is an important cause of morbidity and mortality in acquired immunodeficiency syndrome (AIDS) patients. We report a 34-year-old man infected with HIV-1 who presented with frequent general tonic clonic seizure and left side weakness for 2 months. Clinical features and magnetic resonance imaging (MRI) findings with hyperintensity on T2-weighted imaging and low density on T2 fluid attenuated inversion recovery involving multiple white matter were compatible with PML. He died of sepsis 2 months after diagnosis. Autopsy demonstrated progressive multifocal leukoencephalopathy according to characteristic histopathologic picture with multifocal demyelination, bizarre astrocytes formation and basophilic intranuclear inclusion bodies in the oligodendrocytes. JCV genome was demonstrated in the nucleus of oligodendrocytes using in situ hybridization. In conclusion, in AIDS patients with neurologic signs and typical MRI findings who present with multifocal demyelination lesions, PML should be diagnosed clinically.

  8. Microsporidial keratoconjunctivitis in a patient with AIDS.

    PubMed Central

    Metcalfe, T W; Doran, R M; Rowlands, P L; Curry, A; Lacey, C J

    1992-01-01

    A male patient is described with acquired immune deficiency syndrome (AIDS) who developed chronic keratoconjunctivitis and chronic sinusitis due to infection with the microsporidian Encephalitozoon cuniculi. Diagnosis was confirmed by electron microscopic examination of conjunctival epithelial cells and nasal polypectomy specimens. Treatment with propamidine isethionate 0.1% (Brolene) eye drops six times daily led to a prompt resolution of the keratoconjunctivitis. Images PMID:1540567

  9. Development and application of patient decision aids.

    PubMed

    Bae, Jong-Myon

    2015-01-01

    With the current overdiagnosis of thyroid cancer resulting from routine screening in Korea, it is necessary to educate the public that not all cancers are malignant. The exposure to patient decision aids (PtDAs) compared to usual care reduced the number of people choosing to undergo prostate-specific antigen screening. This article introduces the definition, usefulness, and developmental processes of PtDAs and suggests the urgent need for a Korean PtDA related to thyroid cancer screening.

  10. Optimal management of cytomegalovirus retinitis in patients with AIDS

    PubMed Central

    Stewart, Michael W

    2010-01-01

    Cytomegalovirus (CMV) retinitis is the most common cause of vision loss in patients with acquired immunodeficiency syndrome (AIDS). CMV retinitis afflicted 25% to 42% of AIDS patients in the pre-highly active antiretroviral therapy (HAART) era, with most vision loss due to macula-involving retinitis or retinal detachment. The introduction of HAART significantly decreased the incidence and severity of CMV retinitis. Optimal treatment of CMV retinitis requires a thorough evaluation of the patient’s immune status and an accurate classification of the retinal lesions. When retinitis is diagnosed, HAART therapy should be started or improved, and anti-CMV therapy with oral valganciclovir, intravenous ganciclovir, foscarnet, or cidofovir should be administered. Selected patients, especially those with zone 1 retinitis, may receive intravitreal drug injections or surgical implantation of a sustained-release ganciclovir reservoir. Effective anti-CMV therapy coupled with HAART significantly decreases the incidence of vision loss and improves patient survival. Immune recovery uveitis and retinal detachments are important causes of moderate to severe loss of vision. Compared with the early years of the AIDS epidemic, the treatment emphasis in the post- HAART era has changed from short-term control of retinitis to long-term preservation of vision. Developing countries face shortages of health care professionals and inadequate supplies of anti-CMV and anti-HIV medications. Intravitreal ganciclovir injections may be the most cost effective strategy to treat CMV retinitis in these areas. PMID:20463796

  11. The Creative Use of Psychotherapy with Terminally Ill AIDS Patients.

    ERIC Educational Resources Information Center

    Fraenkel, William A.

    One clinical psychologist who worked with terminally ill, end-stage Acquired Immune Deficiency Syndrome (AIDS) patients in a hospice type setting experienced more than 150 deaths over an 18-month time period. Many of the patients denied that they had AIDS; some distinguished between having AIDS and testing positive for Human Immunodeficiency Virus…

  12. CT of disseminated plasmacytoma - in an AIDS patient

    SciTech Connect

    Leder, D.S.; Nazarian, L.N.; Burke, M.

    1996-05-01

    It is well known that acquired immunodeficiency syndrome (AIDS) is associated with increased risk of neoplasms, particularly Kaposi sarcoma and non-Hodgkin lymphoma. There have been several recent reports in the literature describing plasma cell tumors in AIDS patients. We report the imaging findings in a case of widely disseminated plasmacytoma in a patient with known AIDS. 7 refs., 3 figs.

  13. Fungal infections in patients with AIDS and AIDS-related complex.

    PubMed

    Holmberg, K; Meyer, R D

    1986-01-01

    Persons with AIDS are predisposed to a variety of previously rare bacterial and fungal infections. Improvement in the quality and duration of survival of AIDS patients depends on the efficacy of treatment for these infections. Between 58-81% of AIDS patients contract fungal infections at some time, and 10-20% of AIDS patients die as a direct consequence of such infections. Oral candidiasis, commonly known as thrush, is the most common fungal infection among AIDS and AIDS Related Complex patients, occurring in 80-90% of cases. In a recent U.S. study, 59% of persons with oral candidiasis who were at high risk of contracting AIDS went on to develop Kaposi's sarcoma and other life- threatening infections. The most common life-threatening fungal infection experienced by AIDS patients is cryptococcosis, a disease occurring among 6% of American AIDS patients and having a mortality rate of 17% during initial infections and 75-100% on relapse. Other opportunistic infections associated with AIDS and AIDS Related Complex are bronchial candidiasis, invasive aspergillosis, disseminated histoplasmosis, and disseminated coccidioidomycosis. All are treatable but eradication i s difficult and relapse common.

  14. Legal briefing: Shared decision making and patient decision aids.

    PubMed

    Pope, Thaddeus Mason; Hexum, Melinda

    2013-01-01

    This "Legal Briefing" column covers recent legal developments involving patient decision aids.This topic has been the subject of recent articles in JCE. It is included in the 2010 Patient Protection and Affordable Care Act. And it has received significant attention in the biomedical literature, including a new book, a thematic issue of Health Affairs, and a recent article in the New England Journal of Medicine. Moreover, physicians and health systems across the United States are increasingly integrating decision aids into their clinical practice. Both federal and state laws play a significant role in promoting this expanded use. On the other hand, concerns about liability could stymie development and implementation. We categorize legal developments concerning patient decision aids into the following five sections: 1. Development of decision aids. 2. Effectiveness of decision aids. 3. Federal regulation of decision aids. 4. State regulation of decision aids. 5. Legal concerns regarding decision aids.

  15. [Pulmonary fungal infection in patients with AIDS].

    PubMed

    Denis, B; Lortholary, O

    2013-10-01

    Fungal infections are the most common opportunistic infections (OI) occurring during the course of HIV infection, though their incidence has decreased dramatically with the introduction of highly active antiretroviral therapy (cART). Most cases occur in untreated patients, noncompliant patients or patients whose multiple antiretroviral regimens have failed and they are a good marker of the severity of cellular immunodepression. Pneumocystis jiroveci pneumonia is the second most frequent OI in France and cryptococcosis remains a major problem in the Southern Hemisphere. With the increase in travel, imported endemic fungal infection can occur and may mimic other infections, notably tuberculosis. Fungal infections often have a pulmonary presentation but an exhaustive search for dissemination should be made in patients infected with HIV, at least those at an advanced stage of immune deficiency. Introduction of cART in combination with anti-fungal treatment depends on the risk of AIDS progression and on the risk of cumulative toxicity and the immune reconstitution inflammatory syndrome (IRIS) if introduced too early. Fungal infections in HIV infected patients remain a problem in the cART era. IRIS can complicate the management and requires an optimised treatment regime.

  16. Solitary ring enhancing brain lesion in a patient with AIDS

    PubMed Central

    Aldeen, Taha; Lunn, Michael

    2009-01-01

    Toxoplasmosis in immune competent patients usually causes asymptomatic infection or mild symptoms, while in immunocompromised and AIDS patients it can be a life threatening condition. We report a case of cerebral toxoplasmosis in a patient with AIDS and review the causes of brain ring enhancing lesions. PMID:22132018

  17. Addressing health literacy in patient decision aids

    PubMed Central

    2013-01-01

    Background Effective use of a patient decision aid (PtDA) can be affected by the user’s health literacy and the PtDA’s characteristics. Systematic reviews of the relevant literature can guide PtDA developers to attend to the health literacy needs of patients. The reviews reported here aimed to assess: 1. a) the effects of health literacy / numeracy on selected decision-making outcomes, and b) the effects of interventions designed to mitigate the influence of lower health literacy on decision-making outcomes, and 2. the extent to which existing PtDAs a) account for health literacy, and b) are tested in lower health literacy populations. Methods We reviewed literature for evidence relevant to these two aims. When high-quality systematic reviews existed, we summarized their evidence. When reviews were unavailable, we conducted our own systematic reviews. Results Aim 1: In an existing systematic review of PtDA trials, lower health literacy was associated with lower patient health knowledge (14 of 16 eligible studies). Fourteen studies reported practical design strategies to improve knowledge for lower health literacy patients. In our own systematic review, no studies reported on values clarity per se, but in 2 lower health literacy was related to higher decisional uncertainty and regret. Lower health literacy was associated with less desire for involvement in 3 studies, less question-asking in 2, and less patient-centered communication in 4 studies; its effects on other measures of patient involvement were mixed. Only one study assessed the effects of a health literacy intervention on outcomes; it showed that using video to improve the salience of health states reduced decisional uncertainty. Aim 2: In our review of 97 trials, only 3 PtDAs overtly addressed the needs of lower health literacy users. In 90% of trials, user health literacy and readability of the PtDA were not reported. However, increases in knowledge and informed choice were reported in those studies

  18. Peginterferon alfa-2a for AIDS-associated Kaposi sarcoma: experience with 10 patients.

    PubMed

    Rokx, Casper; van der Ende, Marchina E; Verbon, Annelies; Rijnders, Bart J A

    2013-11-01

    In this observational cohort study, 10 patients with extensive or treatment-refractory AIDS-associated Kaposi sarcoma were treated with peginterferon alfa-2a. Tumor responses were observed in 9 patients with a median progression-free survival of 645 days. Peginterferon alfa-2a could be an effective therapy for extensive or treatment-resistant Kaposi sarcoma.

  19. Solitary hypothalamopituitary toxoplasmosis abscess in a patient with AIDS.

    PubMed

    Legrand, L; Catherine, L; Brivet, F; Musset, D

    2011-01-01

    Toxoplasmosis is a disease caused by an obligate intracellular protozoal parasite, Toxoplasma gondii. It is the most common cause of focal brain lesions in patients with AIDS. The imaging features and endocrine disorders of CNS toxoplasmosis in patients with AIDS are reviewed.

  20. Preference for One or Two Hearing Aids among Adult Patients

    PubMed Central

    Cox, Robyn M; Schwartz, Kathryn S.; Noe, Colleen M.; Alexander, Genevieve C.

    2010-01-01

    Objectives Most practitioners believe that use of two hearing aids is the ideal fitting for adults with bilateral symmetrical hearing loss. However, previous research has consistently shown that a substantial proportion of these patients actually prefer to use only one hearing aid. The current study explored whether this pattern of preferences is seen with technologically advanced hearing aids. In addition, a selection of variables that were available pre-fitting were used to attempt to predict which patients will prefer one hearing aid rather than two. Design The study was designed as a 12-week field trial including structured and unstructured use of one and two hearing aids. Ninety-four subjects with mild to moderate bilaterally symmetrical hearing loss were bilaterally fit with 2005-2007 era hearing aids. Potential predictors included demographic, audiometric, auditory lifestyle, personality, and binaural processing variables. After the field trial, each subject stated his/her preference for one or two hearing aids and completed three self-report outcome questionnaires for their preferred fitting. Results Previous research was confirmed with modern technology hearing aids: after the field trial 46% of the subjects preferred to use one hearing aid rather than two. Subjects who preferred two hearing aids tended to report better real-world outcomes than those who preferred one. Subjects who reported more hearing problems in daily life, who experienced more binaural loudness summation, and whose ears were more equivalent in dichotic listening were more likely to prefer to use two hearing aids. Contrary to conventional wisdom (ideas that are generally accepted as true), audiometric hearing loss and auditory lifestyle were not predictive of aiding preference. However, the best predictive approach from these data yielded accurate predictions for only two-thirds of subjects. Conclusions Evidence-based practice calls for a conscientious melding of current evidence

  1. Radiology of AIDS in the pediatric patient.

    PubMed

    Grattan-Smith, D; Harrison, L F; Singleton, E B

    1992-01-01

    The Acquired Immunodeficiency Syndrome (AIDS) has involved the pediatric age group and is especially prevalent in babies born of mothers who are intravenous drug abusers or prostitutes. Approximately 30% of children born to mothers who are seropositive for the human immunodeficiency virus (HIV) will develop HIV infection. There are several important differences in children and adults with AIDS. The incubation period of the disease is shorter, and initial clinical manifestations occur earlier in children. In addition, certain infections are more common in children, and the different types of malignancy, especially Kaposi's sarcoma, are unusual in the pediatric age group. The altered immune system involves both T cells and humoral immunity and increases susceptibility to a variety of infections, particularly opportunistic organisms. In this publication the complications of pediatric AIDS involving the lungs, cardiovascular system, gastrointestinal tract, genitourinary system, and neurological system are described. The most common pulmonary complications in our experience are Pneumocystis carinii pneumonia and pulmonary lymphoid hyperplasia. The spectrum of cardiovascular involvement in pediatric AIDS includes myocarditis, pericarditis, and infectious endocarditis. Gastrointestinal tract involvement is usually due to opportunistic organisms that produce esophagitis, gastritis, and colitis. Abdominal lymphadenopathy is a common finding either due to disseminating Mycobacterium avium-intracellulare infection or nonspecific lymphadenopathy. Although cholangitis is more commonly seen in adults, it may occur in children with AIDS and, in most cases, is due to related opportunistic infections. Genitourinary infections may be the first evidence of HIV disease. Cystitis, pyelonephritis, renal abscesses, and nephropathy with renal insufficiency are complications of pediatric AIDS. A variety of neurological abnormalities may occur in pediatric AIDS. The most common cause of

  2. Blood vessel growth blocker may treat AIDS-related Kaposi’s sarcoma

    Cancer.gov

    Patients with an AIDS-associated cancer, Kaposi's sarcoma (KS), showed improvement after receiving the combination of bevacizumab, a cancer drug that blocks the growth of new blood vessels, and highly active antiretroviral therapy (HAART).

  3. Preservation of monocyte effector functions against Mycobacterium avium-M. intracellulare in patients with AIDS.

    PubMed Central

    Johnson, J L; Shiratsuchi, H; Toba, H; Ellner, J J

    1991-01-01

    Mycobacterium avium-M. intracellulare is a frequent cause of late disseminated infection in patients with AIDS. The ability of human peripheral blood monocytes to phagocytose and kill M. avium was examined in an in vitro model. Monocytes were obtained from 13 healthy volunteers and 11 patients with AIDS, three of whom had documented disseminated M. avium infection. Monocytes were precultured for 2 days before infection with two AIDS-associated and two non-AIDS-associated strains of M. avium. Uptake of M. avium as measured by counting intracellular acid-fast bacilli did not differ among healthy subjects, patients with AIDS, or patients with AIDS and previously documented disseminated M. avium infection. Intracellular growth of M. avium was examined by a CFU assay of cell lysates from M. avium-infected monocytes after 0, 4, and 7 days of culture. Intracellular growth inhibition of M. avium at 7 days after infection was comparable between patients with AIDS and healthy donors for all M. avium strains tested. The effects of the addition of recombinant gamma interferon on M. avium uptake and intracellular growth in monocytes also were studied. Pretreatment of monocytes with gamma interferon prior to infection suppressed monocyte phagocytosis of M. avium. Continuously coculturing of monocytes with gamma interferon after infection augmented killing of M. avium among both patients with AIDS and healthy controls for three of the four strains of M. avium tested. The magnitude of this effect, however, was variable from donor to donor and strain to strain. No significant differences were noted between the growth-inhibiting abilities of gamma-interferon-treated monocytes obtained from healthy volunteers and those obtained from patients with AIDS. PMID:1910011

  4. Problems in Financing the Care of AIDS Patients.

    ERIC Educational Resources Information Center

    Ozawa, Martha N.; And Others

    1993-01-01

    Notes that financing care of patients with Acquired Immune Deficiency Syndrome (AIDS) has reached crisis proportions. Discusses how components of U.S. health care financing system attempt to minimize their financial exposure to AIDS. Presents remedies that have been suggested in literature. Points out flaws in current system for dealing with…

  5. Nurses' Attitudes toward Gay and Hemophiliac Patients with AIDS.

    ERIC Educational Resources Information Center

    Strasser, Judith A.; Damrosch, Shirley

    A sample of nurses (N=183) enrolled in a School of Nursing's master degree program was randomly assigned to read one of six vignettes about a patient who differed only in terms of diagnosis and lifestyle. Possible diagnoses were Acquired Immune Deficiency Syndrome (AIDS), AIDS acquired by a hemophiliac through blood therapy, and leukemia; possible…

  6. Burnout in Hospital Social Workers Who Work with AIDS Patients.

    ERIC Educational Resources Information Center

    Oktay, Julianne S.

    1992-01-01

    Surveyed 128 hospital social workers who worked with Acquired Immune Deficiency Syndrome (AIDS) patients. Found that hospital AIDS social workers had slightly higher rates of emotional exhaustion and depersonalization on Maslach Burnout Inventory but also felt substantially higher level of personal accomplishment. Age, autonomy, and belonging to…

  7. Anti-class II antibodies in AIDS patients and AIDS-risk groups.

    PubMed Central

    de la Barrera, S; Fainboim, L; Lugo, S; Picchio, G R; Muchinik, G R; de Bracco, M M

    1987-01-01

    The specificity of anti-lymphocyte antibodies was evaluated in AIDS patients and in individuals at risk of AIDS [R-AIDS: male homosexuals (Ho) and haemophiliacs (He)]. Antibodies capable of inducing antibody-dependent cell-mediated cytotoxicity (ADCC) against non-T cells and lymphoblastoid cell lines (P3HR-1K and Raji) were detected in AIDS patients and in R-AIDS with positive or negative human immune deficiency virus (HIV) serology. Anti-class II antigen specificity was revealed by experiments in which class II antigens on target cells were blocked with monoclonal anti-class II antibody (DA6,231) and the cytotoxic reaction induced by patient's sera was abolished. In contrast, ADCC was not impaired by preincubating the target cells with anti-class I monoclonal antibody (W6/32). Prevalence of antibodies to non-T cells was confirmed by standard C-mediated microlymphocytotoxicity. However, with this technique anti-T lymphocyte cytotoxicity was also observed in three AIDS patients with haemophilia. R-AIDS peripheral blood mononuclear cells (PBMC) were also cytotoxic against autologous non-T cells, and lysis was slightly increased by sensitization of the target cells with autologous serum. In addition to ADCC and C-mediated cytotoxicity, the specificity of anti-lymphocyte antibodies was assayed by their ability to interfere the binding of fluorescein-labelled anti-class II (HLA-DR) and anti-class I (W6/32) monoclonal antibodies to PBMC, non-T cells, P3HR-1K and Raji. Anti-class II specificity was confirmed, and antibody titres tended to be higher in Ho than in He R-AIDS, using non-T cells and Raji as targets. Higher titres of anti-class II antibodies in the Ho group could play a role in the different susceptibility of HIV-infected Ho when compared to HIV (+) He to develop AIDS. PMID:3501399

  8. Cardiovascular considerations in patients treated with HIV protease inhibitors.

    PubMed

    Colagreco, Joseph P

    2004-01-01

    Highly active antiretroviral therapy (HAART) has dramatically reduced mortality from HIV infection, transforming it in many cases to a chronic condition. However, protease inhibitors (PIs), which are integral components of most HAART regimens, are commonly associated with a host of metabolic disturbances that may increase the risk of cardiovascular disease in patients with HIV infection, potentially counteracting some of the positive health effects of PIs. Dyslipidemia is of particular concern. The Adult AIDS Clinical Trials Group has established preliminary guidelines to evaluate and treat PI-associated dyslipidemia. A number of strategies exist for the management of PI-based dyslipidemia in HAART recipients; their advantages and disadvantages should be considered when treating patients with HIV infection.

  9. Secondary mania due to AIDS and cryptococcal meningitis in a 78-year-old patient.

    PubMed

    Chou, Po-Han; Ouyang, Wen-Chen; Lan, Tsuo-Hung; Chan, Chin-Hong

    2016-03-01

    We report a 78-year-old man without past psychiatric history who experienced his first manic episode successfully treated with quetiapine and lorazepam, but was ultimately found to have AIDS and Cryptococcus neoformans meningitis. Our presented case highlights the importance of comprehensive differential diagnoses to rule out secondary causes of psychiatric symptoms presenting for the first time in elderly patients.

  10. Early, computer-Aided Design/Computer-Aided Modeling Planned, Le Fort I Advancement With Internal Distractors to Treat Severe Maxillary Hypoplasia in Cleft Lip and Palate.

    PubMed

    Chang, Catherine S; Swanson, Jordan; Yu, Jason; Taylor, Jesse A

    2017-04-11

    Traditionally, maxillary hypoplasia in the setting of cleft lip and palate is treated via orthognathic surgery at skeletal maturity, which condemns these patients to abnormal facial proportions during adolescence. The authors sought to determine the safety profile of computer-aided design/computer-aided modeling (CAD/CAM) planned, Le Fort I distraction osteogenesis with internal distractors in select patients presenting at a young age with severe maxillary retrusion. The authors retrospectively reviewed our "early" Le Fort I distraction osteogenesis experience-patients performed for severe maxillary retrusion (≥12 mm underjet), after canine eruption but prior to skeletal maturity-at a single institution. Patient demographics, cleft characteristics, CAD/CAM operative plans, surgical complications, postoperative imaging, and outcomes were analyzed. Four patients were reviewed, with a median age of 12.8 years at surgery (range 8.6-16.1 years). Overall mean advancement was 17.95 + 2.9 mm (range 13.7-19.9 mm) with mean SNA improved 18.4° to 87.4 ± 5.7°. Similarly, ANB improved 17.7° to a postoperative mean of 2.4 ± 3.1°. Mean follow-up was 100.7 weeks, with 3 of 4 patients in a Class I occlusion with moderate-term follow-up; 1 of 4 will need an additional maxillary advancement due to pseudo-relapse. In conclusion, Le Fort I distraction osteogenesis with internal distractors is a safe procedure to treat severe maxillary hypoplasia after canine eruption but before skeletal maturity. Short-term follow-up demonstrates safety of the procedure and relative stability of the advancement. Pseudo-relapse is a risk of the procedure that must be discussed at length with patients and families.

  11. Evaluation of bone mineral density in Iranian HIV/AIDS patients.

    PubMed

    Badie, Banafsheh Moradmand; Soori, Tahereh; Kheirandish, Parastoo; Izadyar, Saeed; SeyedAlinagh, SeyedAhmad; Foroughi, Maryam; Rostamian, Alireza; Mohraz, Minoo

    2011-01-01

    Bone disorders have emerged as a worrisome complication in HIV-infected patients in recent years. It is not clear that HIV infection itself or antiretroviral treatment or both are causes of bone loss. However, most studies have found a high prevalence of osteopenia and osteoporosis in HIV/AIDS patients. The objectives of this study were to determine the prevalence of osteopenia and osteoporosis in HIV-infected patients either untreated or receiving Highly Active Antiretroviral Therapy as compared with HIV negative persons. We also assessed the factors associated with these conditions. Bone Mineral Density was assessed by Dual Energy X-Ray Absorptiometry scans at the hip and lumbar spine in 36 AIDS patients receiving antiretroviral therapy and 44 HIV infected patients not receiving antiretroviral therapy (naïve patients) and 40 HIV negative individuals as control. Factors that affect BMD were also determined. Prevalence of osteopenia or osteoporosis in different regions was significantly higher in HIV/AIDS patients compared with HIV negative subjects (77.3% in HIV positive naïve patients, 86.1% in HAART-treated patients and 60% in the control group, P=0.002). Mean serum alkaline phosphatase was higher in HIV/AIDS patients than the control group (P=0.003). Osteopenia and osteoporosis in HIV-infected patients were associated with duration of HIV infection (P<0.0001) and antiretroviral treatment (P=0.012). Prevalence of osteopenia and osteoporosis in HIV/AIDS patients was higher than HIV negative individuals. Osteopenia and osteoporosis in HIV/AIDS patients was associated with duration of HIV infection and antiretroviral treatment.

  12. A Case on Streptococcal Pneumonia Associated with Leptomeningitis, Osteomyelitis and Epidural Abscess in a Patient with AIDS

    PubMed Central

    Jeon, Jae Woong; Kim, Joo Seok; Ryu, Il Hwan; Choi, Ji Wook; Kim, Min Gyu; Na, Young Min; Yun, Hyeon Jeong

    2014-01-01

    Patients with acquired immunodeficiency syndrome (AIDS) are at higher risks of bacterial pneumonia than the general population, and the pathogen is the most commonly involved Streptococcus pneumoniae. We hereby report a case of pneumococcal pneumonia associated with leptomeningitis, osteomyelitis and epidural abscess in a patient with AIDS. He is being successfully treated with ampicillin/sulbactam and clindamycin. And because the pneumococcal infection is usually associated with morbidity and mortality rates in the setting of AIDS, we should consider for pneumococcal vaccinations among the AIDS populations. PMID:24624217

  13. Medical Students' Perceptions and Proposed Treatment Strategies for AIDS Patients.

    ERIC Educational Resources Information Center

    Ladany, Nicholas; Stern, Marilyn

    Research has consistently found that health care providers report having negative attitudes and perceptions toward Acquired Immune Deficiency Syndrome (AIDS) patients. This study was conducted to examine the independent and joint influences of a patient's mode of acquisition of illness (blood transfusion versus sexual promiscuity), patient blame…

  14. QTc interval prolongation in patients with HIV and AIDS.

    PubMed Central

    Sani, Mahmoud U.; Okeahialam, Basil N.

    2005-01-01

    A higher prevalence of QT prolongation has been reported among HIV/AIDS patients, possibly related to drugs prescribed for them or to an acquired form of long QT syndrome. A prolonged QTc is a predictor of cardiovascular mortality. We set out to study this interval in a group of AIDS patients. One-hundred consecutive AIDS patients admitted into the Jos University Teaching Hospital and who satisfied the inclusion criteria were recruited. All were evaluated for symptomatology of cardiovascular disease and had a 12-lead surface electrocardiogram recording. QT interval, taken from the onset of the QRS complex to the end of the T wave, was corrected for heart rate. Eighty HIV-negative, healthy persons and 78 HIV-positive, asymptomatic subjects were used as controls. Forty-five percent of the AIDS patients had prolonged QTc interval. Prolonged QTc was present in 28% of HIV-positive controls and 10% of HIV-negative controls. The mean QTc interval differs significantly between the AIDS patients and the two control groups. From our study, Nigerian HIV-positive asymptomatic subjects have higher prevalence of QTc prolongation compared to HIV-negative subjects and, as they move to AIDS, the prevalence of QTc prolongation increases. This makes for increased cardiovascular mortality. PMID:16396057

  15. The DREAM model's effectiveness in health promotion of AIDS patients in Africa.

    PubMed

    Magnano San Lio, M; Mancinelli, S; Palombi, L; Buonomo, E; Altan, A Doro; Germano, P; Magid, N A; Pesaresi, A; Renzi, E; Scarcella, P; Zimba, I; Marazzi, M C

    2009-03-01

    This study evaluates the effectiveness of a holistic model for treating people living with AIDS in Africa; the model aims to improve knowledge about AIDS prevention and care, increase trust in the health centre, impact behaviour, and promote a high level of adherence to HAART. The study took place in the context of the DREAM (Drug Resource Enhancement against AIDS and Malnutrition) programme in Mozambique, designed by the Community of Sant'Egidio to treat HIV patients in Africa. It provides patients with free anti-retroviral drugs, laboratory tests (including viral load), home care and nutritional support. This is a prospective study involving 531 patients over a 12-month period. The patients, predominantly poor and with a low level of education, demonstrated a good level of knowledge about AIDS (more than 90% know how it is transmitted) and trust in the treatment, with a relatively small percentage turning to traditional healers. Overall the patients had a low level of engaging in risky sexual behaviour and a very good level of adherence to HAART (69.5% of the 531 subjects had a pill count higher than 95%). The positive results of the programme's educational initiatives were confirmed with the patients' good clinical results.

  16. Frequent hemorrhagic lesions in cerebral toxoplasmosis in AIDS patients.

    PubMed

    Bhagavati, Satyakam; Choi, Jan

    2009-04-01

    Cerebral toxoplasmosis is a frequent complication in immunosuppressed patients such as AIDS (acquired immunodeficiency syndrome). Frequently, lesions are located deep in the brain which are inaccessible for biopsy making rapid diagnosis dependent on accurate interpretation of neuroimaging findings. The commonest cranial CT findings reported in toxoplasmosis are ring enhancing hypodense lesions in basal ganglia or cortical gray matter. Hemorrhage has only rarely been described and is usually seen following antitoxoplasma treatment. We reviewed the records of 11 AIDS patients with cerebral toxoplasmosis and found multiple hemorrhagic cerebral, cerebellar, or brain stem lesions in 7 of 11 patients. Six patients had hemorrhage at the time of initial clinical presentation and one developed hemorrhage following 2 weeks of antitoxoplasma treatment. We conclude that hemorrhagic lesions are frequently found on cranial MRI scans in cerebral toxoplasmosis. AIDS patients presenting with hemorrhagic cerebral lesions should be considered for a trial of presumptive antitoxoplasma treatment.

  17. Detection of AIDS Virus in Macrophages in Brain Tissue from AIDS Patients with Encephalopathy

    NASA Astrophysics Data System (ADS)

    Koenig, Scott; Gendelman, Howard E.; Orenstein, Jan M.; Canto, Mauro C.; Pezeshkpour, Gholam H.; Yungbluth, Margaret; Janotta, Frank; Aksamit, Allen; Martin, Malcolm A.; Fauci, Anthony S.

    1986-09-01

    One of the common neurological complications in patients with the acquired immune deficiency syndrome (AIDS) is a subacute encephalopathy with progressive dementia. By using the techniques of cocultivation for virus isolation, in situ hybridization, immunocytochemistry, and transmission electron microscopy, the identity of an important cell type that supports replication of the AIDS retrovirus in brain tissue was determined in two affected individuals. These cells were mononucleated and multinucleated macrophages that actively synthesized viral RNA and produced progeny virions in the brains of the patients. Infected brain macrophages may serve as a reservoir for virus and as a vehicle for viral dissemination in the infected host.

  18. Citric acid treatment of post operative wound infections in HIV/AIDS patients.

    PubMed

    Nagoba, Basavraj; Patil Dawale, Chandrakala; Raju, Reena; Wadher, Bharat; Chidrawar, Shruti; Selkar, Sohan; Suryawanshi, Namdev

    2014-02-01

    The normal cellular immunity is required for normal wound healing. The HIV infection affects wound healing adversely. Wound infections in HIV/AIDS patients are difficult to manage because of compromised immunity. The result is delayed wound healing and increased susceptibility to wound infection. Here we report two cases of HIV positive patients who had developed the post operative wound gape, not responding to the conventional treatment, treated simply by local application of three percent citric acid ointment.

  19. Toxoplasmosis of the central nervous system in patients with AIDS in Mexico.

    PubMed

    del Rio-Chiriboga, C; Orzechowski-Rallo, A; Sanchez-Mejorada, G

    1997-01-01

    Toxoplasmosis of the central nervous system (CNS) is the most common cause of intracerebral lesions in patients with AIDS. It is now standard clinical practice to treat empirically, based on clinical and radiographic findings, and to perform a biopsy of the lesion only in those patients who fail to have a clinical and radiographic response after two weeks of therapy. This study describes the presentation and response to therapy of central nervous system toxoplasmosis in patients with AIDS at a private practice in Mexico City. A retrospective chart and radiology review of all patients with AIDS treated empirically for toxoplasmosis between 1988 and 1993 was performed. A total of 177 patients with AIDS were seen, nine (5.1%) had toxoplasmosis. Patients with toxoplasmosis were males with a median age of 39 years (range 26 - 65). In two patients, toxoplamosis of the CNS was the initial manifestation of HIV infection, all others had a prior diagnosis of AIDS with a mean of 10 months between their first AIDS defining event and the diagnosis of toxoplasmosis. The median CD4+ T-cell count at the time of the diagnosis of toxoplamsosis was 78 cells/microL. Most patients had headache associated with other focal neurological symptoms such as hemiplegia (2), hemiparesis (2) or seizures (4). Only 4 out of 9 patients had fever as part of their initial clinical presentation. Serum IgG antibodies against Toxoplasma gondii were positive in 6 out of 7 patients tested, while IgM antibodies were negative in all patients. On imaging studies (Computerized Tomography or Magnetic Resonance Imaging), 4 patients had a single lesion while the rest had two or more lesions. Two patients were initially treated with pyrimethamine/sulfadiazine and were later changed to pyrimethamine/clindamycin, which was the treatment given from the beginning to all other patients. One patient died of an intralesional hemorrhage two weeks after the diagnosis despite adequate therapy. The probability of surviving

  20. The relationship between personality traits and AIDS in patients with human immunodeficiency virus.

    PubMed

    Salehi, Bahman; Zarinfar, Nader; Noori, Hasan

    2016-06-01

    This study carried out to survey the relationship between personality traits and Acquired Immunodeficiency Syndrome (AIDS) in patients with human immunodeficiency virus. This case-control study was conducted on 79 AIDS patients of Triangle Clinic in Arak (case group) and 80 healthy people of Valiasr Hospital in Arak (control group). Demographic information checklist and Cloninger' Temperament and Character inventory (TCI) were two instruments applied in the study. SPSS software V.19 and tests independent t-tests, Chi squared and Spearman correlation coefficient were used for data analysis with significant level of <0.05. The average of innovativeness variables (M:74.12), harm avoidance (M: 65.17), reward dependence (M:50.030), and self-directedness (M:35.02) in case group in comparison with control group was significantly higher, and there was a significant difference between two groups variables (P-0.000). The novelty seeking had the highest average in the AIDS patients with a history of addiction (M:74.00), and there was statistically significant difference between perseverance variable (P-0.021) and cooperativeness variable (P-0.041) in the two groups of AIDS patients. There was a significant relationship between novelty seeking and age at the onset of AIDS (P-0.038), harm avoidance and age at the onset of addiction (P-0.046), persistence and age at the onset of AIDS (P-0.035) and the time infected with HIV (P-0.033). It is found that two groups are different due to the personalities, so it is essential to consider the personality traits in order to prevent AIDS and also successfully treat patients suffering from AIDS.

  1. Understanding diabetes in patients with HIV/AIDS

    PubMed Central

    2011-01-01

    This paper reviews the incidence, pathogenetic mechanisms and management strategies of diabetes mellitus in patients with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). It classifies patients based on the aetiopathogenetic mechanisms, and proposes rational methods of management of the condition, based on aetiopathogenesis and concomitant pharmacotherapy. PMID:21232158

  2. Latent ocular deviations in patients with advanced AIDS.

    PubMed

    España-Gregori, E; Montés-Micó, R; Bueno-Gimeno, I; Díaz-Llopi, M; Menezo-Rozalén, J L

    2001-11-01

    The purpose of this study is to determine horizontal latent ocular deviations in patients with advanced AIDS (CD4+ count <0.050 x 10(9)/l) and to compare with normal values by means of the von Graefe technique. Twenty patients aged between 17 and 44 years with AIDS and aged-matched control groups were submitted to study. The AC/A ratio was also measured in both groups using the Gradient test. The AIDS patients showed a horizontal latent deviation value of 0.28+/-1.07delta exo at near (40 cm.) and 2.12+/-1.37delta eso at distance (6 m). The AC/A ratio obtained was 2.03+/-0.65. Statistically significant differences were obtained in relation to aged-matched control group at near and at distance (p<0.01). The horizontal latent ocular deviation at near and at distance in advanced AIDS patients showed lower values than the expected. The AC/A relationship also was lower. The results obtained in this study indicate that AIDS patients suffer a divergence insufficiency, which could add to other visual complaints such as blurred vision, photophobia, nyctalopia and reading difficulty.

  3. STD Clinic Patients' Awareness of Non-AIDS Complications of HIV Infection

    PubMed Central

    Castro, José Guillermo; Granovsky, Inna; Jones, Deborah; Weiss, Stephen M.

    2016-01-01

    Participants were recruited from a sexually transmitted disease (STD) clinic in Florida and were assessed regarding the knowledge and awareness of non-AIDS conditions associated with HIV infection. Questionnaires were administered before and after a brief information session on non-AIDS conditions associated with HIV infection. Participants included men (n = 46) and women (n = 51). Prior to the information session, at baseline, only 34% of the participants were worried about HIV infection. Most participants (82%) agreed that HIV could be treated with antiretroviral therapy (ART), while only 38% were aware that HIV-associated conditions cannot be easily treated with ART. After the information session, almost all participants reported they were concerned regarding the risk of HIV infection. High-risk patients may have limited knowledge about the consequences of HIV infection beyond the traditional AIDS-associated conditions. Increased awareness of these less known consequences of HIV infection may decrease the potential for complacency regarding acquiring HIV infection. PMID:25331221

  4. Health Concerns (excluding AIDS) for Male Homosexual Patients

    PubMed Central

    Willoughby, Brian C.

    1988-01-01

    Since 1981, the Acquired Immune Deficiency Syndrome (AIDS) has emerged as the major infectious epidemic of our time and has focused much attention on the male homosexual community. While AIDS is the most serious of gay-related health concerns, it is only one of several infectious diseases that have particular relevance for this group of patients. In addition, the mere acknowledgement of homosexuality by a male patient evokes unique psychosocial concerns that are important considerations for the primary health-care provider. The author of this article describes an approach to gay male patients for those who provide health care to such men and provides a review of specific infectious diseases (excluding AIDS) for which they are at risk. PMID:21253077

  5. [Diagnosis and treatment of ocular viral infections in AIDS patients].

    PubMed

    Guex-Crosier, Y

    1998-11-01

    Ocular complication of AIDS are seen in about 75% of patients. Viral infections are predominant and can involve either external segment in the eye (Herpes type 8 in Kaposi sarcoma, molluscum contagiosum, Herpes simplex and zoster), or the posterior segment of the eye (CMV retinitis). The introduction of a Highly Active Antiretroviral Therapy (HAART) which associates two reverse transcriptase inhibitors and one antiprotease has changed the evolution of AIDS. The decrease of onset of CMV retinitis in AIDS patient is one of the best exemple. For the first time it was possible to stop the maintenance therapy against CMV retinitis in patients that have a sufficient increase in CD4+ cells and they did not present any relapse of CMV retinitis. But an increase of ocular inflammation can be observed with the onset of HAART such as uveitis or cystoid macular edema.

  6. Who Treats Patients with Diabetes and Compensated Cirrhosis

    PubMed Central

    Barritt IV, A. Sidney; Weinberger, Morris; Paul, John E.; Fried, Bruce; Trogdon, Justin G.

    2016-01-01

    Background Increasingly, patients with multiple chronic conditions are being managed in patient-centered medical homes (PCMH) that coordinate primary and specialty care. However, little is known about the types of providers treating complex patients with diabetes and compensated cirrhosis. Objective We examined the mix of physician specialties who see patients dually-diagnosed with diabetes and compensated cirrhosis. Design Retrospective cross-sectional study using 2000–2013 MarketScan® Commercial Claims and Encounters and Medicare Supplemental Databases. Patients We identified 22,516 adults (≥ 18 years) dually-diagnosed with diabetes and compensated cirrhosis. Patients with decompensated cirrhosis, HIV/AIDS, or liver transplantation prior to dual diagnosis were excluded. Main Measures Physician mix categories: patients were assigned to one of four physician mix categories: primary care physicians (PCP) with no gastroenterologists (GI) or endocrinologists (ENDO); GI/ENDO with no PCP; PCP and GI/ENDO; and neither PCP nor GI/ENDO. Health care utilization: annual physician visits and health care expenditures were assessed by four physician mix categories. Key Results Throughout the 14 years of study, 92% of patients visited PCPs (54% with GI/ENDO and 39% with no GI/ENDO). The percentage who visited PCPs without GI/ENDO decreased 22% (from 63% to 49%), while patients who also visited GI/ENDO increased 71% (from 25% to 42%). Conclusions This is the first large nationally representative study to document the types of physicians seen by patients dually-diagnosed with diabetes and cirrhosis. A large proportion of these complex patients only visited PCPs, but there was a trend toward greater specialty care. The trend toward co-management by both PCPs and GI/ENDOs suggests that PCMH initiatives will be important for these complex patients. Documenting patterns of primary and specialty care is the first step toward improved care coordination. PMID:27783702

  7. [Hygiene practices for patients with HIV/AIDS].

    PubMed

    da Cunha, Gilmara Holanda; de Araujo, Thelma Leite; Lima, Francisca Elisângela Teixeira; Cavalcante, Tahissa Frota; Galvão, Marli Teresinha Gimeniz

    2014-09-01

    The objective of this study was to analyze the scientific production on health interventions related to hygiene for adults with HIV/AIDS. An integrative literature review was performed using six databases in June 2013. The descriptors AIDS and Hygiene were used, in Portuguese, English or Spanish. A total of 682 articles were found and 16 were selected. Personal hygiene practices were identified, such as hand washing, showers, tooth brushing and quitting smoking. Food hygiene practices involved washing food and kitchen utensils, using treated water, conserving and cooking food. Environmental hygiene took into account raising domestic animals, control of disease vectors, household cleanliness, waste disposal and basic sanitation. In conclusion, these specific hygiene interventions can be applied to the general population and, especially, to people with HIV/AIDS, due to immunosuppression.

  8. Neuropsychological abnormalities in AIDS and asymptomatic HIV seropositive patients.

    PubMed Central

    Villa, G; Monteleone, D; Marra, C; Bartoli, A; Antinori, A; Pallavicini, F; Tamburrini, E; Izzi, I

    1993-01-01

    Neuropsychological and immunological parameters were studied in 36 AIDS patients with early disease and without clinical, laboratory, and neuroradiological signs of CNS impairment, and also in 33 asymptomatic HIV seropositive subjects. Many AIDS patients performed abnormally on timed psychomotor tasks, tasks involving sequencing and "set-shifting", and memory tasks stressing attention, learning, active retrieval, and monitoring of information. Asymptomatic HIV seropositive subjects as a group did not perform significantly worse than controls. However, on the basis of a cut off number of pathological performances on neuropsychological tasks, 52.8% of AIDS and 30.3% of asymptomatic HIV seropositive subjects had cognitive impairment, compared with 3.9% of HIV seronegative controls. Low values of CD4+ cells and of CD4+/CD8+ ratio and high titres of P-24 antigen in the blood prevailed among subjects with cognitive impairment, especially in the asymptomatic HIV seropositive group. PMID:8350104

  9. Evaluation of a Computerized Contraceptive Decision Aid for Adolescent Patients.

    ERIC Educational Resources Information Center

    Chewning, Betty; Mosena, Pat; Wilson, Dale; Erdman, Harold; Potthoff, Sandra; Murphy, Anita; Kuhnen, Kathleen Kennedy

    1999-01-01

    Discusses a computer-based contraceptive decision aid used with adolescent female family planning clinic patients (N=949). Results show improved short-term knowledge of and confidence in oral contraceptive (OC) efficacy. Higher OC knowledge after one year and fewer pregnancies were seen in one group. Findings suggest the usefulness of informatics…

  10. [Secondary bladder lymphoma in a patient with AIDS].

    PubMed

    Vendrell, J R; Alcaraz, A; Gutíerrez, R; Rodríguez, A; Barranco, M A; Carretero, P

    1996-10-01

    Contribution of one case of non-Hodgkin lymphoma (NHL) with vesical involvement, that presented clinically with urological symptomatology. Vesical involvement is typical of NHL, and is becoming more frequent in association with the increased number of AIDS patients under immunosuppressive therapy. It should be expected that this currently unusual entity will become more common in the future.

  11. Bordetella bronchiseptica pneumonia in a patient with AIDS.

    PubMed Central

    de la Fuente, J; Albo, C; Rodríguez, A; Sopeña, B; Martínez, C

    1994-01-01

    Bordetella bronchiseptica is recognised as a respiratory tract pathogen in many mammalian species, but has rarely been implicated in human infection. A case is reported of pneumonia caused by B bronchiseptica in a patient suffering from acquired immunodeficiency syndrome (AIDS). Images PMID:8066571

  12. AIDS

    MedlinePlus

    ... page: //medlineplus.gov/ency/article/000594.htm HIV/AIDS To use the sharing features on this page, ... immunodeficiency virus (HIV) is the virus that causes AIDS. When a person becomes infected with HIV, the ...

  13. Laparoscopic diverticulectomy with the aid of intraoperative gastrointestinal endoscopy to treat epiphrenic diverticulum

    PubMed Central

    Yu, Lei; Wu, Ji-xiang; Chen, Xiao-hong; Zhang, Yun-Feng; Ke, Ji

    2016-01-01

    OBJECTIVE: Most researchers believe that the presence of large epiphrenic diverticulum (ED) with severe symptoms should lead to the consideration of surgical options. The choice of minimally invasive techniques and whether Heller myotomy with antireflux fundoplication should be employed after diverticulectomy became points of debate. The aim of this study was to describe how to perform laparoscopic transhiatal diverticulectomy (LTD) and oesophagomyotomy with the aid of intraoperative gastrointestinal (GI) endoscopy and how to investigate whether the oesophagomyotomy should be performed routinely after LTD. PATIENTS AND METHODS: From 2008 to 2013, 11 patients with ED underwent LTD with the aid of intraoperative GI endoscopy at our department. Before surgery, 4 patients successfully underwent oesophageal manometry: Oesophageal dysfunction and an increase of the lower oesophageal sphincter pressure (LESP) were found in 2 patients. RESULTS: There were 2 cases of conversion to an open transthoracic procedure. Six patients underwent LTD, Heller myotomy and Dor fundoplication; and 3 patients underwent only LTD. The dysphagia and regurgitation 11 patients experienced before surgery improved significantly. Motor function studies showed that there was no oesophageal peristalsis in 5 patients during follow-up, while 6 patients showed seemingly normal oesophageal motility. The LESP of 6 patients undergoing LTD, myotomy and Dor fundoplication was 16.7 ± 10.2 mmHg, while the LESPs of 3 patients undergoing only LTD were 26 mmHg, 18 mmHg and 21 mmHg, respectively. In 4 cases experiencing LTD, myotomy and Dor fundoplication, the gastro-oesophageal reflux occurred during the sleep stage. CONCLUSIONS: LTD constitutes a safe and valid approach for ED patients with severe symptoms. As not all patients with large ED have oesophageal disorders, according to manometric and endoscopic results, surgeons can categorise and decide whether or not myotomy and antireflux surgery after LTD will

  14. Clinico-Epidemiological Analysis of HIV/AIDS Patients

    PubMed Central

    Ertunc, Baris; Kaya, Selcuk; Koksal, Iftihar

    2016-01-01

    Objective: The aim of this study was to examine clinico-epidemiological properties of HIV/AIDS patients. Materials and Methods: For this purpose, 115 HIV/AIDS patients monitored in our clinic between January 1, 1998, and December 31, 2013, were retrospectively evaluated. Results: For the 115 patients with a diagnosis of HIV/AIDS that we monitored, the mean age at the time of presentation was 34.5±13.21 (10–79) years. Eighty-nine (76.5%) patients were male and 27 (23.5%), female. In this study, HIV/AIDS was the most prevalent in the young male population with a low educational and sociocultural level. The most common mode of transmission in our patients was heterosexual relations: approximately 1 patient in 3 had a history of traveling to countries with a high prevalence of HIV/AIDS, namely, Russia and Ukraine. The examination of diagnosis with respect to years showed an increase in new cases since 2008. Only 21 (18.3%) of our patients were diagnosed through clinical symptoms, while 91 (81.7%) during routine scanning. At first presentation, 68% of our patients were stage A; 4.7%, stage B; and 27.3%, stage C. The mean length of the monitoring of our patients was 2.74 years (2–180 months). Thirteen (11.3%) patients died due to opportunistic infections and malignities. The most common opportunistic infection was tuberculosis (16.5%), followed by syphilis and HBV. Malignity, most commonly intracranial tumor, was seen in 8.6% patients. Conclusion: The disease was generally seen in the young male population with a low sociocultural level, and it was most frequently transmitted by heterosexual sexual contact. This clearly shows the importance of sufficient, accurate information, and education on the subject of the disease and its prevention. The fact that many of our patients were diagnosed in the late stage due to stigma and that diagnosis was largely made through scanning tests confirms the importance of these tests in early diagnosis. PMID:28149137

  15. Nutritional status in patients with HIV infection and AIDS.

    PubMed

    Stambullian, Marcela; Feliu, Susana; Slobodianik, Nora H

    2007-10-01

    The aim of this study was to evaluate the nutritional status of adults with HIV infection or with AIDS through the use of biochemical parameters. The study was performed on 43 patients (19 HIV+ and 24 AIDS patients), between 26 and 44 years of age, from low and medium socioeconomic status, with access to health care services; 35 patients were under highly active antiretroviral therapy (HAART) treatment. Body weight and height were determined, and the Body Mass Index calculated (kg/m2). Blood samples were collected from fasting patients. Plasma cholesterol (total, HDL and LDL), triacylglycerol, total protein, apolipoproteins A-I and B, albumin, transthyretin, retinol binding protein, and ceruloplasmin concentrations were determined. Plasma levels of zinc, copper, and selenium were determined in a haemolysis-free sample by flame atomic absorption spectrometry. Statistical analyses were performed with the Student's t-test. AIDS patients showed changes in biochemical parameters, particularly an increase in fibrinogen and a trend to decreased transthyretin levels. These findings stress the importance of the inclusion of functional biochemical parameters in the periodic evaluation of these patients. This would allow an early assessment of the need for appropriate nutritional support, implemented along with the specific retroviral treatment. This would aim at delaying the progression of the disease, and might improve the prospects of survival and quality of life.

  16. Opsoclonus-myoclonus-ataxia syndrome in an AIDS patient.

    PubMed

    Vale, Thiago Cardoso; Silva, Rodrigo Alencar E; Cunningham, Mauro César Quintão E Silva; Maia, Débora Palma; Camargos, Sarah Teixeira; Cardoso, Francisco

    2013-12-01

    We report the case of a 38-year-old woman with AIDS who developed opsoclonus-myoclonus-ataxia syndrome during a period different from other cases reported in literature. Opsoclonus-myoclonus-ataxia syndrome had already been reported as the initial neurological presentation of AIDS, as well as at the time of HIV-seroconversion and immune reconstitution syndrome. Our case is unique since the patient had an elevated CD4 count and negative viral load in the period when the opsoclonus-myoclonus-ataxia syndrome occurred.

  17. Otologic surgery in patients with HIV-1 and AIDS.

    PubMed

    Kohan, D; Giacchi, R J

    1999-10-01

    Otologic disease in patients infected with HIV occurs frequently and usually represents rhinologic disease and associated eustachian tube dysfunction rather than manifestations of HIV infection. As in all patients, the decision to operate on an HIV-infected individual who would benefit from major otologic surgery is a balance between the risks of the procedure and the possible benefits to the patient. Many concerns regarding wound infection and healing have been raised. The objective of this study is to evaluate the outcome of otologic procedures in this population. The charts of 9 men and 4 women were reviewed. Seven patients (54%) met the Centers for Disease Control and Prevention criteria for AIDS. Patients with chronic otitis media (46%) underwent tympanomastoidectomies, and the cases of acute mastoiditis (31%) were managed with simple mastoidectomies. Other procedures included repair of cerebrospinal fluid leak (15%) and stapedectomy (8%). Two patients had early complications and died during their hospitalizations. Three patients had prolonged hospital courses requiring long-term antibiotics. These 5 patients underwent urgent procedures and were severely immunocompromised. Of the remaining 8 patients only 2 had AIDS, and all had an uncomplicated postoperative course. Six of these patients were followed up for more than 1 year, and only 2 developed subsequent otologic disease.

  18. The perspectives of iranian physicians and patients towards patient decision aids: a qualitative study

    PubMed Central

    2013-01-01

    Background Patient preference is one of the main components of clinical decision making, therefore leading to the development of patient decision aids. The goal of this study was to describe physicians’ and patients’ viewpoints on the barriers and limitations of using patient decision aids in Iran, their proposed solutions, and, the benefits of using these tools. Methods This qualitative study was conducted in 2011 in Iran by holding in-depth interviews with 14 physicians and 8 arthritis patient. Interviewees were selected through purposeful and maximum variation sampling. As an example, a patient decision aid on the treatment of knee arthritis was developed upon literature reviews and gathering expert opinion, and was presented at the time of interview. Thematic analysis was conducted to analyze the data by using the OpenCode software. Results The results were summarized into three categories and ten codes. The extracted categories were the perceived benefits of using the tools, as well as the patient-related and physician-related barriers in using decision aids. The following barriers in using patient decision aids were identified in this study: lack of patients and physicians’ trainings in shared decision making, lack of specialist per capita, low treatment tariffs and lack of an exact evaluation system for patient participation in decision making. Conclusions No doubt these barriers demand the health authorities’ special attention. Hence, despite patients and physicians’ inclination toward using patient decision aids, these problems have hindered the practical usage of these tools in Iran - as a developing country. PMID:24066792

  19. Examining geographic and socio-economic differences in outpatient and inpatient consumer expenditures for treating HIV/AIDS in Nigeria

    PubMed Central

    Onwujekwe, Obinna E; Ibe, Ogochukwu; Torpey, Kwasi; Dada, Stephanie; Uzochukwu, Benjamin; Sanwo, Olusola

    2016-01-01

    Introduction The expenditures on treatment of HIV/AIDS to households were examined to quantify the magnitude of the economic burden of HIV/AIDS to different population groups in Nigeria. The information will also provide a basis for increased action towards a reduction of the economic burden on many households when accessing antiretroviral therapy (ART). Methods A household survey was administered in three states, Adamawa, Akwa Ibom and Anambra, from the South-East, North-East and South-South zones of Nigeria, respectively. A pretested interviewer-administered questionnaire was used to collect data from a minimum sample of 1200 people living with HIV/AIDS (PLHIV). Data were collected on the medical and non-medical expenditures that patients incurred to treat HIV/AIDS for their last treatment episode within three months of the interview date. The expenditures were for outpatient visits (OPV) and inpatient stays (IPS). The incidence of catastrophic health expenditure (CHE) on ART treatment services was computed for OPV and IPS. Data were disaggregated by socio-economic status (SES) and geographic location of the households. Results The average OPV expenditures incurred by patients per OPV for HIV/AIDS treatment was US$6.1 with variations across SES and urban-rural residence. More than 95% of the surveyed households spent money on transportation to a treatment facility and over 70% spent money on food for OPV. For medical expenditures, the urbanites paid more than rural dwellers. Many patients incurred CHE during outpatient and inpatient visits. Compared to urban dwellers, rural dwellers incurred more CHE for outpatient (p=0.02) and inpatient visits (p=0.002). Conclusions Treatment expenditures were quite high, inequitable and catastrophic in some instances, hence further jeopardizing the welfare of the households and the PLHIV. Strategically locating fully functional treatment centres to make them more accessible to PLHIV will largely reduce expenditures for travel

  20. Discriminatory Attitudes and Practices by Health Workers toward Patients with HIV/AIDS in Nigeria

    PubMed Central

    2005-01-01

    Background Nigeria has an estimated 3.6 million people with HIV/AIDS and is home to one out of every 11 people with HIV/AIDS worldwide. This study is the first population-based assessment of discrimination against people living with HIV/AIDS in the health sector of a country. The purpose of this study was to characterize the nature and extent of discriminatory practices and attitudes in the health sector and indicate possible contributing factors and intervention strategies. The study involved a cross-sectional survey of 1,021 Nigerian health-care professionals (including 324 physicians, 541 nurses, and 133 midwives identified by profession) in 111 health-care facilities in four Nigerian states. Methods and Findings Fifty-four percent of the health-care professionals (550/1,021) were sampled from public tertiary care facilities. Nine percent of professionals reported refusing to care for an HIV/AIDS patient, and 9% indicated that they had refused an HIV/AIDS patient admission to a hospital. Fifty-nine percent agreed that people with HIV/AIDS should be on a separate ward, and 40% believed a person's HIV status could be determined by his or her appearance. Ninety-one percent agreed that staff and health-care professionals should be informed when a patient is HIV-positive so they can protect themselves. Forty percent believed that health-care professionals with HIV/AIDS should not be allowed to work in any area of health-care that requires patient contact. Twenty percent agreed that many with HIV/AIDS behaved immorally and deserve the disease. Basic materials needed for treatment and prevention of HIV were not adequately available. Twelve percent agreed that treatment of opportunistic infections in HIV/AIDS patients wastes resources, and 8% indicated that treating someone with HIV/AIDS is a waste of precious resources. Providers who reported working in facilities that did not always practice universal precautions were more likely to favor restrictive policies toward

  1. Hepatic disease in patients with acquired immunodeficiency syndrome (AIDS).

    PubMed

    Lodenyo, Hudson; Segal, Issy

    2004-01-01

    The acquired immunodeficiency syndrome is now the leading cause of death in the world. Liver involvement in opportunistic infections and neoplasms affecting patients with human immunodeficiency disease syndrome are common. Many of these patients also take many medicines and toxins that are potentially harmful to the liver. This is an overview on the aetiology and possible diagnostic guide to determine liver involvement in patients with HIV infection. A literature review was performed on major published series on the liver and HIV infection between 1985 and 1999, both years inclusive. Data and opinions from 5 general reviews and 31 original articles from MEDLINE on liver disease in patients with HIV infection regarding aetiology, pathology, presentation and patient evaluation are summarised. The liver is frequently affected in patients with AIDS. The majority of the patients have hepatomegaly and abnormal liver enzymes secondary to involvement with opportunities infections, AIDS associated neoplasms and drug therapy. Most of the infections reach the liver by lymphohaematogeneous spread from other sites in the body. Methodical approach in patient evaluation is therefore essential for prompt diagnosis and treatment to minimise morbidity and early mortality.

  2. [Bone protection in corticosteroid treated patients].

    PubMed

    Savoldi, Silvana; Giacchino, Franca; Rollino, Cristiana; Manganaro, Marco; Besso, Luca; Izzo, Cristina; Gianoglio, Bruno; Amore, Alessandro; Fenoglio, Roberta; Stratta, Piero

    2015-01-01

    The Piedmont Group of Clinical Nephrology compared the activity of 15 nephrology centers in Piedmont and Aosta Valley as regards bone protection in patients on corticosteroids therapy. Fracture prevalence shows great variability: in 4/15 centers (27%) no fractures were found, in 6/15 centers (40%) fractures were present in 1-4% of cases, in 1 center in 18% of patients. Clinical risk of fracture was based on sex, age and postmenopausal status in 11/14 of the centers (79%), history of fractures and bone disease in 4/14 centers (27%), smoking and alcohol consumption in 3 and 2 centers respectively, glucocorticoid dose and duration in 4, in children bone age and calcium phosphorus status. Dual energy X-ray absorptiometry was performed in 12 centers based on risk factors, in 8 (57%) DXA was performed during the follow-up, in 4 it was performed after 12 months and in 2 after 2-3 years. DXA is not prescribed in children. Only in one center, risk assessment is based on FRAX. Most of the patients are treated with vitamin D supplementation at a dose of steroids of 5 mg/d (80%). Calcium carbonate is used in 9 centers (60%), in two it is used only in the presence of low ionized calcium or bone mineral density. Bisphosphonates are used following AIFA prescription, in particular alendronate in all centers, risedronate in seven and denosumab in one. The analysis shows the great variability of the clinical and therapeutic approach regarding bone protection in patients on corticosteroids therapy, in Piedmont and Aosta Valley.

  3. Pseudomembranous candidiasis in HIV/AIDS patients in Cali, Colombia.

    PubMed

    Castro, Luz Ángela; Álvarez, María Inés; Martínez, Ernesto

    2013-02-01

    Candida albicans is the most frequently isolated yeast from the oral cavity of HIV/AIDS individuals. The use of fluconazole has increased the number of resistant or less-sensitive Candida species different than C. albicans. The purpose of this study was to identify the Candida species producing pseudomembranous candidiasis in patients suffering from AIDS, their relationship with CD4(+) counts and their sensitivity to fluconazole and itraconazole. We studied 71 patients at a hospital in the city of Cali. Samples of white plaque were seeded on CHROMagar Candida, yeast identification was done with API 20C Aux, and susceptibility testing was determined by E test. Ninety-three yeast isolates were obtained, 52 single and 41 mixed. C. albicans was the most isolated, followed by C. glabrata. An increased frequency of isolates and variety of Candida species occurred in patients with a CD4(+) cell count ≤100 cells/mm(3) without significant differences (p = 0.29). The susceptibility study showed that 8 (8.6%) isolates were resistant to fluconazole and 11 (11.8%) to itraconazole, while 6 (8.8%) C. albicans were simultaneously resistant. No association was found between the isolates of C. albicans or Candida species different than C. albicans and the use of fluconazole (p = 0.21). The results of this study indicate that in the tested population, fluconazole continues to be the best treatment option for oropharyngeal candidiasis in patients suffering from AIDS (HIV/AIDS); however, susceptibility tests are necessary in patients who present therapeutic failure.

  4. Non-cytomegalovirus ocular opportunistic infections in patients with AIDS

    PubMed Central

    Gangaputra, Sapna; Drye, Lea; Vaidya, Vijay; Thorne, Jennifer E.; Jabs, Douglas A; Lyon, Alice T.

    2014-01-01

    Purpose To report the incidence and clinical outcomes of non-cytomegalovirus (non-CMV) ocular opportunistic infections in patients with AIDS in the era of highly active antiretroviral therapy (HAART). Design Multicenter, prospective, observational study of patients with AIDS Methods Medical history, ophthalmologic examination, and laboratory tests were performed at enrollment and every 6 months subsequently. Once an ocular opportunistic infection was diagnosed, patients were seen every 3 months for outcomes. Results At enrollment, 37 non-CMV ocular opportunistic infections were diagnosed: 16 patients, herpetic retinitis; 11 patients, toxoplasmic retinitis; and 10 patients, choroiditis. During the follow-up period, the estimated incidences (and 95% confidence intervals [CI]) of these were: herpetic retinitis, 0.007/100 person-years (PY) (95% CI 0.0004, 0.039); toxoplasmic retinitis, 0.007/100 PY (95% CI 0.004, 0.039); and choroiditis 0.014/100 PY (95% CI 0.0025, 0.050). The mortality rates appeared higher among those patients with newly diagnosed or incident herpetic retinitis and choroiditis (rates=21.7 deaths/100 PY [P=0.02] and 12.8 deaths/100 PY [P=0.04]) respectively, than that for patients with AIDS without an ocular opportunistic infection (4.1 deaths/100 PY); Toxoplasmic retinitis did not appear to be associated with greater mortality (6.4/100 PY, P=0.47). Eyes with newly-diagnosed herpetic retinitis appeared to have a poor visual prognosis with high rates of visual impairment (37.9/100 PY) and blindness (17.5/100 PY), whereas those outcomes in eyes with choroiditis appeared to be lower (2.3/100 PY and 0/100 PY, respectively). Conclusions Although uncommon, non-CMV ocular opportunistic infections may be associated with high rates of visual loss and/or mortality. PMID:23068916

  5. Computer-aided diagnosis of leukoencephalopathy in children treated for acute lymphoblastic leukemia

    NASA Astrophysics Data System (ADS)

    Glass, John O.; Li, Chin-Shang; Helton, Kathleen J.; Reddick, Wilburn E.

    2005-04-01

    The purpose of this study was to use objective quantitative MR imaging methods to develop a computer-aided diagnosis tool to differentiate white matter (WM) hyperintensities as either leukoencephalopathy (LE) or normal maturational processes in children treated for acute lymphoblastic leukemia with intravenous high dose methotrexate. A combined imaging set consisting of T1, T2, PD, and FLAIR MR images and WM, gray matter, and cerebrospinal fluid a priori maps from a spatially normalized atlas were analyzed with a neural network segmentation based on a Kohonen Self-Organizing Map. Segmented regions were manually classified to identify the most hyperintense WM region and the normal appearing genu region. Signal intensity differences normalized to the genu within each examination were generated for two time points in 203 children. An unsupervised hierarchical clustering algorithm with the agglomeration method of McQuitty was used to divide data from the first examination into normal appearing or LE groups. A C-support vector machine (C-SVM) was then trained on the first examination data and used to classify the data from the second examination. The overall accuracy of the computer-aided detection tool was 83.5% (299/358) with sensitivity to normal WM of 86.9% (199/229) and specificity to LE of 77.5% (100/129) when compared to the readings of two expert observers. These results suggest that subtle therapy-induced leukoencephalopathy can be objectively and reproducibly detected in children treated for cancer using this computer-aided detection approach based on relative differences in quantitative signal intensity measures normalized within each examination.

  6. Toxoplasmosis in HIV/AIDS patients in Malaysia.

    PubMed

    Nissapatorn, V; Lee, C K C; Cho, S M; Rohela, M; Anuar, A Khirul; Quek, K F; Latt, H M

    2003-01-01

    Three hundred and one sera of HIV/AIDS patients were tested for anti-Toxoplasma IgG antibody by ELISA technique. The seroprevalence of toxoplasmosis was 41.2% (95% CI: 35.5-46.9) in HIV/AIDS patients. The seroprevalence was significantly higher in the Malay (57.9%) than the Chinese (38.7%), followed by the Indian patients (29.6%) (p<0.05). No possible risk factor, such as contact with cats, consumption of uncooked meat, and history of blood transfusions was found to have any significant association with the presence of anti-Toxoplasma antibody in the study sample (p>0.05). Multivariate analysis was employed to find any association between Toxoplasma seroprevalence and a single subject having single or multiple risk factors. It was found that the association was not statistically significant (p>0.05). Among the HIV/AIDS study samples, 124 (41.2%) samples were found to have positive anti-Toxoplasma antibody, the association between the presence of anti-Toxoplasma antibody and CD4 cell count was determined but no statistically significant association was found (p>0.05). During the study period, only one case of active CNS toxoplasmosis was registered and the diagnostic criteria included: clinical presentations, CT scan finding, serological evidence of anti-Toxoplasma IgG antibody, and respose to anti-Toxoplasma therapy.

  7. Do choosing wisely tools meet criteria for patient decision aids? A descriptive analysis of patient materials

    PubMed Central

    Légaré, France; Hébert, Jessica; Goh, Larissa; Lewis, Krystina B; Leiva Portocarrero, Maria Ester; Robitaille, Hubert; Stacey, Dawn

    2016-01-01

    Objectives Choosing Wisely is a remarkable physician-led campaign to reduce unnecessary or harmful health services. Some of the literature identifies Choosing Wisely as a shared decision-making approach. We evaluated the patient materials developed by Choosing Wisely Canada to determine whether they meet the criteria for shared decision-making tools known as patient decision aids. Design Descriptive analysis of all Choosing Wisely Canada patient materials. Data source In May 2015, we selected all Choosing Wisely Canada patient materials from its official website. Main outcomes and measures Four team members independently extracted characteristics of the English materials using the International Patient Decision Aid Standards (IPDAS) modified 16-item minimum criteria for qualifying and certifying patient decision aids. The research team discussed discrepancies between data extractors and reached a consensus. Descriptive analysis was conducted. Results Of the 24 patient materials assessed, 12 were about treatments, 11 were about screening and 1 was about prevention. The median score for patient materials using IPDAS criteria was 10/16 (range: 8–11) for screening topics and 6/12 (range: 6–9) for prevention and treatment topics. Commonly missed criteria were stating the decision (21/24 did not), providing balanced information on option benefits/harms (24/24 did not), citing evidence (24/24 did not) and updating policy (24/24 did not). Out of 24 patient materials, only 2 met the 6 IPDAS criteria to qualify as patient decision aids, and neither of these 2 met the 6 certifying criteria. Conclusions Patient materials developed by Choosing Wisely Canada do not meet the IPDAS minimal qualifying or certifying criteria for patient decision aids. Modifications to the Choosing Wisely Canada patient materials would help to ensure that they qualify as patient decision aids and thus as more effective shared decision-making tools. PMID:27566638

  8. Cognitive impairment in patients with AIDS – prevalence and severity

    PubMed Central

    Watkins, Crystal C; Treisman, Glenn J

    2015-01-01

    The advent of highly active antiretroviral therapy has prolonged the life expectancy of HIV patients and decreased the number of adults who progress to AIDS and HIV-associated dementia. However, neurocognitive deficits remain a pronounced consequence of HIV/AIDS. HIV-1 infection targets the central nervous system in subcortical brain areas and leads to high rates of delirium, depression, opportunistic central nervous system infections, and dementia. Long-term HIV replication in the brain occurs in astrocytes and microglia, allowing the virus to hide from antiviral medication and later compromise neuronal function. The associated cognitive disturbance is linked to both viral activity and inflammatory and other mediators from these immune cells that lead to the damage associated with HIV-associated neurocognitive disorders, a general term given for these disturbances. We review the severity and prevalence of the neuropsychiatric complications of HIV including delirium, neurobehavioral impairments (depression), minor cognitive-motor dysfunction, and HIV-associated dementia. PMID:25678819

  9. Oesophagobronchial fistula caused by varicella zoster virus in a patient with AIDS: a unique case

    PubMed Central

    Moretti, F; Uberti-Foppa, C; Quiros-Roldan, E; Fanti, L; Lillo, F; Lazzarin, A

    2002-01-01

    Human herpesvirus oesophagitis in human immunodeficiency virus positive patients is caused by cytomegalovirus and herpes simplex virus; no cases of oesophagitis and oesophagobrochial fistula as a result of varicella zoster virus (VZV) have been reported to date. This report describes the case of a patient with a 2–3 mm deep oesophageal ulcer whose viral culture was positive for VZV. The patient was treated with acyclovir with resolution of the symptomatology. After the end of the induction treatment, because of the onset of fever and fits of coughing during eating, the patient underwent oesophagography, which showed an ulcer with an oesophagobronchial fistula in the middle and lower third of the oesophagus. This case report stresses the role of VZV infection as a possible cause of oesophagobronchial fistula, a rare but benign condition in patients with AIDS. PMID:11986352

  10. HIV/AIDS Patients’ Medical and Psychosocial Needs in the Era of HAART: A Cross-sectional Study among HIV/AIDS Patients Receiving HAART in Yunnan, China

    PubMed Central

    Wen, Yi; Shi, Yun; Jiang, Chengqin; Detels, Roger; Wu, Di

    2012-01-01

    Background Since the launch of China’s Free Antiretroviral Therapy (ART) Program in 2002, more than 100,000 HIV/AIDS patients have been treated with highly actively antiretroviral therapy (HAART). However, the current evaluation system for this program mainly focused on its medical outcomes. This study aims to evaluate the medical and psychosocial needs of HIV/AIDS patients after initiating HAART. Methods A cross-sectional study was conducted among 499 HIV/AIDS patients who were currently being treated with HAART in three designated hospitals in Luxi City, Yunnan Province. A questionnaire was used to collect information about participants’ demographic characteristics, perceived HIV-related stigma, physician-patient relationship, quality of life, family functioning, etc. Patients’ medical records in the National HIV Information System were linked with their questionnaire by their ART identification number. Results Patients on HAART who were infected with HIV through injection drug use and were current smokers typically had poorer physical health than other participants on HAART. Better financial status and better physician-patient relationship were associated with both physical and psychological well-being. Family awareness of the patient’s HIV status was negatively associated with the patient’s psychological well-being. Higher levels of perceived HIV-related stigma were associated with poorer psychological health and poorer family functioning. Conclusion This study emphasizes the importance of assuring a caring environment in China’s AIDS treatment program and re-enforces the need to combat the stigma encountered with health providers and the public. PMID:23061980

  11. Effect of changing patterns of care and duration of survival on the cost of treating the acquired immunodeficiency syndrome (AIDS).

    PubMed Central

    Seage, G R; Landers, S; Lamb, G A; Epstein, A M

    1990-01-01

    We performed a two-year cost of illness study of 240 AIDS patients (55 percent of all Massachusetts cases) diagnosed and treated at five hospitals from March 1984 through February 1986. Sociodemographic and clinical data as well as information on medical utilization were obtained from review of inpatient and outpatient hospital records. The yearly inpatient cost per patient decreased by 28 percent from $38,369 in year one to $27,714 in year two. These changes were related to shorter lengths of stay (from 20.6 days to 16.8 days per hospitalization, mean difference of 3.8 days, 95% CI of the difference -.2, 7.8), and less costly hospitalizations (from $12,463 to $9,957, mean difference of $2,506, 95% CI of the difference $135, $4,877). The probability of hospitalization, however, was similar in both years. These patterns of care were still evident after controlling for transmission category, race, site, mortality, insurance, age, gender, number and type of opportunistic diseases and time since diagnosis. Although the cost per patient per year decreased between years one and two, median survival increased by 70 percent (from 10 to 17 months). Hence overall estimated lifetime costs increased by 24 percent. PMID:2356908

  12. The Clinical Usefulness of Ultrasound-Aided Fixation Using an Absorbable Plate System in Patients with Zygomatico-Maxillary Fracture

    PubMed Central

    Park, Jun Hyung

    2013-01-01

    Background Ultrasound-aided fixation is a recently developed alternative method of treatment of zygomatico-maxillary (ZM) fracture, and it can resolve the problems of excessive torsion force and subsequent fractures of screws. We conducted this study to evaluate the clinical usefulness of ultrasound-aided fixation as compared with the conventional fixation method using a drill and an expander in patients with ZM fracture. Methods We conducted a retrospective study in 35 patients with ZM fracture who had been treated at our hospital during a period ranging from March of 2008 to December of 2010. We divided them into two groups: an ultrasound-aided fixation group, comprising 13 patients who underwent ultrasound-aided fixation (SonicWeld Rx, KLS Martin), and a conventional group, comprising 22 patients who underwent conventional fixation (Biosorb FX, Linvatec Biomaterials Ltd.). We compared such variables as sex, direction, age at operation, follow-up period, operation duration, number of fixed holes, and time to discharge between the two groups. Results The ultrasound-aided fixation reduced the operation duration by about 30 minutes as compared with that of conventional fixation. There was no significant difference in follow-up period, number of fixed holes, or time to discharge between the two groups. Furthermore, there were no complications in either group. Conclusions The ultrasound-aided fixation of fractured ZM bone using an absorbable implant system is safe and effective in promptly reducing the bone fracture and providing satisfactory cosmetic outcomes over time. PMID:23898427

  13. Thalidomide in Treating Patients With Myelodysplastic Syndrome

    ClinicalTrials.gov

    2013-01-23

    Chronic Myelomonocytic Leukemia; de Novo Myelodysplastic Syndromes; Previously Treated Myelodysplastic Syndromes; Refractory Anemia; Refractory Anemia With Excess Blasts; Refractory Anemia With Excess Blasts in Transformation; Refractory Anemia With Ringed Sideroblasts; Secondary Myelodysplastic Syndromes

  14. Abdominal miliary tuberculosis in a patient with AIDS: a case report.

    PubMed

    Pop, Monica; Pop, Cezar; Homorodean, Daniela; Itu, Corina; Man, Milena; Goron, Monica; Gherasim, Ruxandra; Coroiu, Georgiana

    2003-09-01

    We present a 34 year old patient, intravenous drug user, hospitalized with fever, distortion of general status, dry irritating cough, abdominal colicative pains, and we established the diagnosis of HIV infection advanced stage/AIDS; his antecedents revealed (August 2000) abdominal tuberculosis not treated during the last 3 months. He presented a pneumonia with Pneumocystis carinii during hospitalization. Death was due to a colon perforation with secundary peritonitis. Miliary tuberculous lesions in liver, spleen and colon were revealed at necropsy and cytomegalovirus was identified in necrotic samples also.

  15. Ga-67 citrate myocardial uptake in a patient with AIDS, toxoplasmosis, and myocarditis

    SciTech Connect

    Memel, D.S.; DeRogatis, A.J.; William, D.C. )

    1991-05-01

    A 38-year-old man with AIDS presented with fever of unknown origin, splenomegaly, anemia, and thrombocytopenia. Admission laboratory data revealed a positive toxoplasmosis titer in the blood. The initial chest x-ray showed small bilateral pleural effusions, a normal cardiac silhouette, no infiltrates, and no interstitial edema. Ga-67 imaging revealed markedly abnormal uptake in the myocardium. A diagnosis of toxoplasmosis myocarditis was made based on laboratory and imaging data. The patient was treated for toxoplasmosis. No myocardial uptake of tracer was demonstrated on a follow-up Ga-67 scan, performed after completion of treatment for toxoplasmosis.

  16. Tuberculosis and histoplasmosis co-infection in AIDS patients.

    PubMed

    Agudelo, Carlos A; Restrepo, Carlos A; Molina, Diego A; Tobón, Angela M; Kauffman, Carol A; Murillo, Carolina; Restrepo, Angela

    2012-12-01

    Abstract. Coinfection with tuberculosis in some countries occurs in 8-15% of human immunodeficiency virus (HIV) -infected patients who have histoplasmosis. This coinfection interferes with prompt diagnosis, and treatment is difficult because of drug interactions. We retrospectively reviewed the cases of 14 HIV-infected patients who had concomitant tuberculosis and histoplasmosis. The most frequent clinical manifestations were weight loss (85.7%), asthenia (78.5%), and fever (64.2%). The diagnosis of histoplasmosis was made primarily by histopathology (71.4%), and the diagnosis of tuberculosis was made by means of direct microscopic examination (71.4%). Death occurred in two patients, and relapse of both infections occurred in one patient. Moxifloxacin was substituted for rifampicin in six patients, with good outcomes noted for both infections. The clinical presentation does not readily identify acquired immunodeficiency syndrome (AIDS) patients who have tuberculosis and histoplasmosis. The use of a fluoroquinolone as an alternative agent in place of rifampicin for tuberculosis allows effective therapy with itraconazole for histoplasmosis.

  17. What are the public obligations to AIDS patients?

    PubMed

    Kelley, David

    2002-01-01

    The operating assumption in most discussions of health policy is that government has some responsibility for the health of its citizens and that it may legitimately tax, subsidize, and regulate its citizens in the exercise of that responsibility. On this assumption, public obligations to HIV/AIDS patients are a function of their needs in relationship to other health needs. This paper challenges the operating assumption by arguing that it cannot be grounded in the obligations that individuals have to each other. The paper rests on its own assumption: the moral theory of individualism. On this theory, individuals are ends in themselves who have the right to choose their own actions and uses of their resources; they do not have unchosen obligations to help others. In regard to HIV/AIDS patients, consequently, individuals have no duty to help, nor any other obligation beyond that of respecting their rights; and there is no valid basis for government regulations or subsidies on their behalf. The paper argues against the two approaches commonly used to defend a more expansive view of individual obligations and the role of government. The first is the assumption of welfare rights to goods and services; the second is the assumption that distributive justice requires some redistribution of health care resources.

  18. A systematic development process for patient decision aids

    PubMed Central

    2013-01-01

    Background The original version of the International Patient Decision Aid Standards (IPDAS) recommended that patient decision aids (PtDAs) should be carefully developed, user-tested and open to scrutiny, with a well-documented and systematically applied development process. We carried out a review to check the relevance and scope of this quality dimension and, if necessary, to update it. Methods Our review drew on three sources: a) published papers describing PtDAs evaluated in randomised controlled trials and included in the most recent Cochrane Collaboration review; b) linked papers cited in the trial reports that described how the PtDAs had been developed; and c) papers and web reports outlining the development process used by organisations experienced in developing multiple PtDAs. We then developed an extended model of the development process indicating the various steps on which documentation is required, as well as a checklist to assess the frequency with which each of the elements was publicly reported. Results Key features common to all patient decision aid (PtDA) development processes include: scoping and design; development of a prototype; ‘alpha’ testing with patients and clinicians in an iterative process; ‘beta’ testing in ‘real life’ conditions (field tests); and production of a final version for use and/or further evaluation. Only about half of the published reports on the development of PtDAs that we reviewed appear to have been field tested with patients, and even fewer had been reviewed or tested by clinicians not involved in the development process. Very few described a distribution strategy, and surprisingly few (17%) described a method for reviewing and synthesizing the clinical evidence. We describe a model development process that includes all the original elements of the original IPDAS criterion, expanded to include consideration of format and distribution plans as well as prototype development. Conclusions The case for including

  19. Clinical analysis of non-AIDS patients pathologically diagnosed with pulmonary cryptococcosis

    PubMed Central

    Liu, Kaixiong; Ding, Haibo; Xu, Bing; You, Ruixiong; Xing, Zhen; Chen, Jianfeng

    2016-01-01

    Background Pulmonary cryptococcosis (PC) was not a rare infectious disease in non-AIDS patients. However, data on the immune status were lacking in southern China for comparative analysis of differences between immunocompromised and immunocompetent hosts. This study was to investigate the epidemiological, clinical, radiological, and treatment profiles for patients with PC. Methods We performed a retrospective review of 88 patients diagnosed with tissue-confirmed PC who were not HIV-infected from 2003 to 2013. Results Of 88 patients, 35(39.7%) were immunocompromised host. Fever and CNS symptom were significantly common in immunocompromised patients compared to immunocompetent patients (P=0.019 and P=0.036, respectively). The most frequent radiologic abnormalities were solitary or multiple pulmonary nodules, and masses or consolidations, and most lesions were located in the peripheral lung field. Cavitations and halo sign were significantly frequent in immunocompromised patients than in immunocompetent patients (P<0.05). The most frequently applied and reliable diagnostic procedure was CT-guided percutaneous translung biopsy. Treatment included antifungal drug alone in 20 patients, surgery alone in 20 including 3 treated by VATS, surgery plus antifungal drugs in 20 patients. Conclusions PC was not rare in immunocompetent host in southern China. Special differences remained in clinical manifestation and radiological findings of PC between immunocompromised and immunocompetent patients. Future work on the mechanisms of possible differences is required. PMID:27867557

  20. The social sharing of emotions in HIV/AIDS: a comparative study of HIV/AIDS, diabetic and cancer patients.

    PubMed

    Cantisano, Nicole; Rimé, Bernard; Muñoz-Sastre, María T

    2013-10-01

    Studies have shown that chronic illness patients encounter difficulties in the social sharing of emotions. Do HIV/AIDS patients present distinguishing traits in the inhibition of illness and non-illness-related emotions? The differences in the social sharing of emotion between 35 HIV/AIDS, 35 diabetic and 34 cancer outpatients were studied. A questionnaire assessed illness-related emotions, social sharing of emotion and emotional inhibition. The HIV/AIDS group significantly presented superior scoring in shame, guilt and non-sharing of illness-related emotions, lower frequencies of social sharing of emotion and less sharing partners. These findings could lead to future research examining the emotional expression of guilt and shame in HIV/AIDS.

  1. Raised intracranial pressure and visual complications in AIDS patients with cryptococcal meningitis.

    PubMed

    Johnston, S R; Corbett, E L; Foster, O; Ash, S; Cohen, J

    1992-03-01

    The clinical course of cryptococcal meningitis in AIDS shows some important differences from the features of the illness in non-AIDS patients. Complications such as raised intracranial pressure and visual impairment that are recognised in non-AIDS patients may be less frequent in those with AIDS. Persistent intracranial hypertension should be managed actively to prevent visual impairment. In AIDS patients, in whom ventriculo-peritoneal shunts carry additional risks, acetazolamide can be used successfully to lower the CSF pressure and prevent visual loss.

  2. Nigerian dental students' willingness to treat HIV-positive patients.

    PubMed

    Azodo, Clement Chinedu; Ehigiator, Osarobo; Oboro, Helen Oziofu; Ehizele, Adebola Oluyemisi; Umoh, Agnes; Ezeja, Ejike Bartholomew; Omili, Michael; Ehigiator, Laura

    2010-04-01

    Dental care of HIV-positive individuals plays a vital role in improving their nutritional intake, medication tolerance and effectiveness, treatment success rate, and quality of life. It is therefore important to ensure optimal dental care of this group of people, especially since more of them, with or without knowledge of their serologic status, are now utilizing dental services. The objective of this study was to assess Nigerian dental students' willingness to treat HIV-positive individuals. A descriptive cross-sectional survey of all seventy-six final-year dental students of the University of Benin, Nigeria, was conducted in December 2007 using a self-administered questionnaire that elicited information on the students' demography, self-rated knowledge on HIV/AIDS, attitude towards homosexuals, infection control practices, occupational risk perception, and willingness to provide care for HIV-positive individuals. The response rate was 76.3 percent. Over 77 percent of the respondents were in the twenty-five to thirty years age group. The male-female ratio was approximately 1.6:1. HIV-related knowledge was reported as high by only 31 percent of the respondents. Eighty-one percent showed great interest in HIV-related information, while about half (53.4 percent) exhibited significant worry about occupational contagion. Forty-eight (82.7 percent) desired more knowledge about safety precautions during treatment of HIV patients. Fifty respondents (86.2 percent) reported good infection control practices. About three-fourths (74.2 percent) rated the risk of HIV contagion from patients high, while only one-fourth (25.8 percent) reported having an unsympathetic attitude towards homosexuals. Almost all respondents (98.3 percent) agreed that oral care for HIV-positive individuals improves their quality of life, but only 58.8 percent expressed a willingness to treat HIV-positive patients and only 46.5 percent said they will render volunteer dental services in HIV centers. HIV

  3. Crofelemer for the treatment of chronic diarrhea in patients living with HIV/AIDS

    PubMed Central

    Patel, Twisha S; Crutchley, Rustin D; Tucker, Anne M; Cottreau, Jessica; Garey, Kevin W

    2013-01-01

    Diarrhea is a common comorbidity present in patients with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) who are treated with highly active antiretroviral therapy. With a multifactorial etiology, this diarrhea often becomes difficult to manage. In addition, some antiretrovirals are associated with chronic diarrhea, which potentially creates an adherence barrier to antiretrovirals and may ultimately affect treatment outcomes and future therapeutic options for HIV. A predominant type of diarrhea that develops in HIV patients has secretory characteristics, including increased secretion of chloride ions and water into the intestinal lumen. One proposed mechanism that may lead to this type of secretory diarrhea is explained by the activation of the cystic fibrosis transmembrane conductance regulator and calcium-activated chloride channels. Crofelemer is a novel antidiarrheal agent that works by inhibiting both of these channels. The efficacy and safety of crofelemer has been evaluated in clinical trials for various types of secretory diarrhea, including cholera-related and acute infectious diarrhea. More recently, crofelemer was approved by the US Food and Drug Administration for the symptomatic relief of noninfectious diarrhea in adult patients with HIV/AIDS on antiretroviral therapy. Results from the ADVENT trial showed that crofelemer reduced symptoms of secretory diarrhea in HIV/AIDS patients. Because crofelemer is not systemically absorbed, this agent is well tolerated by patients, and in clinical trials it has been associated with minimal adverse events. Crofelemer has a unique mechanism of action, which may offer a more reliable treatment option for HIV patients who experience chronic secretory diarrhea from antiretroviral therapy. PMID:23888120

  4. Clinical outcomes in breast cancer patients with HIV/AIDS: a retrospective study.

    PubMed

    Gomez, Alexandra; Montero, Alberto J; Hurley, Judith

    2015-02-01

    The purpose of the study is to describe what is the presentation of breast cancer in women with HIV, their tolerance to therapy, the most common complications of treatment and their outcomes. Retrospective chart review of patients with HIV diagnosed with breast cancer between January 1, 1989 and December 31, 2013 at the University of Miami/Jackson Memorial Hospital (UM/JMH) 47 females and 1 male were included in the analysis. The median age of diagnosis was 46 years (IQR 41-52) and 64% of the women were premenopausal. Median CD4(+) count was 330 cells/µL (IQR 131-589 cells/µL). 41% had AIDS at time of diagnosis. 94% of patients presented with locoregional disease and 6% with late stage breast cancer. 52% had ER(+) tumors. 6% had HER-2/neu tumor expression and 21 % had triple negative disease. The 5 year PFS was 50% (95% CI 34-64%), the 5 year OS was 44% (95% CI 29-58%), and the Breast cancer-specific survival was 57% (95% CI 40-70%). Death was attributed to breast cancer in 22 patients, AIDS progression in 6 patients, other medical condition in 1, and for 4, the cause was unknown. Serious adverse events were documented in 46% of patients treated with chemotherapy. Targeted therapy was well tolerated. Patients with HIV/AIDS and breast cancer pose a major challenge for oncologists. Surgery, radiation, and endocrine therapy are well tolerated. Standard dose chemotherapy can have life-threatening side effects which can be managed with growth factor support and antimicrobial prophylaxis. All cancer therapy can be given while continuing with antiviral therapy at full dose.

  5. Toxoplasmosis in HIV/AIDS patients: a current situation.

    PubMed

    Nissapatorn, Veeranoot; Lee, Christopher; Quek, Kia Fatt; Leong, Chee Loon; Mahmud, Rohela; Abdullah, Khairul Anuar

    2004-08-01

    The seroprevalence of toxoplasmosis among 505 of human immunodeficiency virus (HIV)/AIDS patients was 226 (44.8%; 95% CI 42.64-51.76): 27 (47.4%) and 199 (44.4%) showed Toxoplasma seropositivity with and without toxoplasmic encephalitis (TE), respectively (P <0.05). The majority of these patients were in the 25-34 age group (44 versus 39%), male (86 versus 76%), and Chinese (49 versus 53%), though no statistical significance was found between the two. Significant differences between these two groups were noted, however, in terms of marital status, occupation, and present address. The heterosexual exhibited the most frequent behavior at risk for HIV infection, and accounted for 51 and 59% of patients with and without TE, respectively. Only 17/260 (6.5%) and 1/137 (0.7%) of them later acquired TE after receiving primary chemoprophylaxis (cotrimoxazole) and antiretroviral therapy including HAART (P <0.05). Fifty-seven (11.3%) out of those 505 patients were diagnosed with AIDS-related TE. The most common clinical manifestation was headache (56%). The computed tomography scan findings showed most lesions to be multiple (96.4%), hypodense (66.7%), and in the parietal region (39.3%). Twenty-seven (47.4%) patients had chronic (latent) Toxoplasma infection as evidenced by seropositivity for anti-Toxoplasma (IgG) antibody. At the time of diagnosis, the range of CD4 cell count was from 0-239 with a median of 25 cells/cumm. We also found that a CD4 count of less than 100 cells/cumm was significantly associated with development of TE (P <0.05). Clinical outcomes showed that among those who survived, 21 (36.8%), 16 (28.1%), and 2 (3.5%) of patients had completed treatment, transferred out, and were lost to follow up, respectively. Unfortunately, 18 (31.6%) of the cases were officially pronounced dead. Overall, 7 (12.3%) patients were detected as recurrent TE in this study.

  6. A digital patient for computer-aided prosthesis design

    PubMed Central

    Colombo, Giorgio; Facoetti, Giancarlo; Rizzi, Caterina

    2013-01-01

    This article concerns the design of lower limb prosthesis, both below and above knee. It describes a new computer-based design framework and a digital model of the patient around which the prosthesis is designed and tested in a completely virtual environment. The virtual model of the patient is the backbone of the whole system, and it is based on a biomechanical general-purpose model customized with the patient's characteristics (e.g. anthropometric measures). The software platform adopts computer-aided and knowledge-guided approaches with the goal of replacing the current development process, mainly hand made, with a virtual one. It provides the prosthetics with a set of tools to design, configure and test the prosthesis and comprehends two main environments: the prosthesis modelling laboratory and the virtual testing laboratory. The first permits the three-dimensional model of the prosthesis to be configured and generated, while the second allows the prosthetics to virtually set up the artificial leg and simulate the patient's postures and movements, validating its functionality and configuration. General architecture and modelling/simulation tools for the platform are described as well as main aspects and results of the experimentation. PMID:24427528

  7. Hearing Function in Patients Living with HIV/AIDS

    PubMed Central

    Luque, Amneris E.; Orlando, Mark S.; Leong, U-Cheng; Allen, Paul D.; Guido, Joseph J.; Yang, Hongmei; Wu, Hulin

    2014-01-01

    Background During the earlier years of the HIV/AIDS epidemic, initial reports described sensorineural hearing loss in up to 49% of individuals with HIV/AIDS. During those years, patients commonly progressed to advanced stages of HIV disease, and frequently had neurological complications. However, the abnormalities on pure-tone audiometry and brainstem evoked responses outlined in small studies were not always consistently correlated with advanced stages of HIV/AIDS. Moreover, these studies could not exclude the confounding effect of concurrent opportunistic infections and syphilis. Additional reports also have indicated that some antiretroviral (ARV) medications may be ototoxic, thus it has been difficult to make conclusions regarding the cause of changes in hearing function in HIV-infected patients. More recently, accelerated aging has been suggested as a potential explanation for the disproportionate increase in complications of aging described in many HIV-infected patients, hence accelerated aging associated hearing loss may also be playing a role in these patients. Methods We conducted a large cross-sectional analysis of hearing function in over 300 patients with HIV-1 infection and in 137 HIV-uninfected controls. HIV-infected participants and HIV-uninfected controls underwent a two-hour battery of hearing tests including the Hearing Handicap Inventory, standard audiometric pure-tone air and bone conduction testing, tympanometric testing and speech reception and discrimination testing. Results Three-way ANOVA and logistic regression analysis of 278 eligible HIV-infected subjects stratified by disease stage in early HIV disease (n= 127) and late HIV disease (n=148) and 120 eligible HIV-uninfected controls revealed no statistical significant differences among the three study groups in either overall 4-PTA or hearing loss prevalence in either ear. Three-way ANOVA showed significant differences in word recognition scores (WRS) in the right ear among groups; a

  8. [Diagnosis, treatment and prevention of renal diseases in HIV infected patients. Recommendations of the Spanish AIDS Study Group/National AIDS Plan].

    PubMed

    2010-10-01

    The incidence of opportunistic infections and tumours in HIV-infected patients has sharply declined in the HAART era. At the same time there has been a growing increase of other diseases not directly linked to immunodeficiency. Renal diseases are an increasing cause of morbidity and mortality among HIV-infected patients. In the general population, chronic renal failure has considerable multiorgan repercussions that have particular implications in patients with HIV infection. The detection of occult or subclinical chronic kidney disease is crucial since effective measures for delaying progression exist. Furthermore, the deterioration in glomerular filtration should prompt clinicians to adjust doses of some antiretroviral agents and other drugs used for treating associated comorbidities. Suppression of viral replication, strict control of blood pressure, dyslipidemia and diabetes mellitus, and avoidance of nephrotoxic drugs in certain patients are fundamental components of programs aimed to prevent renal damage and delaying progression of chronic kidney disease in patients with HIV. Renal transplantation and dialysis have also special implications in HIV-infected patients. In this article, we summarise the updated clinical practice guidelines for the evaluation, management and prevention of renal diseases in HIV-infected patients from a panel of experts in HIV and nephrologists on behalf of the Spanish AIDS Study Group (GESIDA) and the National AIDS Plan.

  9. AIDS and patient confidentiality. More dilemmas for physicians--and lawyers.

    PubMed

    Goldberg, B A

    1987-10-01

    If patients who have AIDS or ARC, or who are seropositive for HIV antibody, refuse to engage in "safe sex" to protect their sexual partners, may physicians warn those partners? Must they warn them? Does the law apply equally to symptomatic and asymptomatic patients? The law is not only confusing but in a state of flux. Both physicians and lawyers are cautioned against answering these questions categorically on general principles derived from the famous (or infamous) Tarasoff case. If the questions can be answered at all, they must be preceded by minute examination of the laws of each jurisdiction. The difficulty lies in knowing whether and how the law should be changed. A physician may be required to warn certain contacts of certain patients, and forbidden to warn other contact equally at risk from other patients equally infectious. Issues of morality and politics are posed: Is AIDS to be treated as a sickness or a sin? Of the measures physicians recommend to protect public health, which will be politically acceptable to various pressure groups? And if the laws are enacted, will they survive widespread resistance and evasion?

  10. Core principles in treating suicidal patients.

    PubMed

    Fowler, James Christopher

    2013-09-01

    The treatment of suicidal individuals requires special attention to therapist interventions that promote a viable treatment alliance in the context of shared responsibilities for patient safety. Three core principles in the treatment process (alliance building, enhancing curiosity about the function of suicidal thoughts and urges, as well as enhancing experience and expression of intense emotions) are articulated and brief case vignettes are used to illuminate the principles. Results from open trails and randomized control trials involving suicidal patients are examined to support the evidence-based practice of these principles. The overarching principle undergirding the utility of the principles is a collaborative joining with the patient to decrease isolation and alienation when facing intense and overwhelming emotions.

  11. [Social support and psychological stability in HIV/AIDS patients].

    PubMed

    Laszig, P; Clement, U; Gramatikov, L

    1998-06-01

    An explorative meta-analytic study analysed all published empirical studies on social support of HIV/AIDS patients (n = 57 studies with 347 data sets). Empirical and conceptual questions are addressed. The focus of the empirical questions is to identify meta-analytically confirmed correlates of social support. The conceptual question aims at differentiating the large-scale construct "social support". Results indicate that social support 1. is independent of objective physical parameters, 2. is positively correlated with approach coping and negatively with avoidance coping, 3. shows a substantial negative correlation with indicators of psychological distress, 4. is positively correlated with condom use. The conceptual analysis shows that 5. there is no consensus on how to operationalise the construct of "social support".

  12. Human Resources for Treating HIV/AIDS: Are the Preventive Effects of Antiretroviral Treatment a Game Changer?

    PubMed

    Bärnighausen, Till; Bloom, David E; Humair, Salal

    2016-01-01

    Shortages of human resources for treating HIV/AIDS (HRHA) are a fundamental barrier to reaching universal antiretroviral treatment (ART) coverage in developing countries. Previous studies suggest that recruiting HRHA to attain universal ART coverage poses an insurmountable challenge as ART significantly increases survival among HIV-infected individuals. While new evidence about ART's prevention benefits suggests fewer infections may mitigate the challenge, new policies such as treatment-as-prevention (TasP) will exacerbate it. We develop a mathematical model to analytically study the net effects of these countervailing factors. Using South Africa as a case study, we find that contrary to previous results, universal ART coverage is achievable even with current HRHA numbers. However, larger health gains are possible through a surge-capacity policy that aggressively recruits HRHA to reach universal ART coverage quickly. Without such a policy, TasP roll-out can increase health losses by crowding out sicker patients from treatment, unless a surge capacity exclusively for TasP is also created.

  13. Human Resources for Treating HIV/AIDS: Are the Preventive Effects of Antiretroviral Treatment a Game Changer?

    PubMed Central

    2016-01-01

    Shortages of human resources for treating HIV/AIDS (HRHA) are a fundamental barrier to reaching universal antiretroviral treatment (ART) coverage in developing countries. Previous studies suggest that recruiting HRHA to attain universal ART coverage poses an insurmountable challenge as ART significantly increases survival among HIV-infected individuals. While new evidence about ART’s prevention benefits suggests fewer infections may mitigate the challenge, new policies such as treatment-as-prevention (TasP) will exacerbate it. We develop a mathematical model to analytically study the net effects of these countervailing factors. Using South Africa as a case study, we find that contrary to previous results, universal ART coverage is achievable even with current HRHA numbers. However, larger health gains are possible through a surge-capacity policy that aggressively recruits HRHA to reach universal ART coverage quickly. Without such a policy, TasP roll-out can increase health losses by crowding out sicker patients from treatment, unless a surge capacity exclusively for TasP is also created. PMID:27716813

  14. [Hospital-based psychological first aid provided to patients injured in the Lushan earthquake].

    PubMed

    Yin, Min; Li, Xiao-Lin; Li, Jing; Huang, Xue-Hua; Tao, Qing-Lan; Luo, Xi

    2015-04-01

    In the aftermath of the 7.0 earthquake that struck Lushan in China's Sichuan Province on April 20, 2013, a psychological crisis intervention working group was established in a hospital that was treating earthquake victims. Patients at this hospital received psychological first aid that was delivered in accordance with scientific, systematic, and standardized principles. This first aid employed a "rooting mode" methodology and was designed as a supportive psychological intervention. Mental assessment results showed that the general mental health, acute stress reactions, and anxiety and depression status of all of the 131 injured who received the psychological intervention had significantly improved (p < .05) during the two-week intervention period. This paper introduces the basic principles used to develop and provide this first aid, the approach used to organize the working groups, the main contents of the intervention, specific methods used, and intervention outcomes. This information is provided as a reference for providing localized psychological assistance in the aftermath of a disaster incident.

  15. Treating navicular syndrome in equine patients.

    PubMed

    Waguespack, R Wayne; Hanson, R Reid

    2011-01-01

    Navicular syndrome is a chronic, progressive condition affecting the navicular bone and bursa, deep digital flexor tendon (DDFT), and associated soft tissue structures composing the navicular apparatus. The treatment options for navicular syndrome are as varied as the proposed causes of the condition. The severity of clinical signs, intended use and workload of the horse, and owner compliance with therapy are important considerations in developing a treatment plan. Nonsurgical treatment of navicular syndrome consists of rest, hoof balance and corrective trimming/shoeing, and medical therapy, including administration of systemic antiinflammatories, hemorheologic medications, and intraarticular medications. While surgical therapy can include desmotomy of the collateral (suspensory) ligaments of the navicular bone, palmar digital neurectomy is more commonly performed when medical therapy is ineffective. Recently, adjunct therapies, such as acupuncture and extracorporeal shock wave therapy, have also been used to treat horses with navicular syndrome. Because of the wide range of pathologic changes and the lack of a definitive cure associated with navicular syndrome, treatment is directed toward the individual horse, focusing on the management of clinical signs to alleviate stress and retard degenerative changes of the navicular bursal and navicular regions.

  16. American brain tumor patients treated with BNCT in Japan

    SciTech Connect

    Laramore, G.E.; Griffin, B.R.; Spence, A.

    1995-11-01

    The purpose of this work is to establish and maintain a database for patients from the United States who have received BNCT in Japan for malignant gliomas of the brain. This database will serve as a resource for the DOE to aid in decisions relating to BNCT research in the United States, as well as assisting the design and implementation of clinical trials of BNCT for brain cancer patients in this country. The database will also serve as an information resource for patients with brain tumors and their families who are considering this form of therapy.

  17. [Penicillium marneffei isolated from a Thai AIDS patient with fungemia].

    PubMed

    Uehara, Masae; Sano, Ayako; Yarita, Kyoko; Kamei, Katsuhiko; Haketa, Makio; Ide, Kyoko; Nagai, Keiko; Takayama, Yoshihiro; Nishimura, Kazuko

    2008-01-01

    Penicillium marneffei was isolated from three blood cultures of a Thai woman with AIDS and then identified as such. The patient, 41 a year-old female from northeast Thailand came to Japan 10 years ago and married a Japanese man. She was reportedly the third patient infected with this fungal species in Japan, and considered to be the first case from whom the causative fungus was successfully cultured, which led to the diagnosis of penicilliosis marneffei. The colony of the isolate, which was cultured on Sabouraud dextrose agar at 25-27 degrees C, was initially white and pannose, gradually turned in color from yellow to yellow-green, and diffused a deep red pigment into the medium. Conidial heads were divergent, and chains of conidia were formed from phialides. Colonies of the isolate, which was cultured on brain-heart infusion agar at 35 degrees C, had a grayish white, membranous yeast-like form with fine plicae and microscopically consisted of short hyphae. Furthermore, 560 bases of the internal transcribed spacer (ITS) region of the ribosomal RNA gene including the 5.8S region (ITS1-5.8S-ITS2) (DDBJ accession number AB298970) were sequenced and allowed an unequivocal species identification.

  18. Serum zinc levels in corticosteroid-treated asthmatic patients

    PubMed Central

    Ellul-Micallef, R.; Galdes, A.; Fenech, F. F.

    1976-01-01

    Serum zinc levels have been measured in twenty-four asthmatic patients, of whom sixteen were on long term corticosteroid therapy. They were carefully screened to exclude any concomitant disease. The non-steroid-treated asthmatics had normal serum zinc levels which ranged from 89 to 138 μg/ml. The corticosteroid-treated patients had a mean serum zinc level of 64 ± 9 μg/100 ml; this was significantly lower than normal (P = < 0·001). PMID:1264936

  19. Genetic dissimilarity of two fluconazole-resistant Candida albicans strains causing meningitis and oral candidiasis in the same AIDS patient.

    PubMed Central

    Berenguer, J; Diaz-Guerra, T M; Ruiz-Diez, B; Bernaldo de Quiros, J C; Rodriguez-Tudela, J L; Martinez-Suarez, J V

    1996-01-01

    We describe a patient with AIDS who simultaneously developed Candida meningitis with three positive cerebrospinal fluid cultures and oral candidiasis. This patient also had a history or recurrent episodes of oral candidiasis treated with fluconazole. The patient did not respond to this therapy but was cured with amphotericin B and flucytosine. In vitro susceptibility tests revealed that each infection was caused by fluconazole-resistant Candida albicans isolates. Strain delineation by karyotyping, NotI restriction pattern analysis, hybridization with the specific probe 27A, and PCR fingerprinting with the phage M13 core sequence clearly demonstrated that meningitis and oral thrush were caused by two genetically different isolates. PMID:8735114

  20. Ventriculitis: a rare case of primary cerebral toxoplasmosis in AIDS patient and literature review.

    PubMed

    Cota, Gláucia Fernandes; Assad, Elisa Caroline Pereira; Christo, Paulo Pereira; Giannetti, Alexandre Varella; Santos Filho, José Augusto Malheiros Dos; Xavier, Marcelo Antonio Pascoal

    2008-02-01

    Cerebral toxoplasmosis remains the most important neurological opportunistic infection and the most common cause of intracerebral mass lesion in patients with acquired immunodeficiency syndrome (AIDS). We report a case of an adult AIDS patient with an atypical pattern of toxoplasma encephalitis, presenting with ventriculitis and obstructive hydrocephalus without any focal parenchymal lesion.

  1. An audit of first-aid treatment of pediatric burns patients and their clinical outcome.

    PubMed

    Cuttle, Leila; Kravchuk, Olena; Wallis, Belinda; Kimble, Roy M

    2009-01-01

    This study describes the first aid used and clinical outcomes of all patients who presented to the Royal Children's Hospital, Brisbane, Australia in 2005 with an acute burn injury. A retrospective audit was performed with the charts of 459 patients and information concerning burn injury, first-aid treatment, and clinical outcomes was collected. First aid was used on 86.1% of patients, with 8.7% receiving no first aid and unknown treatment in 5.2% of cases. A majority of patients had cold water as first aid (80.2%), however, only 12.1% applied the cold water for the recommended 20 minutes or longer. Recommended first aid (cold water for >or=20 minutes) was associated with significantly reduced reepithelialization time for children with contact injuries (P=.011). Superficial depth burns were significantly more likely to be associated with the use of recommended first aid (P=.03). Suboptimal treatment was more common for children younger than 3.5 years (P<.001) and for children with friction burns. This report is one of the few publications to relate first-aid treatment to clinical outcomes. Some positive clinical outcomes were associated with recommended first-aid use; however, wound outcomes were more strongly associated with burn depth and mechanism of injury. There is also a need for more public awareness of recommended first-aid treatment.

  2. Failure of highly active antiretroviral therapy in reconstituting immune response to Clostridium tetani vaccine in aged AIDS patients.

    PubMed

    Andrade, Regis M; Andrade, Arnaldo F B; Lazaro, Marta A; Vieira, Morgana M M; Barros, Priscila O; Borner, Alice R S; Silva-Filho, Renato G; Santos, Juliana O; Brindeiro, Rodrigo M; Tanuri, Amilcar; Bento, Cleonice A M

    2010-05-01

    The purpose of this study was to evaluate the impact of age on tetanus-specific immune response in successfully highly active antiretroviral therapy-treated AIDS patients, using healthy age-matched individuals as controls. Whole Peripheral blood mononuclear cells or CD8(+) cell-depleted peripheral blood mononuclear cells from previously tetanus toxoid (TT)-immunized individuals were activated with TT plus IL-2, and cell proliferation, cytokine production, and in vitro HIV-1 replication were measured. The in vivo magnitude of the humoral immune response was also assessed by antibody measurements. Our results showed that, compared with other groups, both in vitro TT-specific lymphoproliferation and serum antibody concentration were lower in older AIDS patients. Although the IL-1beta and tumour necrosis factor alpha (TNF-alpha) production were higher in cultures from aged HIV-1-infected patients, a dramatic damage on the interferon gamma (IFN-gamma) release was observed, when compared with younger patients. CD8(+) T lymphocytes depletion reduced IL-1beta and TNF-alpha release in the older groups, however, it did not significantly alter their IFN-gamma production. Furthermore, the neutralization of endogenous IL-10 did not change the IFN-gamma deficiency in older AIDS patients. Finally, the lower cellular immune response in this patient group was not related to in vitro HIV-1 replication. The results suggest that successfully highly active antiretroviral therapy-treated aged AIDS patients do not reconstitute the immune response to TT, making them probably more susceptible to tetanus even after vaccination.

  3. Evaluation of patient satisfaction with different hearing aids: A study of 107 patients.

    PubMed

    Ulusoy, Seçkin; Muluk, Nuray Bayar; San, Turhan; Cingi, Cemal

    2017-01-01

    We retrospectively investigated patient satisfaction with different types of hearing aids in 107 patients-60 males and 47 females, aged 8 to 84 years (mean: 53.8)-with unilateral or bilateral hearing loss, each of whom used two different hearing devices for at least 3 years per device. The International Outcome Inventory for Hearing Aids, Turkish edition (IOI-HA-TR) was used to evaluate satisfaction levels; we also calculated our own total individual subjective satisfaction (TISS) scores. We divided 16 different hearing devices into two types: device 1 and device 2; on average, device 2 had more channels, a lower minimum frequency, and a higher maximum frequency. We found that the IOI-HA-TR scores and TISS scores were higher and usage time was greater during device 2 use, and that there was a positive correlation between IOI-HA-TR and TISS scores. A total of 69 patients (64.5%) used device 2 for more than 8 hours per day, while 38 patients (35.5%) used it for 4 to 8 hours per day during the final 2 weeks of the trial. In contrast, 40 patients (37.4%) used device 1 for more than 8 hours, 50 (46.7%) used it for 4 to 8 hours, and the remaining 17 (15.9%) used it for less than 4 hours; the difference in the duration of use of the two devices was statistically significant (p < 0.001). Younger patients and patients with more education were more satisfied with their devices than were older patients and those who were not as well educated. We conclude that devices with good technologic features such as more channels, a lower minimum frequency, and a higher maximum frequency result in better hearing. Also, based on the age difference that we observed, we recommend that psychological support be provided to older patients with aided hearing to enhance their mental health and quality of life.

  4. [Acute abdomen due to cytomegalovirus in AIDS patients. Apropos 2 cases].

    PubMed

    Ferré, C; Mascaró, J; Benasco, C; Ramos, E; Pérez, J L; Podzamczer, D

    1994-07-09

    Two cases of acute abdomen--because of acute appendicitis and paralytic ileus--due to cytomegalovirus infection in AIDS patients are reported. In both patients evolution was subacute and cytomegalic inclusions were seen in the histologic examination of the surgical samples. The two patients died after surgery. The possibility of cytomegalovirus infection must be kept in mind in AIDS patients who undergo urgent abdominal laparatomy and early treatment should be instituted.

  5. Toxoplasma encephalitis in AIDS patients in São Paulo during 1988 and 1991. A comparative retrospective analysis.

    PubMed

    Passos, L N; Araújo Filho, O F; Andrade Junior, H F

    2000-01-01

    We conducted a retrospective analysis of Toxoplasma encephalitis patients from Instituto de Infectologia Emílio Ribas, the main AIDS hospital of São Paulo, Brazil, during two different stages of the HIV epidemics, in 1988 (38 patients) and 1991 (33 patients). There were AIDS-related demographic differences, but the clinical presentation and diagnostic efficiency were similar, usually based on tomography and clinical response to therapy, with a clear distinction from other CNS infections, based on clinical and laboratory findings. Specific serologic studies were performed less often in 1991, with a high frequency of therapy change. The direct acute death rate from Toxoplasma encephalitis was high during both periods, i.e. 8/38 in 1988 and 10/33 in 1991. The direct acute death rate for the patients from the two periods as a whole was 25.4% (18/71), related to the time of HIV infection, absence of fever and presence of meningeal irritation at presentation, blood leukocytes higher than 10,000/mm3 and blood lymphocytes lower than 350/mm3. Toxoplasma encephalitis is a preventable disease when adequate prophylactic therapy is used and is relatively easy to treat in diagnosed HIV patients. Unfortunately, this severe and deadly disorder is the HIV diagnostic disease in several patients, and our data support the need for careful management of these patients, especially in those countries with a high toxoplasmosis prevalence where AIDS is concurrent with economic and public health problems.

  6. HIV positive patients first presenting with an AIDS defining illness: characteristics and survival.

    PubMed Central

    Poznansky, M. C.; Coker, R.; Skinner, C.; Hill, A.; Bailey, S.; Whitaker, L.; Renton, A.; Weber, J.

    1995-01-01

    OBJECTIVES--To study the presentation and survival of patients who present with their first diagnosis of being HIV positive at the same time as their AIDS defining illness. DESIGN--Retrospective study of patients presenting with AIDS between 1991 and 1993. SETTING--Department of genitourinary medicine, St Mary's Hospital, London. MAIN OUTCOME MEASURES--AIDS defining illness at presentation and survival after diagnosis of AIDS. RESULTS--Between January 1991 and December 1993, 97 out of 436 patients (22%) presented with their first AIDS defining illness coincident with their first positive result of an HIV test (group B). The remaining 339 patients (78%) had tested positive for HIV-1 infection within the previous eight years and had consequently been followed up in clinics before developing their first AIDS defining illness (group A). The two groups of patients did not differ in age and sex distribution, risk factors for HIV-1 infection, nationality, country of origin, or haematological variables determined at the time of the AIDS defining illness. However, the defining illnesses differed between the two groups. Illnesses associated with severe immunodeficiency (the wasting syndrome, cryptosporidiosis, and cytomegalovirus infection) were seen almost exclusively in group A whereas extrapulmonary tuberculosis and Pneumocystis carinii pneumonia were more common in group B. The survival of patients in group B after the onset of AIDS was significantly longer than that of patients in group A as determined by Kaplan-Meier log rank analysis (P = 0.0026). CONCLUSIONS--Subjects who are HIV positive and present late are a challenge to the control of the spread of HIV infection because they progress from asymptomatic HIV infection to AIDS without receiving health care. The finding that presentation with an AIDS defining illness coincident with a positive result in an HIV test did not have a detrimental effect on survival gives insights into the effects of medical intervention on

  7. AIDS in Africa

    DTIC Science & Technology

    2006-03-09

    have recommended that Africans infected with HIV be treated with an antibiotic/ sulfa drug combination known as cotrimoxazole in order to prevent...response is the subject of much debate. An estimated 500,000 Africa AIDS patients were being treated with antiretroviral drugs in mid-2005, up from 150,000...whether drugs can be made widely accessible without costly health infrastructure improvements. U.S. concern over AIDS in Africa grew in the 1980s, as the

  8. [Assessment criteria in the choice of aids for the lifting of patients].

    PubMed

    Panciera, D; Menoni, O; Ricci, M G; Occhipinti, E

    1999-01-01

    A fundamental part of the prevention strategies aimed at reducing risk due to manual handling of patients is the use of appropriate aids. This paper defines the basic types of aids for hospital wards: patient lifting devices, aids for hygiene and minor aids; and also proposes a procedure for choice of the type of aid: the procedure uses a specific protocol and also analyzes work organization and the environmental features of the ward. The proposed criteria for choice concern in the first place the fundamental requirements of the equipment: safety for operator and patient, simplicity of use and comfort for the patient. Secondly the basic determinants for choice of the type of aid are the type of disabled patient usually present in the ward and the analysis of the movements made in handling patients. On this basis, for each type of aid, the specific features are defined which direct the choice of supply for the various wards that will be adequate and effective both in reducing risk due to manual handling of patients and in improving the comfort of the patients.

  9. Intrahepatic Flow Redistribution in Patients Treated with Radioembolization

    SciTech Connect

    Spreafico, Carlo Morosi, Carlo; Maccauro, Marco; Romito, Raffaele; Lanocita, Rodolfo Civelli, Enrico M.; Sposito, Carlo Bhoori, Sherrie; Chiesa, Carlo; Frigerio, Laura F.; Lorenzoni, Alice; Cascella, Tommaso Marchianò, Alfonso; Mazzaferro, Vincenzo

    2015-04-15

    IntroductionIn planning Yttrium-90 ({sup 90}Y)-radioembolizations, strategy problems arise in tumours with multiple arterial supplies. We aim to demonstrate that tumours can be treated via one main feeding artery achieving flow redistribution by embolizing accessory vessels.MethodsOne hundred {sup 90}Y-radioembolizations were performed on 90 patients using glass microspheres. In 19 lesions/17 patients, accessory branches were found feeding a minor tumour portion and embolized. In all 17 patients, the assessment of the complete perfusion was obtained by angiography and single photon emission computerized tomography–computerized tomography (SPECT–CT). Dosimetry, toxicity, and tumor response rate of the patients treated after flow redistribution were compared with the 83 standard-treated patients. Seventeen lesions in 15 patients with flow redistribution were chosen as target lesions and evaluated according to mRECIST criteria.ResultsIn all patients, the complete tumor perfusion was assessed immediately before radioembolization by angiography in all patients and after the {sup 90}Y-infusion by SPECT–CT in 15 of 17 patients. In the 15 assessable patients, the response rate in their 17 lesions was 3 CR, 8 PR, and 6 SD. Dosimetric and toxicity data, as well tumour response rate, were comparable with the 83 patients with regular vasculature.ConclusionsAll embolization procedures were performed successfully with no complications, and the flow redistribution was obtained in all cases. Results in term of toxicity, median dose administered, and radiological response were comparable with standard radioembolizations. Our findings confirmed the intratumoral flow redistribution after embolizing the accessory arteries, which makes it possible to treat the tumour through its single main feeding artery.

  10. "Patient Zero": the absence of a patient's view of the early North American AIDS epidemic.

    PubMed

    McKay, Richard A

    2014-01-01

    This article contextualizes the production and reception of And the Band Played On, Randy Shilts's popular history of the initial recognition of the American AIDS epidemic. Published over twenty-five years ago, the book and its most notorious character, "Patient Zero," are in particular need of a critical historical treatment. The article presents a more balanced consideration-a "patient's view"-of Gaétan Dugas's experience of the early years of AIDS. I oppose the assertion that Dugas, the so-called Patient Zero, ignored incontrovertible information about the condition and was intent on spreading his infection. Instead I argue that scientific ideas in 1982 and 1983 about AIDS and the transmissibility of a causative agent were later portrayed to be more self-evident than they were at the time. The article also traces how Shilts's highly selective-and highly readable-characterization of Dugas rapidly became embedded in discussions about the need to criminalize the reckless transmission of HIV.

  11. Effectiveness and Comparison of Various Audio Distraction Aids in Management of Anxious Dental Paediatric Patients

    PubMed Central

    Johri, Nikita; Khan, Suleman Abbas; Singh, Rahul Kumar; Chadha, Dheera; Navit, Pragati; Sharma, Anshul; Bahuguna, Rachana

    2015-01-01

    Background Dental anxiety is a widespread phenomenon and a concern for paediatric dentistry. The inability of children to deal with threatening dental stimuli often manifests as behaviour management problems. Nowadays, the use of non-aversive behaviour management techniques is more advocated, which are more acceptable to parents, patients and practitioners. Therefore, this present study was conducted to find out which audio aid was the most effective in the managing anxious children. Aims and Objectives The aim of the present study was to compare the efficacy of audio-distraction aids in reducing the anxiety of paediatric patients while undergoing various stressful and invasive dental procedures. The objectives were to ascertain whether audio distraction is an effective means of anxiety management and which type of audio aid is the most effective. Materials and Methods A total number of 150 children, aged between 6 to 12 years, randomly selected amongst the patients who came for their first dental check-up, were placed in five groups of 30 each. These groups were the control group, the instrumental music group, the musical nursery rhymes group, the movie songs group and the audio stories group. The control group was treated under normal set-up & audio group listened to various audio presentations during treatment. Each child had four visits. In each visit, after the procedures was completed, the anxiety levels of the children were measured by the Venham’s Picture Test (VPT), Venham’s Clinical Rating Scale (VCRS) and pulse rate measurement with the help of pulse oximeter. Results A significant difference was seen between all the groups for the mean pulse rate, with an increase in subsequent visit. However, no significant difference was seen in the VPT & VCRS scores between all the groups. Audio aids in general reduced anxiety in comparison to the control group, and the most significant reduction in anxiety level was observed in the audio stories group

  12. Dental school deans' and dentists' perceptions of infection control and HIV/AIDS patient care: a challenge for dental education in Mexico.

    PubMed

    Vázquez-Mayoral, E E; Sánchez-Pérez, L; Olguín-Barreto, Y; Acosta-Gío, A E

    2009-07-01

    HIV/AIDS patients face unique oral diagnostic and treatment challenges. The aim of this investigation among dental school deans (DSD) and graduate school applicants (GSA) who had qualified from 30 different dental schools was to assess their perceptions on dental education relevant to infection control (IC) and HIV/AIDS patient care. The questionnaire included Likert-type scale evaluations of agreement with statements. Of 158 questionnaires, 23 DSD (68% response rate), and 123 GSA (100% response rate) returned valid questionnaires. Fifteen (65%) DSD and 89 (72%) GSA ranked as "very strong" their perception that infection control prevents the transmission of blood borne viruses. However, the perception prevailed, among DSD and GSA, that HIV infection was a "very strong" to "strong" occupational hazard. Special reprocessing of instruments used on HIV patients was frequently reported. Many considered "very strong" to "strong" that HIV/AIDS patients must be treated in specialized clinics, and nearly half (48%) of the DSD and one third (35%) of the GSA stated that their school does refer HIV/AIDS patients to dental treatment in specialized clinics. These results indicate that many dental schools in Mexico must provide better education on IC and HIV/AIDS patient care to enhance attitudes toward HIV/AIDS patients.

  13. Hair cortisol measurement in mitotane-treated adrenocortical cancer patients.

    PubMed

    Manenschijn, L; Quinkler, M; van Rossum, E F C

    2014-04-01

    The only approved drug for the treatment of adrenocortical cancer (ACC) is mitotane. Mitotane is adrenolytic and therefore, hydrocortisone replacement therapy is necessary. Since mitotane increases cortisol binding globulin (CBG) and induces CYP3A4 activity, high doses of hydrocortisone are thought to be required. Evaluation of hydrocortisone therapy in mitotane-treated patients has been difficult since there is no good marker to evaluate hydrocortisone therapy. Measurement of cortisol in scalp hair is a novel method that offers the opportunity to measure long-term cortisol levels. Our aim was to evaluate whether hair cortisol measurements could be useful in evaluating recent hydrocortisone treatment in mitotane-treated ACC patients. Hair cortisol levels were measured in 15 mitotane-treated ACC patients on hydrocortisone substitution and 96 healthy individuals. Cortisol levels were measured in 3 cm hair segments, corresponding to a period of 3 months. Hair cortisol levels were higher in ACC patients compared to healthy individuals (p<0.0001). Seven ACC patients (47%) had hair cortisol levels above the reference range. None of the patients had hair cortisol levels below normal. In contrast to hydrocortisone doses (β=0.03, p=0.93), hair cortisol levels were associated with BMI (β=0.53, p=0.042). There was no correlation between hair cortisol levels and hydrocortisone doses (β=0.41, p=0.13). Almost half of the ACC patients had high hair cortisol levels, suggesting long-term over-substitution of hydrocortisone in some of the patients, whereas none of the patients was under-substituted. Hair cortisol measurements might be useful in long-term monitoring hydrocortisone treatment in mitotane-treated ACC patients.

  14. Have dentists assimilated information about AIDS?

    PubMed

    Atchison, K A; Dolan, T A; Meetz, H K

    1987-11-01

    A random sample of 396 general dentists, oral surgeons, and periodontists in Los Angeles was interviewed in fall 1986. The purpose was to determine their experience in treating patients infected with HIV, factors associated with their knowledge about signs and symptoms of AIDS, and their sources of information regarding AIDS. The results showed that one-third of the dentists reported treating a known or suspected AIDS patient and that 56 percent indicated that they would not or could not treat patients with AIDS. Dentists displayed little knowledge of the oral and systemic signs and symptoms of AIDS. They reported professional journals, continuing education, and the popular press as the sources of information regarding AIDS that they found most useful. Yet those who reported attending continuing education were found to have only slightly greater knowledge of diagnostic signs. After two or more reported lectures on AIDS, 31 percent still named no oral signs and symptoms of AIDS.

  15. The Characteristics of Treated Pulmonary Arterial Hypertension Patients in Ontario

    PubMed Central

    Vaid, Haris M.; Camacho, Ximena; Granton, John T.; Mamdani, Muhammad M.; Yao, Zhan; Singh, Samantha; Juurlink, David N.; Gomes, Tara

    2016-01-01

    Background. There are no Canadian prevalence studies on pulmonary arterial hypertension (PAH) to date. We described the characteristics of treated PAH patients and the healthcare utilization and costs associated with PAH in a population of public drug plan beneficiaries in Ontario, Canada. Methods. A retrospective cross-sectional analysis was conducted between April 2010 and March 2011 to identify treated PAH patients using population-based health administrative databases. We investigated demographic and clinical characteristics of treated PAH patients and conducted a cohort study to determine treatment patterns, healthcare utilization, and associated costs, over a one-year follow-up period (March 2012). Results. We identified 326 treated PAH cases in Ontario's publicly funded drug plan. Overall mean age was 59.4 years (±20.3 years) and over 77% of cases were women (n = 251). Combination therapy was used to treat 22.9% (n = 69) of cases, costing an average of $4,569 (SD $1,544) per month. Median monthly healthcare costs were $264 (IQR $96–$747) for those who survived and $2,021 (IQR $993–$6,399) for those who died over a one-year period, respectively (p < 0.01). Conclusions. PAH care in Ontario is complex and has high healthcare costs. This data may help guide towards improved patient management. PMID:27445555

  16. Cohort profile: Seek and treat for the optimal prevention of HIV/AIDS in British Columbia (STOP HIV/AIDS BC).

    PubMed

    Heath, Kate; Samji, Hasina; Nosyk, Bohdan; Colley, Guillaume; Gilbert, Mark; Hogg, Robert S; Montaner, Julio Sg

    2014-08-01

    The Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) cohort is a census of all identified HIV-positive individuals in the province of British Columbia. It was formed through the linkage of nine provincial treatment, surveillance and administrative databases. This open cohort allows for bidirectional analyses from 1996 onward and is refreshed annually. Extensive data collection for cohort members includes demographic information, detailed clinical and laboratory data, complete prescription drug use including antiretroviral agents, and information on health service utilization encompassing inpatient and outpatient care, addictions treatment and palliative care. This cohort provides an unprecedented opportunity to evaluate, over an extended time period, patterns and determinants of key outcomes including engagement in the cascade of HIV care from diagnosis to treatment to viral suppression as well as monitoring trends in medical costs, health outcomes and other key healthcare delivery indicators at a population level with wide-ranging, high-quality data. The overall purpose of these activities is to enable the development and implementation of strategically targeted interventions to improve access to testing, care and treatment for all HIV-positive individuals living in British Columbia.

  17. Rupioid histoplasmosis: first case reported in an AIDS patient in Argentina.

    PubMed

    Corti, Marcelo; Villafañe, María F; Palmieri, Omar; Negroni, Ricardo

    2010-01-01

    Disseminated histoplasmosis is a relatively common AIDS-defining illness, occurring in almost 4% of patients living in endemic areas and it may be the first clinical expression of the HIV infection. A broad spectrum of clinical skin lesions associated with Histoplasma capsulatum infection have been described in AIDS patients, such as erythematous macules, papules, nodules, and pustules. Herpetic, acneiform, erythema multiforme-like, molluscum contagiosum-like, vasculitic, and exfoliative forms have also been reported. To our knowledge, this is the first case of disseminated histoplasmosis in an AIDS patient presented as a rupioid eruption.

  18. Patterns of gallium-67 scintigraphy in patients with acquired immunodeficiency syndrome and the AIDS related complex

    SciTech Connect

    Bitran, J.; Bekerman, C.; Weinstein, R.; Bennett, C.; Ryo, U.; Pinsky, S.

    1987-07-01

    Thirty-two patients with AIDS related complex (ARC) or acquired immunodeficiency syndrome (AIDS) underwent /sup 67/Ga scans as part of their evaluation. Three patterns of /sup 67/Ga biodistribution were found: lymph node uptake alone; diffuse pulmonary uptake; normal scan. Gallium-67 scans were useful in identifying clinically occult Pneumocystis carinii pneumonia in seven of 15 patients with ARC who were asymptomatic and had normal chest radiographs. Gallium scans are a useful ancillary procedure in the evaluation of patients with ARC or AIDS.

  19. Ten years of the International Patient Decision Aid Standards Collaboration: evolution of the core dimensions for assessing the quality of patient decision aids.

    PubMed

    Volk, Robert J; Llewellyn-Thomas, Hilary; Stacey, Dawn; Elwyn, Glyn

    2013-01-01

    In 2003, the International Patient Decision Aid Standards (IPDAS) Collaboration was established to enhance the quality and effectiveness of patient decision aids by establishing an evidence-informed framework for improving their content, development, implementation, and evaluation. Over this 10 year period, the Collaboration has established: a) the background document on 12 core dimensions to inform the original modified Delphi process to establish the IPDAS checklist (74 items); b) the valid and reliable IPDAS instrument (47 items); and c) the IPDAS qualifying (6 items), certifying (6 items + 4 items for screening), and quality criteria (28 items). The objective of this paper is to describe the evolution of the IPDAS Collaboration and discuss the standardized process used to update the background documents on the theoretical rationales, evidence and emerging issues underlying the 12 core dimensions for assessing the quality of patient decision aids.

  20. Limited usefulness of lymphocytopenia in screening for AIDS in hospital patients.

    PubMed Central

    Boyko, W J; Schechter, M T; Constance, P; Nitz, R

    1985-01-01

    Lymphocytopenia is often present in patients with acquired immune deficiency syndrome (AIDS) and has been suggested as a useful screening test for AIDS. Of 625 patients consecutively admitted to an acute care university teaching hospital 91 (15%) were found to have a lymphocyte count of less than 1 X 10(9)/L, and 25 (4%) had a count of less than 0.5 X 10(9)/L. The corresponding figures for 32 patients at the hospital in whom AIDS had been diagnosed were 13 (41%) and 4 (13%). Absolute lymphocyte counts in hospitalized patients should not be used as the sole means of identifying patients at high risk for AIDS. PMID:4016638

  1. Unilateral Ischemic Maculopathy Associated with Cytomegalovirus Retinitis in Patients with AIDS: Optical Coherence Tomography Findings

    PubMed Central

    Arevalo, J. Fernando; Garcia, Reinaldo A.; Arevalo, Fernando A.; Fernandez, Carlos F.

    2015-01-01

    To describe the clinical and optical coherence tomography (OCT) characteristics of ischemic maculopathy in two patients with acquired immunodeficiency syndrome (AIDS). Two patients with AIDS and cytomegalovirus (CMV) retinitis developed ischemic maculopathy. Both patients presented with central visual loss and active granular CMV retinitis. The presence of opacification of the superficial retina in the macular area and intraretinal edema suggested the diagnosis. Fluorescein angiography changes were similar in the two cases with enlargement of the foveal avascular zone and late staining of juxtafoveal vessels. OCT changes were suggestive of retinal ischemia: Increased reflectivity from the inner retinal layer and decreased backscattering from the retinal photoreceptors due to fluid and retinal edema. Ischemic maculopathy may cause a severe and permanent decrease in vision in AIDS patients. Fluorescein angiography and OCT should be considered in any patient with AIDS and unexplained visual loss. The mechanism of ischemic maculopathy may be multifactorial. PMID:27051496

  2. Collective AIDS Activism and Individuals' Perceived Self-Advocacy in Physician-Patient Communication.

    ERIC Educational Resources Information Center

    Brashers, Dale E.; Haas, Stephen M.; Klingle, Renee S.; Neidig, Judith L.

    2000-01-01

    Describes parallel persuasive processes between social or political activism and personal self-advocacy in a study of AIDS activism and communication patterns between people with HIV or AIDS and health care personnel. Encourages greater patient education about the illness and treatment options. Promotes a more assertive stance toward health care,…

  3. Cultural Competence in a Group Intervention Designed for Latino Patients Living with HIV/AIDS

    ERIC Educational Resources Information Center

    Acevedo, Vanessa

    2008-01-01

    Although the trajectory of the HIV/AIDS epidemic has changed dramatically over the past 25 years, addressing the psychosocial needs of patients living with HIV/AIDS remains vital. Ensuring the effective delivery of services demands that interventions be rooted in cultural competence and aimed at vulnerable populations. This article describes a…

  4. 21 CFR 801.420 - Hearing aid devices; professional and patient labeling.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Hearing aid devices; professional and patient labeling. 801.420 Section 801.420 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND...) Identification of any known side effects associated with the use of a hearing aid that may warrant...

  5. 21 CFR 801.420 - Hearing aid devices; professional and patient labeling.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Hearing aid devices; professional and patient labeling. 801.420 Section 801.420 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND...) Identification of any known side effects associated with the use of a hearing aid that may warrant...

  6. Put a Face to a Name (Part A): The Effects of Photographic Aids on Patient Satisfaction, Clinician Communication, and Quality of Care

    ClinicalTrials.gov

    2014-04-04

    Effects of Photographic Aids (Photos of Faces) on Patient Recall of Their Clinical Care Team; Effects of Photographic Aids (Photos of Faces) on Clinician-patient Communication; Effects of Photographic Aids (Photos of Faces) on Overall Patient Satisfaction

  7. Ofuji's disease in an immunocompetent patient successfully treated with dapsone

    PubMed Central

    Anjaneyan, Gopikrishnan; Manne, Sindhura; Panicker, Vinitha Varghese; Eapen, Malini

    2016-01-01

    Eosinophilic pustular folliculitis or Ofuji's disease is a non-infectious eosinophilic infiltration of hair follicles, which usually presents with itchy papules and pustules in a circinate configuration. We report this case of an immunocompetent patient with erythematous papules and plaques without macropustules diagnosed as eosinophilic pustular folliculitis—a rarely reported entity outside Japan. He was successfully treated with oral dapsone. PMID:27730038

  8. Psychiatrists' Perceptions and Practices in Treating Patients' Obesity

    ERIC Educational Resources Information Center

    Lichwala-Zyla, Christine; Price, James H.; Dake, Joseph A.; Jordan, Timothy; Price, Joy Ann

    2009-01-01

    Objective: This study identified psychiatrists' perceptions and practices regarding advising and treating obese patients. Methods: Questionnaires were mailed to a national random sample of 500 members of APA. A three-wave mailing was used to maximize the return rate. The questionnaire contained items on weight control based on the Stages of Change…

  9. Silent venous thromboembolism in multiple myeloma patients treated with lenalidomide.

    PubMed

    Isoda, Atsushi; Sato, Naru; Miyazawa, Yuri; Matsumoto, Yoshinobu; Koumoto, Mina; Ookawa, Masahito; Sawamura, Morio; Matsumoto, Morio

    2015-09-01

    Lenalidomide treatment in combination with dexamethasone and/or chemotherapy is associated with a significant risk of venous thromboembolism (VTE) in patients with multiple myeloma (MM). However, the incidence of asymptomatic VTE in lenalidomide-treated MM patients remains unclear. A total of 80 relapsed and refractory MM patients treated with lenalidomide-containing regimens in a single institution between July 2010 and July 2014 were retrospectively analyzed. Of these, eight patients had asymptomatic VTE before starting lenalidomide. The remaining 72 patients received thromboprophylaxis with low-dose aspirin (100 mg daily) and monitoring of plasma D-dimer levels on each visit. During the median follow-up time of 7.3 months (range 1.0-43.5 months), 29 patients (40.3 %) showed an elevation of D-dimer (≥2.5 μg/mL), and 13 (18.1 %) showed asymptomatic VTE in a lower extremity. Median time to asymptomatic VTE events from initiation of lenalidomide treatment was 3.0 months (range 1.0-13.1 months). All patients having an asymptomatic VTE continued lenalidomide treatment on warfarinization (target international normalized ratio 1.5-2.5), and none of them developed symptomatic VTE. In conclusion, an asymptomatic VTE event occurred in 18 % of Japanese MM patients receiving lenalidomide-containing therapy despite aspirin prophylaxis. Serial monitoring of plasma D-dimer levels and early intervention may help to prevent symptomatic or lethal VTE events.

  10. Physical Activity in Patients Treated With Peritoneal Dialysis

    PubMed Central

    Thangarasa, Tharshika; Imtiaz, Rameez; Hiremath, Swapnil; Zimmerman, Deborah

    2017-01-01

    Background: Patients with chronic diseases are known to benefit from exercise. Despite a lack of compelling evidence, patients with end-stage kidney disease treated with peritoneal dialysis are often discouraged from participating in exercise programs that include resistance training due to concerns about the development of hernias and leaks. The actual effects of physical activity with or without structured exercise programs for these patients remain unclear. The purpose of this study is to more completely define the risks and benefits of physical activity in the end-stage kidney disease population treated with peritoneal dialysis. Methods/design: We will conduct a systematic review examining the effects of physical activity on end-stage kidney disease patients treated with peritoneal dialysis. For the purposes of this review, exercise will be considered a purposive subcategory of physical activity. The primary objective is to determine if physical activity in this patient population is associated with improvements in mental health, physical functioning, fatigue and quality of life and if there is an increase in adverse outcomes. With the help of a skilled librarian, we will search MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials for randomized trials and observational studies. We will include adult end-stage kidney disease patients treated with peritoneal dialysis that have participated in an exercise training program or had their level of physical activity assessed directly or by self-report. The study must include an assessment of the association between physical activity and one of our primary or secondary outcomes measures. We will report study quality using the Cochrane Risk of Bias Assessment Tool for randomized controlled trials and the Newcastle–Ottawa Scale for observational studies. Quality across studies will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The

  11. The prevalence and management of pain in patients with AIDS: a review of 134 cases.

    PubMed

    Lebovits, A H; Lefkowitz, M; McCarthy, D; Simon, R; Wilpon, H; Jung, R; Fried, E

    1989-09-01

    In light of the lack of any prior systematic evaluations of the prevalence and types of pain syndromes and treatments found in patients with AIDS, a chart review study was undertaken to evaluate this issue. Fifty-two of 96 charts reviewed (54%) had at least one note on nonprocedural pain or analgesic prescription. Although chest pain was the most prevalent pain location (22%), presumably because of the high incidence of Pneumocystis carinii pneumonia, other possible AIDS-related entities, such as peripheral neuropathy and thrombophlebitis, were also found. No specific AIDS syndromes could be identified that were related to a higher incidence of pain. Nearly one-third of patients with pain received codeine (31%), others received acetaminophen (27%), and 17% of patients received acetaminophen and oxycodone HCl. Specific pain management interventions must be evaluated and applied to control the nontrivial occurrence of pain in patients who have AIDS symptoms that may be overlooked by the physician given the overwhelming disease process.

  12. Severe hyponatraemia in an amiloride/hydrochlorothiazide-treated patient.

    PubMed

    van Assen, S; Mudde, A H

    1999-03-01

    A 85-year-old woman treated with, among other drugs, a thiazide diuretic presented with a severe hyponatraemia. She met several of the criteria for SIADH and, besides drugs, no cause for SIADH was found. After stopping the thiazide diuretic and restricting fluid intake the patient recovered fully. It was later proved that the thiazide was the cause of the water intoxication by rechallenging the patient with a single dose of amiloride/hydrochlorothiazide 5/50 mg. This "thiazide provocation test" showed its usefulness in the differential diagnosis of suspected SIADH. Moreover, the test demonstrated the paradoxal effect of thiazide diuretics to cause water retention in susceptible patients.

  13. Accumulation of guanylate binding proteins in patients treated with interferons.

    PubMed

    Cheng, Y S; Becker-Manley, M F; Rucker, R G; Borden, E C

    1988-06-01

    We have previously described an interferon (IFN)-induced protein with a molecular weight of 67,000. This protein has an affinity to guanylates and is thus called guanylate binding protein (GBP). The synthesis of GBP is inducible by IFNs in all human diploid fibroblast cell lines that we studied. To determine whether or not the GBP synthesis is IFN-inducible in humans as well as in cultured cells, we have studied the levels of GBP in the peripheral blood leukocytes (PBL) of patients treated with either type I or type II IFN. An increased GBP level was found the day immediately after treatment with either type of IFN, and the elevated GBP levels were maintained for at least 8 days. Among the patients studied, we found a higher level GBP accumulation (2.3x) in patients treated with IFN-beta than in those treated with IFN-gamma (1.6x). The increase of GBP in patients receiving IFN-gamma correlated with increases in class II histocompatibility antigens, HLA-DR and HLA-DQ in monocytes. Thus, the levels of GBP in peripheral blood leukocytes may be used as a parameter for the study of IFN responses in patients.

  14. Distinguishing tumor recurrence from irradiation sequelae with positron emission tomography in patients treated for larynx cancer

    SciTech Connect

    Greven, K.M.; Williams, D.W. III; Keyes, J.W. Jr.; McGuirt, W.F.; Harkness, B.A.; Watson, N.E. Jr.; Raben, M.; Frazier, L.C.; Geisinger, K.R.; Capellari, J.O.

    1994-07-01

    Distinguishing persistent or recurrent tumor from postradiation edema, or soft tissue/cartilage necrosis in patients treated for carcinoma of the larynx can be difficult. Because recurrent tumor is often submucosal, multiple deep biopsies may be necessary before a diagnosis can be established. Positron emission tomography with 18F-2-fluro-2-deoxglucose (FDG) was studied for its ability to aid in this problem. Positron emission tomography (18FDG) scans were performed on 11 patients who were suspected of having persistent or recurrent tumor after radiation treatment for carcinoma of the larynx. Patients underwent thorough history and physical examinations, scans with computerized tomography, and pathologic evaluation when indicated. Standard uptake values were used to quantitate the FDG uptake in the larynx. The time between completion of radiation treatment and positron emission tomography examination ranged from 2 to 26 months with a median of 6 months. Ten patients underwent computed tomography (CT) of the larynx, which revealed edema of the larynx (six patients), glottic mass (four patients), and cervical nodes (one patient). Positron emission tomography scans revealed increased FDG uptake in the larynx in five patients and laryngectomy confirmed the presence of carcinoma in these patients. Five patients had positron emission tomography results consistent with normal tissue changes in the larynx, and one patient had increased FDG uptake in neck nodes. This patient underwent laryngectomy, and no cancer was found in the primary site, but nodes were pathologically positive. One patient had slightly elevated FDG uptake and negative biopsy results. The remaining patients have been followed for 11 to 14 months since their positron emission studies and their examinations have remained stable. In patients without tumor, average standard uptake values of the larynx ranged from 2.4 to 4.7, and in patients with tumor, the range was 4.9 to 10.7. 18 refs., 3 figs., 1 tab.

  15. Treating 'AIDS blindness': a critical pedagogical approach to HIV education at tertiary level.

    PubMed

    Wood, Lesley; Rens, Julialet

    2014-01-01

    HIV and AIDS affect all South Africans, irrespective of gender, race, age and economic status. Teachers should therefore be able to meaningfully integrate HIV content into the school curriculum. However, pre-service teacher education programmes still do not pay adequate attention to HIV education, particularly in institutions where students are being prepared to work in environments that are perceived to be unaffected by the consequences of the pandemic. This article advocates that HIV education should be integrated into contexts of privilege and presents evidence of the influence that a critical pedagogical approach can have on changing student perceptions of the need to address HIV in and through their teaching. We led 109 Post-graduate Certificate of Education students through a series of activities that required them to critically reflect on their feelings, attitudes and perceived skills with regard to HIV and AIDS education; to identify potential areas of personal change; and to begin to imagine alternative professional possibilities. We generated qualitative data through drawings, group discussions, individual written reflections, and a voluntary focus group. A content analysis of the data revealed that the participating students initially felt incompetent to incorporate HIV and related issues into their teaching, and felt hesitant and uncomfortable at the prospect. However, a critical reflection on their thinking, both individually and in a group setting, served to shift them towards a more holistic, critical and humanising understanding of the pandemic and the role they could play as future teachers in helping to mitigate its impact. The findings provide evidence that a critical pedagogical approach - particularly with groups who believe that HIV and AIDS is not something that concerns them - can provide an effective way to mediate the knowledge, skills and attitudes that competent teachers need in today's world.

  16. [AIDS Study Group/Spanish AIDS Consensus Plan Document on sexually transmitted infections in HIV-infected patients].

    PubMed

    2011-04-01

    Sexually transmitted infections (STI) are a major public health problem. Considering their high morbidity and potential short and long term after effects, physicians must have enough knowledge on the management of these infections for a correct prevention, diagnosis and treatment. HIV infection is associated with STI, not only because they share route of transmission, but also because they lead to an increased risk of HIV transmission. In this article, we summarise the updated clinical practice guidelines, for the evaluation, management and prevention of STI in HIV-infected patients, from a panel of experts in HIV, dermatologists, proctologic surgeons, and microbiologists on behalf of the Spanish AIDS Study Group (GESIDA) and the National AIDS Plan (PNS).

  17. Hearing Loss in Patients with Shunt-Treated Hydrocephalus.

    PubMed

    Panova, Margarita V; Geneva, Ina E; Madjarova, Kalina I; Bosheva, Miroslava N

    2015-01-01

    Hearing loss is a common manifestation of the long-term complications in patients with shunt treated hydrocephalus along with motor development disturbance, cognitive and visual impairment, epilepsy and endocrine disorders. The aim of the present study was to investigate the alterations of hearing in patients with shunt treated hydrocephalus of non-tumor etiology and at least one year after implantation of ventriculo-peritoneal shunt, as well as their impact on the quality of life of patients. The study included 70 patients (age range 1.25 years - 21.25 years) with shunted non-tumor hydrocephalus and at least one year after placement of the shunt system. Hearing alterations were proved by measuring the brainstem auditory evoked potentials (BAEP) for children up to 5 years of age and children with mental retardation; audiograms was used for children older than 5 years with normal neuro-psychological development (NPD). Of the 70 studied patients 17 (24%) had hearing loss (10 bilateral and 7-unilateral) and all of them had sensorineural hearing loss, which is associated with low weight at birth, posthemorrhagic hydrocephalus and brainstem symptoms at the time of diagnosis of hydrocephalus. Hearing pathology was found more often in shunt-treated patients with NPD retardation, poor functional status and low quality of life. Children with shunt-treated hydrocephalus have hearing loss of sensorineural type. Children with brain stem symptomatology at diagnosing hydrocephalus and children with post-hemorrhagic hydrocephalus show higher risk of hearing loss. Children with shunted hydrocephalus and hearing loss show lower NPD, lower quality of life and lower functional status.

  18. The Opinion of Professional Caregivers About The Platform UnderstAID for Patients with Dementia

    PubMed Central

    Malak, Roksana; Krawczyk-Wasielewska, Agnieszka; Mojs, Ewa; Grobelny, Bartosz; Głodowska, Katarzyna B.; Millán-Calenti, José Carlos; Núñez-Naveira, Laura; Samborski, Włodzimierz

    2016-01-01

    Background The person with dementia should be treated as an unique person regarding symptoms directly associated with dementia, such as problems with memory, hallucinations, and delusions, as well as other physical, mental, or neurological deficits. The symptoms not directly typical of dementia, such as musculoskeletal disorders or depression, should be also be considered in order to improve the quality of life of a person with dementia. That is why professional caregivers have to broaden their current knowledge not only of medical symptoms but also of the patient’s psychosocial condition and increase their inquisitiveness about the individual condition of the patient. The aim of the study was to get to know the opinion of professional caregivers about the UnderstAID platform and its usefulness for informal caregivers. Material/Methods Participants in the study group consisted of professional caregivers: nurses, sociologists, psychologists, physiotherapists, and occupational therapists, all of whom specialized in geriatrics and had experience in working with people with dementia. All professional caregivers answered 24 questions that refer to positive and negative aspects of the UnderstAID platform. Results The study group of professional caregivers highly appreciated that the application could give support to caregivers (mean score of 4.78; 5 points means that they totally agreed, and 1 point means that they totally disagreed) and that a wide range of multimedia materials helped the informal caregivers to gain a better understanding of the contents (mean score of 4.78). There was a statistically significant correlation between the age of the professional caregivers and the frequency of positive opinions that the UnderstAID application gave support to caregivers of relatives with dementia (p=0.028) and the opinion that videos, photos, and pictures may help the informal caregivers to gain a better understanding of the contents (p=0.028). Conclusions A group of

  19. Hospital care for patients with AIDS at "Lazzaro Spallanzani" Institute in the last decade.

    PubMed

    Lauria, F N; Petrecchia, A; Girardi, E; Ippolito, G

    2001-01-01

    We reviewed data on hospital care of HIV/AIDS patients at Lazzaro Spallazani Institute between 1991 and 1999. The number of newly diagnosed AIDS cases increased until 1995 and decreased constantly thereafter. The proportion of AIDS cases diagnosed at our institution over the total number of cases reported in our region and in our country increased from 31.2 to 59.8% and from 3.9 to 8.7% respectively (p<0.001). In the entire study period, 10044 out of 18,434 (54.5%) of patients admitted to acute care wards were diagnosed with HIV related pathologies. The number of admission of HIV/AIDS patients to acute-care wards increased until 1995 and remained constant thereafter. Our data suggest that a consistent need for inpatient hospital care remains even in the era of HAART.

  20. Neurocognitive function in patients with recurrent glioblastoma treated with bevacizumab

    PubMed Central

    Wefel, Jeffrey S.; Cloughesy, Timothy; Zazzali, James L.; Zheng, Maoxia; Prados, Michael; Wen, Patrick Y.; Mikkelsen, Tom; Schiff, David; Abrey, Lauren E.; Yung, W.K. Alfred; Paleologos, Nina; Nicholas, Martin K.; Jensen, Randy; Vredenburgh, James; Das, Asha; Friedman, Henry S.

    2011-01-01

    Neurocognitive decline is a frequent adverse effect of glioblastoma. Antitumor therapies that are efficacious, as measured by traditional endpoints such as objective response (OR) and progression-free survival (PFS), and have beneficial effects on neurocognitive function (NCF) are of clinical benefit to these patients. We evaluated neurocognitive changes across time in 167 patients with recurrent glioblastoma treated with bevacizumab-based therapy in BRAIN, a phase II, randomized, multicenter trial. All patients underwent MRI and neurocognitive testing at baseline and every 6 weeks thereafter. Memory, visuomotor scanning speed, and executive function were evaluated using the Hopkins Verbal Learning Test–Revised, the Trail Making Test, and the Controlled Oral Word Association test, respectively. NCF relative to baseline for patients with an OR, PFS >6 months, or disease progression was evaluated at time of OR, 24 weeks, and time of progression, respectively. For patients with an OR or PFS >6 months, median standardized test scores were examined from baseline to week 24. Most patients with an OR or PFS >6 months had poorer NCF performance compared to the general population at baseline and had improved or stable NCF at the time of response or at the 24-week assessment, respectively; most patients with progressive disease had neurocognitive decline at the time of progression. For patients with an OR or PFS >6 months, median standardized test scores were largely stable across the first 24 weeks on study. Neurocognitive testing was an objective, valid, and feasible method of monitoring NCF in patients with recurrent glioblastoma. PMID:21558074

  1. [Diagnosis and treatment of opportunistic infections in HIV/AIDS adult patients].

    PubMed

    Lasso B, Martín

    2011-10-01

    The following guidelines for the diagnosis and treatment of opportunistic infections (OI) in adult HIV/AIDS patients represent the first approach to standardize the management of this patient group in Chile. The guidelines are based on scientific evidence. They intend to serve as a practical and easy-to-use tool for physicians during the process of selecting appropriate diagnostic tests and effective treatments for their patients. They also include the local experience in Chile related to OI in HIV/AIDS patients. Regular up-dates to include new scientific knowledge are proposed.

  2. Syphilis and HIV co-infection in patients who attend an AIDS outpatient clinic in Vitoria, Brazil

    PubMed Central

    Callegari, Fabiola Mesquita; Pinto-Neto, Lauro Ferreira da Silva; Medeiros, Charlla Jezus; Scopel, Camila Binsi; Page, Kimberly; Miranda

    2013-01-01

    Our goal was to determine the prevalence of, and risk factors associated with, syphilis in HIV-infected patients who attend an AIDS outpatient clinic in Vitoria, Brazil. We conducted a cross-sectional study—including interviews for demographic, behavioral, and clinical characteristics—and blood collection (venipuncture and fingerstick) for VDRL and treponemal tests (rapid test) in a total of 438 patients. The mean age was 43.0 years (SD = 11), and mean years of school was 8.1 (SD = 4.2). The prevalence of syphilis was 5.3% (95% CI, 3.3%–7.3%). The treponemal test was positive in 18.9% of participants. In multivariate analysis, prevalent syphilis infection was independently associated with male gender (AOR 4.6, 95% CI, 1.1–20.0), a history of male-male sex (AOR 1.8, 95% CI, 1.6–4.1), current use of antiretroviral therapy (AOR 5.5, 95% CI, 1.7–16.7), and history of treated syphilis infection (AOR 5.5, 95% CI, 2.0–15.8). Syphilis prevalence was high in patients living with HIV/AIDS who attend an AIDS clinic; therefore, routine STI counseling and screening should be included in their care. PMID:23732958

  3. Effect of Ethiopian multiflora honey on fluconazole-resistant Candida species isolated from the oral cavity of AIDS patients.

    PubMed

    Mulu, A; Diro, E; Tekleselassie, H; Belyhun, Y; Anagaw, B; Alemayehu, M; Gelaw, A; Biadglegne, F; Desalegn, K; Yifiru, S; Tiruneh, M; Kassu, A; Nishikawa, T; Isogai, E

    2010-11-01

    This study aimed to determine the antifungal effect of Ethiopian multiflora honey against Candida species isolated from the oral cavity of AIDS patients. Oral rinses were obtained from 13 AIDS patients and cultured on CHROMagar plates at 37°C for 48 hours. Candida species were identified by microbiological and molecular techniques. The antifungal effect of the honey sample on Candida was investigated by an agar dilution technique. Susceptibility of the Candida species to fluconazole was tested following a semi-modified microdilution method. Growth of both fluconazole-susceptible and -resistant Candida species was inhibited with a minimum fungicidal concentration (MFC) of 35-40% (v/v) honey. The MFC of different Candida species was not significantly different (P > 0.05). From the total of 25 Candida isolates tested for susceptibility, 11 (44%), eight (32%) and six (24%) of the isolates were sensitive (minimum inhibitory concentrations [MICs] < 8 µg/mL), susceptible (dose-dependent: MICs 16-32 µg/mL) and resistant (MICs > 64 µg/mL) to fluconazole, respectively. Ethiopian multiflora honey has antifungal activity against fluconazole-resistant Candida species isolated from the oral cavity of AIDS patients. This supports the existing folkloric practice of using honey to treat oral lesions. Nevertheless, identification of the bioactive agents in honey, their clinical evaluation and pharmacological standardization are crucial.

  4. Isolation of Mycobacterium avium complex from bone marrow aspirates of AIDS patients in Brazil.

    PubMed

    Barreto, J A; Palaci, M; Ferrazoli, L; Martins, M C; Suleiman, J; Lorenço, R; Ferreira, O C; Riley, L W; Johnson, W D; Galvão, P A

    1993-09-01

    Mycobacterium avium complex (MAC) infection has not been reported as a major opportunistic infection among patients with AIDS in Latin America or Africa. In this study, 125 AIDS patients who had persistent fever, anemia, and leukopenia were examined among 2628 AIDS patients admitted to Instituto de Infectologia Emilio Ribas between May 1990 and April 1992. From the bone marrow aspirates of the 125 patients, MAC was isolated from 23 (18.4%) and Mycobacterium tuberculosis was isolated from 9 (7.2%). Between 1985 and 1990, only 11 MAC isolations among 60,000 cultures obtained from human immunodeficiency virus-seronegative patients were documented in São Paulo. Hence, the minimal estimated rate of MAC infection in AIDS patients in this city was 23/2628, or 0.88%. These findings suggest that MAC infection is an important opportunistic infection, especially among a subset of patients with AIDS in Brazil who have clinical characteristics and risk activities similar to those associated with MAC infections in North America and Europe.

  5. Dyspnoea management in acute coronary syndrome patients treated with ticagrelor

    PubMed Central

    Parodi, Guido; Storey, Robert F

    2015-01-01

    The occurrence of dyspnoea in acute coronary syndrome (ACS) patients has always been considered a challenging diagnostic and therapeutic clinical scenario. P2Y12 platelet receptor inhibitors (i.e., clopidogrel, prasugrel and ticagrelor) are currently the cornerstone of treatment of ACS patients. Thus, in the last few years, the potential association between ACS and dyspnoea has also become more challenging with the increasing use of ticagrelor in these patients due to its beneficial effects on ischaemic event prevention and mortality, since ticagrelor can induce dyspnoea as a side effect. The present article is intended to review the current literature regarding dyspnoea occurrence in ACS patients, especially those treated with ticagrelor, and to propose ticagrelor-associated dyspnoea management recommendations based on current knowledge. PMID:25267878

  6. Treating a transgender patient: overview of the guidelines.

    PubMed

    Wilczynski, Cory; Emanuele, Mary Ann

    2014-11-01

    Transgenderism and gender dysphoria are becoming more prevalent diagnoses and the patient population is increasing. Primary care practitioners, endocrinologists, and mental health professionals are all part of the medical care team that treats these patients, but family and internal medicine physicians continue to deliver the care in the long term. Transgender medicine is not a strong part of the medical curriculum, and recent studies have shown there is anxiety in new physicians in taking care of these patients. There are many aspects to transgender care that involve different specialities, including, but not limited to, mental health, primary care, endocrinology, surgery, and obstetrics and gynecology. This article gives an overview of the current guidelines for standards of care of transgender patients as delineated by the World Professional Association for Transgender Health and the Endocrine Society.

  7. Isolated hypomagnesemia in a patient treated with capecitabine.

    PubMed

    Rajapakse, Senaka; Rodrigo, Chaturaka; Rajapakse, Anoja C

    2013-09-01

    Hypomagnesemia is known to occur for a variety of renal, gastrointestinal and other causes, and is often associated with other electrolyte and metabolic disturbances. We present a case of isolated hypomagnesemia in a patient who had been treated with the chemotherapy agent capecitabine. The approach to diagnosis and treatment is discussed. We postulate that capecitabine may cause isolated hypomagnesemia, possibly due to renal magnesium loss.

  8. Successful treatment of hemophagocytic lymphohistiocytosis and disseminated intravascular coagulation secondary to histoplasmosis in a patient with HIV/AIDS.

    PubMed

    Nieto, John Fredy; Gómez, Sandra Milena; Moncada, Diana Carolina; Serna, Lina María; Hidrón, Alicia Inés

    2016-04-01

    Haemophagocytic lymphohistiocytosis is an uncommon syndrome that results from an uncontrolled activation of macrophages and lymphocytes resulting in the compromise of multiple organs that is potentially fatal without timely treatment. It can be hereditary or a secondary result of infectious processes, neoplasms or autoimmune conditions. We present the case of a patient with HIV/AIDS who developed hemophagocytic lymphohistiocytosis as well as disseminated intravascular coagulation associated with histoplasmosis and who was successfully treated with amphotericin B, steroids and transitory dialytic support.

  9. [Pneumatic dilatation of achalasia: local experience in treating 41 patients].

    PubMed

    Honein, Khalil; Slim, Rita; Yaghi, César; Kheir, Bahaa; Bou Jaoudé, Joseph; Sayegh, Raymond

    2007-01-01

    L'achalasia is the best known primary motor disorder of the esophagus in which the lower esophageal sphincter (LES) has abnormally high resting pressure and incomplete relaxation with swallowing. Pneumatic dilatation (PD) remains the first choice of treatment. Our aim was to report, in a retrospective way, our experience in treating with pneumatic dilatation 41 achalasia patients admitted to the gastroenterology unit at Hôtel-Dieu de France (HDF) hospital between 1994 and 2004. A total of 46 dilatations were performed in 41 patients with achalasia [20 males and 21 females, the mean age was 46.8 years (range, 15-90)]. All patients underwent an initial dilatation by inflating a 35 mm balloon to 7 psi three times successively under fluoroscopic control. The need for subsequent dilatation with the same technique or for surgical treatment was based on symptom assessment. The mean follow-up period was 36.7 months (3 mo-7 years). Among the patients whose follow-up information was available, a satisfactory result was achieved in 29 patients (80.5%) after only one or two sessions of pneumatic dilatation. Esophageal perforation as a short-term complication was observed in one patient (2.17%). Seven patients were referred for surgery (one for esophageal perforation and six for persistent or recurrent symptoms). In conclusion, performing balloon dilatation under fluoroscopic observation is simple, safe and efficacious for treating patients with achalasia. Referral to repeated PD or to surgical myotomy should be discussed in case of no response to a first session of PD.

  10. Seroprevalence of Toxoplasma gondii Infection among HIV/AIDS Patients in Eastern China.

    PubMed

    Shen, Guoqiang; Wang, Xiaoming; Sun, Hui; Gao, Yaying

    2016-02-01

    Toxoplasmosis, a neglected tropical disease caused by the protozoan parasite Toxoplasma gondii, occurs throughout the world. Human T. gondii infection is asymptomatic in 80% of the population; however, the infection is life-threatening and causes substantial neurologic damage in immunocompromised patients such as HIV-infected persons. The major purpose of this study was to investigate the seroprevalence of T. gondii infection in subjects infected with HIV/AIDS in eastern China. Our findings showed 9.7% prevalence of anti-T. gondii IgG antibody in HIV/AIDS patients, which was higher than in intravenous drug users (2.2%) and healthy controls (4.7%), while no significant difference was observed in the seroprevalence of anti-Toxoplasma IgM antibody among all participants (P>0.05). Among all HIV/AIDS patients, 15 men (7.7%) and 10 women (15.9%) were positive for anti-T. gondii IgG antibody; however, no significant difference was detected in the seroprevalence of anti-Toxoplasma IgG antibody between males and females. The frequency of anti-Toxoplasma IgG antibody was 8.0%, 13.2%, 5.5%, and 0% in patients with normal immune function (CD4(+) T-lymphocyte count ≥500 cells/ml), immunocompromised patients (cell count ≥200 and <500 cells/ml), severely immunocompromised patients (cell count ≥50 and <200 cells/ml), and advanced AIDS patients, respectively (cell count <50 cells/ml), while only 3 immunocompromised patients were positive for anti-T. gondii IgM antibody. The results indicate a high seroprevalence of T. gondii infection in HIV/AIDS patients in eastern China, and a preventive therapy for toxoplasmosis may be given to HIV/AIDS patients based on CD4(+) T lymphocyte count.

  11. Are critically ill older patients treated differently than similarly ill younger patients?

    PubMed Central

    Stillman, A E; Braitman, L E; Grant, R J

    1998-01-01

    Our goal was to determine whether critically ill older patients are treated differently than middle-aged patients. If so, what factors besides age contribute to that difference? Internal medicine residents (n = 46) and practicing internists (n = 41) received 8 clinical vignettes of 4 critically ill 85-year-old patients and 4 critically ill 50-year-old patients. Each patient had a distinct premorbid mental and physical state. Each respondent selected from 4 levels of therapeutic aggressiveness for each patient. The main outcome measure was the proportion of physicians who intended to treat the older of each matched pair of patients less aggressively than the younger one (that is, downgraded for age). Eight physicians (9%) treated a previously unimpaired 85-year-old patient less aggressively than a comparable 50-year-old patient. When the matched patients were either premorbidly mentally or physically impaired (but not both), about 20% of physicians downgraded for age. Most downgraded for age in matched patients who were premorbidly both mentally and physically impaired. We conclude that age alone does not engender much therapeutic bias against older patients as long as they are physically and mentally intact before the onset of their acute illness. As premorbid disabilities multiply, older patients may be treated less aggressively than younger ones with similar impairments and clinical presentations. PMID:9771155

  12. Nursing research on a first aid model of double personnel for major burn patients.

    PubMed

    Wu, Weiwei; Shi, Kai; Jin, Zhenghua; Liu, Shuang; Cai, Duo; Zhao, Jingchun; Chi, Cheng; Yu, Jiaao

    2015-03-01

    This study explored the effect of a first aid model employing two nurses on the efficient rescue operation time and the efficient resuscitation time for major burn patients. A two-nurse model of first aid was designed for major burn patients. The model includes a division of labor between the first aid nurses and the re-organization of emergency carts. The clinical effectiveness of the process was examined in a retrospective chart review of 156 cases of major burn patients, experiencing shock and low blood volume, who were admitted to the intensive care unit of the department of burn surgery between November 2009 and June 2013. Of the 156 major burn cases, 87 patients who received first aid using the double personnel model were assigned to the test group and the 69 patients who received first aid using the standard first aid model were assigned to the control group. The efficient rescue operation time and the efficient resuscitation time for the patients were compared between the two groups. Student's t tests were used to the compare the mean difference between the groups. Statistically significant differences between the two groups were found on both measures (P's < 0.05), with the test group having lower times than the control group. The efficient rescue operation time was 14.90 ± 3.31 min in the test group and 30.42 ± 5.65 min in the control group. The efficient resuscitation time was 7.4 ± 3.2 h in the test group and 9.5 ± 2.7 h in the control group. A two-nurse first aid model based on scientifically validated procedures and a reasonable division of labor can shorten the efficient rescue operation time and the efficient resuscitation time for major burn patients. Given these findings, the model appears to be worthy of clinical application.

  13. Recurrent and self-healing cutaneous monoclonal plasmablastic infiltrates in a patient with AIDS and Kaposi sarcoma.

    PubMed

    Gilaberte, M; Gallardo, F; Bellosillo, B; Saballs, P; Barranco, C; Serrano, S; Pujol, R M

    2005-10-01

    Infection with human immunodeficiency virus (HIV) increases the risk of developing non-Hodgkin lymphoma. Plasmablastic lymphoma (PBL) is a rare variant of diffuse large cell lymphoma that often involves the oral cavity of HIV+ patients. It is characterized by immunoblastic morphology and plasma cell phenotype. Cutaneous involvement in PBL appears to be rare. We report a 44-year-old man with AIDS and Kaposi sarcoma (KS) previously treated with doxorubicin who, following treatment with highly active antiretroviral therapy, developed an erythematous infiltrated nodule on the right arm. Histology showed subcutaneous fat necrosis and clusters of atypical large plasma cells (plasmablastic cells). Immunohistochemistry revealed lambda light chain restriction. Epstein-Barr virus (EBV) mRNA was detected by in situ hybridization within the plasmablastic cells. Polymerase chain reaction amplification with specific primers for human herpesvirus 8 (HHV-8) performed on the skin biopsy specimen detected a specific band. A complete screening (bone marrow biopsy, computed tomographic scan, radiological survey) disclosed no abnormalities. The lesion resolved spontaneously after 3 months. Two years later an infiltrated plaque developed on the abdominal wall. The clinical and histopathological features of this new lesion were similar to those observed 2 years previously. No evidence of extracutaneous involvement was detected. The lesion again resolved spontaneously after 25 days. PBL may be seen in patients with transplants or receiving chemotherapy, but is usually observed in patients with advanced AIDS. The observation of recurrent self-healing EBV- and HHV-8-associated cutaneous monoclonal plasmablastic infiltrates, in a patient with AIDS and KS, expands the clinical spectrum of AIDS-associated plasmablastic lymphoproliferative disorders.

  14. Aquaporin-4 antibody titration in NMO patients treated with rituximab

    PubMed Central

    Marnetto, Fabiana; Granieri, Letizia; Capobianco, Marco; Bertolotto, Antonio

    2016-01-01

    Objective: We undertook an observational retrospective study to investigate the usefulness of aquaporin-4 (AQP4) antibodies (Ab) titration in the management of patients with neuromyelitis optica (NMO) treated with rituximab (RTX) by studying (1) the correlation between AQP4-Ab titer and disease activity, (2) the influence of RTX on antibody levels, and (3) the association between AQP4-Ab levels and responsiveness to RTX. Methods: A cell-based assay was used for AQP4-Ab titration in 322 serum samples from 7 patients with NMO treated with RTX (median follow-up 65 months), according to a treatment-to-target approach. Serum samples were collected every month following standardized procedures. Results: (1) In group analysis, AQP4-Ab titers correlated with the disease activity, showing higher titers during and preceding relapses than during remission. However, in individual analysis, an increase in AQP4-Ab titers and CD19+ B cells did not always precede a relapse. (2) A reduction of AQP4-Ab titers in the short-term and long-term period was observed during RTX treatment. (3) Reduction of AQP4-Ab titers was observed in responder patients both 3 months after RTX infusion and in the long-term follow-up. In one nonresponder patient, AQP4-Ab levels never decreased during the treatment period. Conclusions: Titration of AQP4-Abs could be useful in the clinical management of patients with NMO treated with RTX: titration before each reinfusion and 3 months after each reinfusion may provide information about responsiveness to RTX. Although a relationship among AQP4-Ab levels, disease activity, and response to RTX was observed, the usefulness of AQP4-Ab titration to predict relapses is limited. PMID:28054001

  15. COMPARISON OF LARGE RESTRICTION FRAGMENTS OF MYCOBACATERIUM AVIUM ISOLATES RECOVERED FROM AIDS AND NON-AIDS PATIENTS WITH THOSE OF ISOLATES FROM POTABLE WATER

    EPA Science Inventory

    We examined potable water in Los Angeles, California, as a possible source of infection in AIDS and non-AIDS patients. Nontuberculous mycobacteria were recovered from 12 (92%) of 13 reservoirs, 45 (82%) of 55 homes, 31 (100%) of 31 commercial buildings, and 15 (100%) of 15 hospi...

  16. COMPARISON OF LARGE RESTRICTION FRAGMENTS OF MYCOBACTERIUM AVIUM ISOLATES RECOVERED FROM AIDS AND NON-AIDS PATIENTS WITH THOSE OF ISOLATES FROM POTABLE WATER

    EPA Science Inventory

    We examined potable water in Los Angeles, California, as a possible source of infection in AIDS and non-AIDS patients. Nontuberculous mycobacteria were recovered from 12 (92%) of 13 reservoirs, 45 (82%) of 55 homes, 31 (100%) of 31 commercial buildings, and 15 (100%) of 15 hospit...

  17. Computer-aided diagnosis and lipidomics analysis to detect and treat breast cancer

    NASA Astrophysics Data System (ADS)

    Meyer-Bäse, Anke; Retter, Felix; Steinbrücker, Frank; Görke, Robert; Burgeth, Bernhard; Schlossbauer, Thomas

    2010-04-01

    Multi-modality diagnosis techniques are more and more replacing traditional medical imaging for breast cancer detection. Newly emerging advances in both intelligent cancer detection systems and lipidomics technologies offer an excellent opportunity to detect tumors and to understand regulation at the molecular level in many diseases such as cancer. In this paper, we present a detailed computer-aided diagnosis (CAD) systems combining motion artefact reduction and automated feature extraction and classification, and a novel data mining approach for visualization of gene therapy leading to apoptosis in U87 MG glioblastoma cells, a secondary tumor of breast cancer. The achieved results show that the CAD system represents a robust and integrative tool for reliable small contrast enhancing lesions. Graph-clustering methods are introduced as powerful correlation networks which enable a simultaneous exploration and visualization of co-regulation in glioblastoma data. These new paradigms are providing unique "fingerprints" by revealing how the intricate interactions at the lipidome level can be employed to induce apoptosis (cell death) and are thus opening a new window to biomedical frontiers.

  18. Disseminated Acanthamoeba sinusitis in a patient with AIDS: a possible role for early antiretroviral therapy.

    PubMed

    Carter, Wendy W; Gompf, Sandra G; Toney, John F; Greene, John N; Cutolo, Edward P

    2004-01-01

    Acanthamoeba, a free-living ameba, has been reported to infect humans with subacute encephalitis, sinusitis, or keratitis. Multiple cases of Acanthamoeba sinusitis with dissemination have been reported in association with AIDS, with high mortality. We report successful treatment of a 35-year-old woman who presented with sinusitis that progressed to disseminated acanthamebiasis as her initial manifestation of AIDS. To our knowledge, our patient was one of the few and longest-lived survivors of disseminated Acanthamoeba infection with AIDS. As with other opportunistic infections, early aggressive therapy including HAART may alter the outcome in this almost uniformly fatal disease.

  19. Treating Pain in Addicted Patients: Recommendations from an Expert Panel

    PubMed Central

    Cheatle, Martin; Wunsch, Martha; Skoufalos, Alexis; Reddy, Yeshwant

    2014-01-01

    Abstract Clinicians may face pragmatic, ethical, and legal issues when treating addicted patients. Equal pressures exist for clinicians to always address the health care needs of these patients in addition to their addiction. Although controversial, mainly because of the lack of evidence regarding their long-term efficacy, the use of opioids for the treatment of chronic pain management is widespread. Their use for pain management in the addicted population can present even more challenges, especially when evaluating the likelihood of drug-seeking behavior. As the misuse and abuse of opioids continues to burgeon, clinicians must be particularly vigilant when prescribing chronic opioid therapy. The purpose of this article is to summarize recommendations from a recent meeting of experts convened to recommend how primary care physicians should approach treatment of chronic pain for addicted patients when an addiction specialist is not available for a referral. As there is a significant gap in guidelines and recommendations in this specific area of care, this article serves to create a foundation for expanding chronic pain guidelines in the area of treating the addicted population. This summary is designed to be a practical how-to guide for primary care physicians, discussing risk assessment, patient stratification, and recommended therapeutic approaches. (Population Health Management 2014;17:79–89) PMID:24138341

  20. Toxic Epidermal Necrolysis in Polymedicated Patient Treated With Radiotherapy

    PubMed Central

    Pérez-Calderón, Remedios; Corrales-Vargas, Silvia; Jiménez-Ferrera, Gloria; Rodríguez-Nevado, Isabel; Díaz-Delgado, Mario

    2015-01-01

    Temozolomide is an oral alkylating agent indicated for the treatment of patients with glioblastoma multiforme concomitantly with radiotherapy and subsequently as monotherapy treatment. We report the case of a patient who developed toxic epidermal necrolysis (TEN) while she was being treated with chemoradiotherapy and several drugs. Cutaneous tests were performed with the drugs involved with negative result. Although the occurrence of TEN contraindicates suspected drug readministration, we based the decision to perform the controlled administration of temozolomide on the following reasons: (1) the poor prognosis of the underlying disease, (2) the lack of therapeutic alternatives, (3) the suspicion that other drugs taken by the patient simultaneously may be responsible (as anticonvulsants and trimethoprim sulfamethoxazole [TMP-SMX]), and (4) temozolomide was the first choice for treating the patient's disease. The administration of a cumulative dose of 60 mg of temozolomide caused a slight skin reaction. Given this result, we conducted controlled administration of other drugs involved. Dexamethasone, codeine, omeprazole and levetiracetam were well tolerated. However, TMP-SMX produced a similar reaction to that caused by temozolomide. In conclusion, we present the first case of TEN induced by temozolomide and TMP-SMX associated with cranial radiotherapy confirmed by controlled administration. Radiotherapy in combination with these drugs could have favored TEN, as some authors have postulated, but we cannot prove this. PMID:25729629

  1. A novel first aid stretcher for immobilization and transportation of spine injured patients.

    PubMed

    Liu, Yan-Sheng; Feng, Ya-Ping; Xie, Jia-Xin; Luo, Zhuo-Jing; Shen, Cai-Hong; Niu, Fang; Zou, Jian; Tang, Shao-Feng; Hao, Jiang; Xu, Jia-Xiang; Xiao, Li-Ping; Xu, Xiao-Ming; Zhu, Hui

    2012-01-01

    Effective immobilization and transportation are vital to the life-saving acute medical care needed when treating critically injured people. However, the most common types of stretchers used today are wrought with problems that can lead to further medical complications, difficulty in employment and rescue, and ineffective transitions to hospital treatment. Here we report a novel first aid stretcher called the "emergency carpet", which solves these problems with a unique design for spine injured patients. Polyurethane composite material, obtained by a novel process of manually mixing isocyanate and additives, can be poured into a specially designed fabric bag and allowed to harden to form a rigid human-shaped stretcher. The effectiveness of the emergency carpet was examined in the pre-hospital management of victims with spinal fractures. Additionally, it was tested on flat ground and complex terrain as well as in the sea and air. We demonstrated that the emergency carpet can be assembled and solidified on the scene in 5 minutes, providing effective immobilization to the entire injured body. With the protection of the emergency carpet, none of the 20 patients, who were finally confirmed to have spinal column fracture or dislocation, had any neurological deterioration during transportation. Furthermore, the carpet can be handled and transported by multiple means under differing conditions, without compromising immobilization. Finally, the emergency carpet allows the critically injured patient to receive multiple examinations such as X-ray, CT, and MRI without being removed from the carpet. Our results demonstrate that the emergency carpet has ideal capabilities for immobilization, extrication, and transportation of the spine injured patients. Compared with other stretchers, it allows for better mobility, effective immobilization, remarkable conformity to the body, and various means for transportation. The emergency carpet is promising for its intrinsic advantages in

  2. Post-ART epidermodysplasia verruciformis in a patient with AIDS.

    PubMed

    da Silva, Leila Cristina Ferreira; Miranda, Angelica Espinosa; Ferreira, Luiz Carlos de Lima; da Silva, Roberto Moreira; Mira, Marcelo Távora; Talhari, Carolina; Talhari, Sinésio

    2010-01-01

    Epidermodysplasia verruciformis (EV) is a rare disorder characterized by persistent human papillomavirus (HPV) infection. Here, we describe a 48-year-old, black, married male with AIDS, presenting a 1-year history of asymptomatic hypopigmented lesions that appeared 3 years after antiretroviral therapy (ART) initiation. Pre-ART, the initial CD4 count was 32 cells/mm(3) and the skin lesions appeared when the CD4 count reached 122 cells/mm(3). Dermatological examination demonstrated thin, scaly, slightly verrucous hypopigmented macules and papules, isolated or presenting with a linear aspect (Köbner phenomenon) in some areas, distributed on the neck, trunk, and superior and inferior members. Skin biopsy of a macular lesion revealed epidermal acanthosis with vacuolated keratinocytes presenting blue-gray pallor, arranged in clusters at the granular and upper spinous layer. Immunohistochemistry revealed expression of p16( INK4a) with diffuse positivity in the upper third of the epithelium, corresponding to the vacuolated keratinocytes. Polymerase chain reaction (PCR) was positive for type 12 HPV, and a diagnosis of EV-like associated to AIDS was made. EV-like is a rare disease and in this patent might be a manifestation of immune reconstitution inflammatory syndrome.

  3. Meningitis caused by Alcaligenes xylosoxidans in a patient with HIV/AIDS.

    PubMed

    Espinoza-Gómez, F; Newton-Sánchez, O A; Melnikov, V; Virgen-González, O; Unrau, J

    2007-12-01

    The purpose of the present work was to inform about the first case of meningitis associated to the bacteria Alcaligenes xylosoxidans in a patient with HIV/AIDS. The patient was a 46-year-old male, with the antecedent of have been diagnosed for HIV/ AIDS, who attended in the Hospital Universitario de Colima, Mexico, with fever, shock and meningismus. The study of the cerebrospinal fluid showed pleocytosis, elevated protein levels and hypoglycorrhachia. The culture yielded the presence of Alcaligenes xylosoxidans with sensitivity to ciprofloxacin. After 14 days of treatment with this antibiotic, the patient showed neurologic improvement and was able to continue with his outpatient antiretroviral treatment. The present case shows the importance of the inclusion of this bacterium in the differential diagnosis of the neurological infections in HIV/AIDS patients and emphasizes the importance of considering the bacterial meningitis in this population.

  4. Concurrent cerebral american trypanosomiasis and toxoplasmosis in a patient with AIDS.

    PubMed

    Yoo, Thomas W; Mlikotic, Anton; Cornford, Marcia E; Beck, C Keith

    2004-08-15

    We report a case of concurrent cerebral infection with Trypanosoma cruzi and Toxoplasma gondii in a patient with acquired immunodeficiency syndrome (AIDS). A 22-year-old El Salvadoran man initially improved during receipt of antitoxoplasmosis therapy, but he had rapidly progressive hemiplegia. Magnetic resonance imaging showed an abnormal finding in the left internal capsule, and cytological analysis of cerebrospinal fluid revealed T. cruzi trypomastigotes. Despite prompt therapy with nifurtimox, the patient's mental status declined, and he died of nosocomial complications. Although infrequent, T. cruzi infection should be considered in the differential diagnosis of brain lesions in patients with AIDS from regions of endemicity.

  5. Mycobacterium ulcerans infection as a cause of chronic diarrhea in an AIDS patient: a case report.

    PubMed

    Huh, Jin-Gook; Kim, You-Sun; Lee, Jong-Sung; Jeong, Tae-Yeob; Ryu, Soo-Hyung; Lee, Jung-Hwan; Moon, Jeong-Seop; Kang, Yun-Kyung; Shim, Myung-Shup; Oh, Myoung-Don

    2008-02-07

    Chronic diarrhea is one of the most frequent gastro-intestinal manifestations in acquired immunodeficiency syndrome (AIDS). Protozoa and nontuberculous mycobacteria (NTM) are opportunistic pathogens that can easily infect these patients. Among the NTM, Mycobacterium avium complex (MAC) is the most frequently observed pathogen in HIV-infected patients. However, NTMs other than MAC have not been reported as a gastrointestinal pathogen as yet. We present a case of chronic diarrhea in an AIDS patient in whom Mycobacterium ulcerans and cryptosporidium co-infection is evidenced from colonic tissue.

  6. Different outcomes of never-treated and treated patients with schizophrenia: 14-year follow-up study in rural China

    PubMed Central

    Ran, Mao-Sheng; Weng, Xue; Chan, Cecilia Lai-Wan; Chen, Eric Yu-Hai; Tang, Cui-Ping; Lin, Fu-Rong; Mao, Wen-Jun; Hu, Shi-Hui; Huang, Yue-Qin; Xiang, Meng-Ze

    2015-01-01

    Background The long-term outcome of never-treated patients with schizophrenia is unclear. Aims To compare the 14-year outcomes of never-treated and treated patients with schizophrenia and to establish predictors for never being treated. Method All participants with schizophrenia (n = 510) in Xinjin, Chengdu, China were identified in an epidemiological investigation of 123 572 people and followed up from 1994 to 2008. Results The results showed that there were 30.6%, 25.0% and 20.4% of patients who received no antipsychotic medication in 1994, 2004 and 2008 respectively. Compared with treated patients, those who were never treated in 2008 were significantly older, had significantly fewer family members, had higher rates of homelessness, death from other causes, being unmarried, living alone, being without a caregiver and poor family attitudes. Partial and complete remission in treated patients (57.3%) was significantly higher than that in the never-treated group (29.8%). Predictors of being in the never-treated group in 2008 encompassed baseline never-treated status, being without a caregiver and poor mental health status in 1994. Conclusions Many patients with schizophrenia still do not receive antipsychotic medication in rural areas of China. The 14-year follow-up showed that outcomes for the untreated group were worse. Community-based mental healthcare, health insurance and family intervention are crucial for earlier diagnosis, treatment and rehabilitation in the community. PMID:26382951

  7. [The use of plasmapheresis in treating urology patients].

    PubMed

    Neĭmark, A I; Astakhov, Iu I; Davydov, A V; Mazyrko, A V; Iakovets, Ia V

    1993-01-01

    The paper presents the results of plasmapheresis inclusion into a combined therapy of pyelonephritis. Out of 79 patients treated, 42 had urosepsis, 25 developed pyelonephritis in pregnancy, 12 had complicating chronic renal failure. Uroseptic patients were examined for hemostasis, the rest for immune status. There were symptoms of DIC syndrome in the former and immunity suppression in the latter. After the combined therapy with plasmapheresis, latent hypercoagulation and intoxication disappeared, uroseptic manifestations reduced. The above treatment of pregnancy pyelonephritis stopped inflammation, promoted activation of the immune system. In patients with chronic renal failure adjuvant plasmapheresis enhanced cellular and humoral immunity, neutrophil function, the number of middle-size molecules in the blood diminished. The latter improved renal function in decreasing uremia.

  8. Computer-aided selection of diagnostic tests in jaundiced patients.

    PubMed Central

    Saint-Marc Girardin, M F; Le Minor, M; Alperovitch, A; Roudot-Thoraval, F; Metreau, J M; Dhumeaux, D

    1985-01-01

    A model has been developed for ordering diagnostic tests in jaundiced patients. The system proceeds in two steps: (i) diagnostic hypotheses are calculated for each patient from the results of physical examination and routine biological investigations; (ii) given these hypotheses, the most efficient test (out of 22) for reaching the final diagnosis is selected using four criteria: diagnostic value, risk, financial cost, and time in obtaining the result. This model was tested in 62 patients. In 43 of them (69%), the selected test was sufficient for reaching a diagnostic accuracy of 100%. In this group of patients, a mean of 3.7 (range 1-6) tests per patient was ordered by physicians. In the 19 remaining patients, the selected test was not sufficient for the final diagnosis, thus requiring a multiple choice process. It is suggested that such a system could help physicians to improve the care of patients by more efficient ordering of diagnostic tests. PMID:3896962

  9. Have Dentists Assimilated Information about AIDS?

    ERIC Educational Resources Information Center

    Atchison, Kathryn A.; And Others

    1987-01-01

    A sample of 396 general dentists, oral surgeons, and periodontists were interviewed to determine their experience in treating patients infected with human immunodeficiency virus HIV, factors associated with their knowledge about AIDS, and their sources of information regarding AIDS. Fifty-six percent indicated a reluctance or inability to treat an…

  10. Clinical analysis of HIV/AIDS patients with drug eruption in Yunnan, China

    PubMed Central

    Li, Yu-Ye; Jin, Yong-Mei; He, Li-Ping; Bai, Jin-Song; Liu, Jun; Yu, Min; Chen, Jian-Hua; Wen, Jing; Kuang, Yi-Qun

    2016-01-01

    Drug eruption is the most common clinical presentation in patients with HIV/AIDS. The systemic clinical and risk factors associated with drug eruption remain unknown. A retrospective analysis in HIV/AIDS patients with drug eruption was carried out with demographic data, epidemiological data, clinical characteristics, laboratory data and follow-up data. The risk factors correlated with prognosis were assessed by case control analysis. A total of 134 out of 1817 HIV/AIDS patients (7.4%) presented drug eruptions. The major class of sensitizing drug was HAART drugs (47.7%), followed by antibiotics (47.0%). Nevirapine (39.6%) was the most common sensitizing drug in the HAART regimens. The patients received HAART or had allergic history were prone to develop drug eruption. The alanine aminotransferase, albumin, globulin, creatinine, blood urea nitrogen (BUN), lymphocytes, red blood cells (RBC) and eosinophils of the drug eruption patients were significantly different the control patients. The allergic history, opportunistic infection, viral load, CD4 cell count, high globulin and low albumin were the risk factors correlated with death in HIV/AIDS patients with drug eruption. It is proposed that patients with higher viral loads, higher globulin levels and lower white blood cells (WBC) should be given special attention for the prevention of complications and death. PMID:27796328

  11. A Review of Shared Decision-Making and Patient Decision Aids in Radiation Oncology.

    PubMed

    Woodhouse, Kristina Demas; Tremont, Katie; Vachani, Anil; Schapira, Marilyn M; Vapiwala, Neha; Simone, Charles B; Berman, Abigail T

    2017-01-30

    Cancer treatment decisions are complex and may be challenging for patients, as multiple treatment options can often be reasonably considered. As a result, decisional support tools have been developed to assist patients in the decision-making process. A commonly used intervention to facilitate shared decision-making is a decision aid, which provides evidence-based outcomes information and guides patients towards choosing the treatment option that best aligns with their preferences and values. To ensure high quality, systematic frameworks and standards have been proposed for the development of an optimal aid for decision making. Studies have examined the impact of these tools on facilitating treatment decisions and improving decision-related outcomes. In radiation oncology, randomized controlled trials have demonstrated that decision aids have the potential to improve patient outcomes, including increased knowledge about treatment options and decreased decisional conflict with decision-making. This article provides an overview of the shared-decision making process and summarizes the development, validation, and implementation of decision aids as patient educational tools in radiation oncology. Finally, this article reviews the findings from decision aid studies in radiation oncology and offers various strategies to effectively implement shared decision-making into clinical practice.

  12. Short communication: oral lesions in HIV/AIDS patients undergoing HAART including efavirenz.

    PubMed

    Aquino-García, S I; Rivas, M A; Ceballos-Salobreña, A; Acosta-Gio, A E; Gaitán-Cepeda, L A

    2008-06-01

    Oral lesions (OL) have an important prognostic value for HIV/AIDS patients. However, the behavior of OL in HIV/AIDS patients undergoing highly active antiretroviral therapy including efavirenz (HAART/EFV) has not been documented. Our objective was to establish the prevalence of OL in HIV/AIDS patients undergoing HAART/EFV and to compare it with the prevalence of OL in patients undergoing antiretroviral therapy including a protease inhibitor (HAART/PI). Seventy-three HIV/AIDS patients undergoing antiretroviral treatment for at least for 6 months at "La Raza" Medical Center's Internal Medicine Unit (IMSS, Mexico City) were included. To detect OL, a detailed examination of oral soft tissues was performed in each patient. Patient records recorded gender, seropositivity time, route of contagion, antiretroviral therapy type and duration, CD4 lymphocyte count/ml, and viral load. Two groups were formed: 38 patients receiving HAART/EFV [two nucleoside analogue reverse transcriptase inhibitors (NARTI) plus efavirenz] and 35 patients receiving HAART/PI (two NARTIs plus one PI). OL prevalence was established in each study group. The Chi-square test was applied (p < 0.05(IC95%)). OL prevalence in the HAART/EFV group (32%) was lower (p < 0.007) than in the HAART/PI group (63%). Candidosis was the most prevalent OL in both groups. Herpes labialis, HIV-associated necrotizing periodontitis, xerostomia, hairy leukoplakia, and nonspecific oral sores were identified. The highest prevalence for all OL was found in the HAART/PI group. These findings suggest that HIV/AIDS patients undergoing HAART/EFV show a lower prevalence of oral lesions than patients undergoing HAART/PI.

  13. Patient Access to Online Visit Notes: Perceptions of Doctors and Patients at an Urban HIV/AIDS Clinic.

    PubMed

    Oster, Natalia V; Jackson, Sara L; Dhanireddy, Shireesha; Mejilla, Roanne; Ralston, James D; Leveille, Suzanne; Delbanco, Tom; Walker, Janice D; Bell, Sigall K; Elmore, Joann G

    2015-01-01

    Patients living with HIV/AIDS face large societal and medical challenges. Inviting patients to read their doctors' visit notes via secure electronic portals may empower patients and improve health. We investigated whether utilization and perceptions about access to doctors' notes differed among doctors and patients in an HIV/AIDS clinic versus primary care setting. We analyzed pre- and 1-year postintervention data from 99 doctors and 3819 patients. HIV clinic patients did not report differences in perceived risks and benefits compared to primary care clinic patients, however, they were more likely to share notes with friends (33% versus 9%, P=.002), other health professionals (24% versus 8%, P=.03), or another doctor (38% versus 9%, P<.0001). HIV clinic doctors were less likely than primary care doctors to change the level of candor in visit notes (P<.04). Our findings suggest that HIV clinic patients and doctors are ready to share visit notes online.

  14. Opportunistic Neurologic Infections in Patients with Acquired Immunodeficiency Syndrome (AIDS).

    PubMed

    Albarillo, Fritzie; O'Keefe, Paul

    2016-01-01

    Infections of the central nervous system (CNS) in individuals with human immunodeficiency virus (HIV) remain a substantial cause of morbidity and mortality despite the introduction of highly active antiretroviral therapy (HAART) especially in the resource-limited regions of the world. Diagnosis of these infections may be challenging because findings on cerebrospinal fluid (CSF) analysis and brain imaging are nonspecific. While brain biopsy provides a definitive diagnosis, it is an invasive procedure associated with a relatively low mortality rate, thus less invasive modalities have been studied in recent years. Diagnosis, therefore, can be established based on a combination of a compatible clinical syndrome, radiologic and CSF findings, and understanding of the role of HIV in these infections. The most common CNS opportunistic infections are AIDS-defining conditions; thus, treatment of these infections in combination with HAART has greatly improved survival.

  15. Seroprevalence of toxoplasmosis in HIV(+)/AIDS patients in Iran.

    PubMed

    Mohraz, Minoo; Mehrkhani, Farhad; Jam, Sara; SeyedAlinaghi, SeyedAhmad; Sabzvari, Duman; Fattahi, Fatemeh; Jabbari, Hossain; Hajiabdolbaghi, Mahboubeh

    2011-01-01

    Toxoplasma gondii has arisen as an important opportunistic agent especially in the central nervous system and in advanced HIV disease can cause significant morbidity and mortality. This study was carried out to determine the seroprevalence of toxoplasmosis among HIV-positive patients in Iran. Blood samples were collected from 201 HIV-positive patients and anti-toxoplasma antibodies were detected by using conventional ELISA. An antibody titer of >3 IU/ml was considered positive. The majority of studied patients were male (male to female ratio: 5 to 1) with the mean age of 36 ± 1 yrs. The seroprevalence of toxoplasmosis in HIV-positive patients was 49.75%. The mean CD4 count in HIV patients with positive toxoplasma serology was 332.5 ± 22.4 cells/µl. Only 1% of the patients had IgM anti-toxoplasma antibodies and 10% of the patients had clinical toxoplasma encephalitis. The mean CD4 count in this group was 66.4 ± 15.5 cells/µl and there was a significant association between CD4 count and rate of toxoplasma encephalitis (P<0.001). Previous reports suggested that toxoplasma encephalitis could be prevented by appropriate chemoprophylaxis. In view of the relatively high prevalence of toxoplasma infection found among the HIV-infected patients in our study, we suggest that routine screening for toxoplasma should be undertaken for all HIV-infected patients in Iran.

  16. Malignancies in the AIDS patient: natural history, treatment strategies, and preliminary results.

    PubMed

    Longo, D L; Steis, R G; Lane, H C; Lotze, M T; Rosenberg, S A; Preble, O; Masur, H; Rook, A H; Fauci, A S; Jacob, J

    1984-01-01

    Almost 40% of the 3000 US patients with acquired immunodeficiency syndrome (AIDS) have a malignancy at the time of reporting, and the incidence of AIDS patients who develop a malignancy during the course of the disease may be 65-70%. 2 types of malignancies have been noted with increased frequency in AIDS victims: Kaposi's sarcoma and malignant lymphomas. About 35% of all AIDS patients and 50% of homosexual or bisexual victims have developed Kaposi's sarcoma, and those with coincident opportunistic infection have 2.5 times the mortality of those without such infection. There are 2 essential features to the histopathology of Kaposi's sarcoma: 1) vascular proliferation and 2) spindle-shaped neoplastic cells in a network of reticulin fibers that appear to be of endothelial origin. The treatment of the epidemic form of Kaposi's sarcoma has not been successful, and the projected 2-year survival is only 30%. The causes of death in the majority of such patients are overwhelming opportunistic infections, especially cytomegalovirus and Pneumocystis carinii, and irreversible cachexia and wasting. Interferon therapy has had a beneficial effect in patients with disease limited to skin, with T4/T8 ratios over 0.5, and without a prior history of opportunistic infection; however, there is no evidence that interferon exerts any beneficial effects on the underlying immune defects. An aggressive 6-drug combination chemotherapy regimen has been tried on patients whose tumors appeared to be life-threatening and was effective in controlling the Kaposi's sarcoma, but again did not appreciably alter immune parameters. Several other approaches to the treatment of epidemic Kaposi's sarcoma are under evaluation, including gamma interferon, interleukin-2, and plasmapheresis. Patients who develop malignant lymphomas require combined treatment with central nervous system radiation and systemic combination chemotherapy. There is no evidence that the antitumor responses obtained in AIDS

  17. Impact of Treatment for Depression on Desire for Hastened Death in Patients With Advanced AIDS

    PubMed Central

    Breitbart, William; Rosenfeld, Barry; Gibson, Christopher; Kramer, Michael; Li, Yuelin; Tomarken, Alexis; Nelson, Christian; Pessin, Hayley; Esch, Julie; Galietta, Michele; Garcia, Nerina; Brechtl, John; Schuster, Michael

    2013-01-01

    Background Despite the development of multi-drug regimens for HIV, palliative care and quality-of-life issues in patients with advanced AIDS remain important areas of clinical investigation. Objective Authors assessed the impact of treatment for depression on desire for hastened death in patients with advanced AIDS. Method Patients with advanced AIDS (N=372) were interviewed shortly after admission to a palliative-care facility, and were reinterviewed monthly for the next 2 months. Patients diagnosed with a major depressive syndrome were provided with antidepressant treatment and reinterviewed weekly. Desire for hastened death was assessed with two questionnaire measures. Results Desire for death was highly associated with depression, and it decreased dramatically in patients who responded to antidepressant treatment. Little change in desire for hastened death was observed in patients whose depression did not improve. Although improved depression was not significantly associated with the use of antidepressant medication, those individuals prescribed antidepressant medication showed the largest decreases in desire for hastened death. Discussion Successful treatment for depression appears to substantially decrease desire for hastened death in patients with advanced AIDS. The authors discuss implications of these findings for palliative-care treatment and the physician-assisted suicide debate. PMID:20332284

  18. Do physicians have an ethical obligation to care for patients with AIDS?

    PubMed Central

    Angoff, N. R.

    1991-01-01

    This paper responds to the question: Do physicians have an ethical obligation to care for patients with acquired immunodeficiency syndrome (AIDS)? First, the social and political milieu in which this question arises is sampled. Here physicians as well as other members of the community are found declaring an unwillingness to be exposed to people with AIDS. Next, laws, regulations, ethical codes and principles, and the history of the practice of medicine are examined, and the literature as it pertains to these areas is reviewed. The obligation to care for patients with AIDS, however, cannot be located in an orientation to morality defined in rules and codes and an appeal to legalistic fairness. By turning to the orientation to morality that emerges naturally from connection and is defined in caring, the physicians' ethical obligation to care for patients with AIDS is found. Through an exploration of the writings of modern medical ethicists, it is clear that the purpose of the practice of medicine is healing, which can only be accomplished in relationship to the patient. It is in relationship to patients that the physician has the opportunity for self-realization. In fact, the physician is physician in relationship to patients and only to the extent that he or she acts virtuously by being morally responsible for and to those patients. Not to do so diminishes the physician's ethical ideal, a vision of the physician as good physician, which has consequences for the physician's capacity to care and for the practice of medicine. PMID:1788990

  19. [Musculoskeletal disorders in HIV-infected patients.National AIDS Plan (PNS) and the AIDS Study Group (GESIDA)].

    PubMed

    2011-01-01

    The aim of this paper is to present the most relevant musculoskeletal disorders, their diagnosis and treatment to the scientific community and the professionals in charge of patients with human immunodeficiency virus (HIV) infection. These recommendations have been agreed by a panel of experts from the National AIDS Plan (PNS) and the AIDS Study Group (GESIDA). The group have reviewed the efficacy and safety results of clinical trials, cohort studies and pharmacokinetic studies published in biomedical journals (PubMed and Embase), or presented at conferences. Three levels of evidence have been defined according to the sources of data: level A, randomized controlled trials; level B, cohort or case-control; and level C, descriptive studies and expert opinion. Based on this evidence, the authors have decided to recommend, consider or not recommend for each situation. The decrease in bone mineral density is common in HIV-infected patients on antiretroviral treatment, especially during the first year (from 2 to 4%), with a subsequent partial recovery. A dual energy x-ray absorptiometry (DEXA) scan is recommended in patients over 50 years old with HIV infection, history of bone fractures and/or risk factors. Treatment with bisphosphonates has been shown to be effective. Osteoarticular infections are more frequent than in the non-infected population. The level of immunosuppression, risk practice, and antiretroviral treatment should be considered for a proper diagnosis and therapeutic approach. Laboratory and imaging procedures recommended for the study of musculoskeletal processes in HIV infected subjects are the same as in the general population. Osteonecrosis and decreased bone mineral density are the most frequent alterations in children. An early diagnosis of bone disorders is needed. The influence of modifiable risk factors must be avoided and initiate treatment when necessary. Bisphosphonates have been effective in osteoporosis.

  20. Vibrant Soundbridge and Bone Conduction Hearing Aid in Patients with Bilateral Malformation of External Ear.

    PubMed

    Mondelli, Maria Fernanda Capoani Garcia; Mariano, Thais Cristina Barbosa; Honório, Heitor Marques; Brito, Rubens Vuono de

    2016-01-01

    Introduction Hearing loss is the most common clinical finding in patients with malformation of the external ear canal. Among the possibilities of treatment, there is the adaptation of hearing aids by bone conduction and the adaptation of implantable hearing aids. Objective To assess speech perception with the use of Vibrant Soundbridge (VBS - MED-EL, Innsbruck, Austria) associated with additional amplification in patients with bilateral craniofacial malformation. Method We evaluated 11 patients with bilateral malformation over 12 years with mixed hearing loss or bilateral conductive. They were using the Softband (Oticon Medical, Sweden) and bone conduction hearing aid in the ear opposite the one with the VSB. We performed the evaluation of speech perception using the Hearing in Noise Test. Results Participants were eight men and three women with a mean of 19.5 years. The signal / noise ratio presented significant results in patients fitted with VSB and bone conduction hearing aid. Conclusion The results of speech perception were significantly better with use of VBS combined with bone conduction hearing aids.

  1. Vibrant Soundbridge and Bone Conduction Hearing Aid in Patients with Bilateral Malformation of External Ear

    PubMed Central

    Mondelli, Maria Fernanda Capoani Garcia; Mariano, Thais Cristina Barbosa; Honório, Heitor Marques; Brito, Rubens Vuono de

    2015-01-01

    Introduction Hearing loss is the most common clinical finding in patients with malformation of the external ear canal. Among the possibilities of treatment, there is the adaptation of hearing aids by bone conduction and the adaptation of implantable hearing aids. Objective To assess speech perception with the use of Vibrant Soundbridge (VBS - MED-EL, Innsbruck, Austria) associated with additional amplification in patients with bilateral craniofacial malformation. Method We evaluated 11 patients with bilateral malformation over 12 years with mixed hearing loss or bilateral conductive. They were using the Softband (Oticon Medical, Sweden) and bone conduction hearing aid in the ear opposite the one with the VSB. We performed the evaluation of speech perception using the Hearing in Noise Test. Results Participants were eight men and three women with a mean of 19.5 years. The signal / noise ratio presented significant results in patients fitted with VSB and bone conduction hearing aid. Conclusion The results of speech perception were significantly better with use of VBS combined with bone conduction hearing aids. PMID:26722343

  2. Immunotherapy and patients treated for cancer with microsatellite instability.

    PubMed

    Colle, Raphaël; Cohen, Romain; Cochereau, Delphine; Duval, Alex; Lascols, Olivier; Lopez-Trabada, Daniel; Afchain, Pauline; Trouilloud, Isabelle; Parc, Yann; Lefevre, Jérémie H; Fléjou, Jean-François; Svrcek, Magali; André, Thierry

    2017-01-01

    Microsatellite instability (MSI) is a tumor phenotype linked to somatic or germline (Lynch syndrome) inactivating alterations of DNA mismatch repair genes. A broad spectrum of neoplasms exhibits MSI phenotype, mainly colorectal cancer, endometrial cancer, and gastric cancer. MSI tumors are characterized by dense immune infiltration and high load of tumor neo-antigens. Growing evidence is accumulating on the efficacy of immune checkpoint inhibition for patients treated for MSI solid tumors. We present a comprehensive overview of MSI phenotype, its biological landscape and current diagnostic methods. Then we focus on MSI as a predictive biomarker of response to immune checkpoint inhibition in the context of colorectal cancer and non-colorectal tumors.

  3. Hepatic lesions in patients treated with synthetic anabolic steriods.

    PubMed

    Sweeney, E C; Evans, D J

    1976-07-01

    Hepatic abnormalities are described in three patients who received synthetic anabolic steroids. A child with Franconi's anaemia was treated for four years and at necropsy the liver showed generalized hyperplasia, hyperplastic nodules, and a benign hepatoma. Two adults received only three months' therapy with synthetic androgens; in one there was generalized hepatic hyperplasia and in the other widespread nodular hyperplasia. It is suggested that anabolic steroids may induce tumours through intermediate hyperplastic lesions, a sequence similar to that seen during tumour induction by carcinogens in experimental animals.

  4. Hepatic lesions in patients treated with synthetic anabolic steriods.

    PubMed Central

    Sweeney, E C; Evans, D J

    1976-01-01

    Hepatic abnormalities are described in three patients who received synthetic anabolic steroids. A child with Franconi's anaemia was treated for four years and at necropsy the liver showed generalized hyperplasia, hyperplastic nodules, and a benign hepatoma. Two adults received only three months' therapy with synthetic androgens; in one there was generalized hepatic hyperplasia and in the other widespread nodular hyperplasia. It is suggested that anabolic steroids may induce tumours through intermediate hyperplastic lesions, a sequence similar to that seen during tumour induction by carcinogens in experimental animals. Images PMID:185239

  5. Aspergillus Tracheobronchitis and Influenza A Co-infection in a Patient with AIDS and Neutropenia

    PubMed Central

    Lee, Ji-Yong; Yeom, Joon-Sup; Song, Jae-Uk; Yim, Seo-Hyung; Shin, Dong-Suk; Yu, Jung-Hee; Ju, Deok-Yun; Yim, Jae-Wan; Song, Young-Seok; Sohn, Yoon-Jeong; Do, Sung-Im

    2014-01-01

    Aspergillus tracheobronchitis (AT), an unusual form of invasive pulmonary aspergillosis (IPA), is characterized by pseudomembrane formation, ulcer or obstruction that is predominantly confined to tracheobronchial tree. Hematologic malignancies, neutropenia, solid organ transplantation, chronic corticosteroid therapy and acquired immunodeficiency syndrome (AIDS) are known to be major predisposing conditions. However, since the introduction of highly active antiretroviral therapy, there is only one reported case of AT in AIDS patient. After pandemic of influenza A/H1N1 2009, there are several reports of IPA in patient with influenza and most of them received corticosteroid or immunosuppressive therapy before the development of IPA. We present a 45 year-old AIDS patient with influenza A infection who developed pseudomembranous AT without corticosteroid use or immunosuppressive therapy. PMID:25298912

  6. First detection of acalculous cholecystitis associated with Sarcocystis infection in a patient with AIDS.

    PubMed

    Agholi, Mahmoud; Heidarian, Hamid Reza; Moghadami, Mohsen; Hatam, Gholam Reza

    2014-06-01

    Acalculous cholecystitis and cholangitis are increasingly being recognized as complications of AIDS. The opportunistic parasites that have been most commonly associated with these disorders are Cryptosporidium species, Isospora belli, Cyclospora cayetanensis and Enterocytozoon bieneusi. The authors performed a parasitological survey on the gallbladder tissue sections of patients underwent cholecystectomy due to chronic acalculous cholecystitis at the Shiraz University of Medical Sciences, Iran. Light microscopic investigation in more than three hundred archived histopathological slides revealed the presence of sexual stages (i.e., mature sporocysts) of a coccidial protozoan in a patient with AIDS who developed acalculous cholecystitis as confirmed by histological, parasitological and molecular tests in which Sarcocystis species was the only identifiable pathogen in gallbladder sections. In the best of our knowledge it's the first documented case of chronic non-calculous cholecystitis due to Sarcocystis parasite in an Iranian AIDS patient from worldwide.

  7. Opportunistic infections in patients treated with immunotherapy for cancer.

    PubMed

    Kyi, Chrisann; Hellmann, Matthew D; Wolchok, Jedd D; Chapman, Paul B; Postow, Michael A

    2014-01-01

    Immunomodulatory antibodies that enhance the immune system to fight cancer are revolutionizing the treatment of patients with an expanding variety of malignancies. There is a unique spectrum of side effects associated with immunomodulatory antibodies, termed immune-related adverse events (irAEs), which include colitis and hepatitis among others. The treatment of refractory or severe irAEs can occasionally require significant immunosuppression, involving steroids or tumor necrosis factor-alpha antagonists, placing these patients at risk for infections. We present the first reported case to our knowledge of an opportunistic infection in a patient treated with an immunomodulatory antibody. As the use of immunomodulatory antibodies expands and more patients develop irAEs that require treatment with immunosuppression, recognition of the potential for opportunistic infections in this emerging patient population will be critical. Prospective trials are needed to define the optimal immunosuppressive management of irAEs and determine whether prophylactic antiviral, antibacterial, or antifungal therapies are beneficial in this unique population.

  8. Hypothyroidism in patients with colorectal carcinoma treated with fluoropyrimidines.

    PubMed

    Fujiwara, Yutaka; Chayahara, Naoko; Mukohara, Toru; Kiyota, Naomi; Tomioka, Hideo; Funakoshi, Yohei; Minami, Hironobu

    2013-10-01

    Targeted therapy with tyrosine kinase inhibitors, including vascular endothelial growth factor receptors, has been demonstrated to induce hypothyroidism and thyroid dysfunction. Cancer patients with thyroid dysfunction may be underdiagnosed and undertreated. Thyroid function in colorectal cancer patients receiving fluoropyrimidine-based chemotherapy with or without bevacizumab was evaluated at baseline and monthly. In the present study, 3 of 27 (11.1%) patients who received fluoropyrimidine-based chemotherapy developed a thyroid-stimulating hormone (TSH) level >10 µU/ml, and 13 (48.1%) developed an elevation above the upper limit of the normal range. No difference in TSH elevation was noted between the bevacizumab and chemotherapy-alone group (50 vs. 45%; P=1.00, respectively). Three (11.1%) patients developed a TSH level >10 µU/ml and 2 with hypothyroidism were treated with thyroid hormone replacement therapy. We demonstrated that bevacizumab does not affect thyroid function but fluoropyrimidines may induce thyroid dysfunction in patients with colorectal cancer. Further investigation is required to clarify the mechanism of fluoropyrimidine-induced thyroid dysfunction.

  9. Thyroid hormone: a "prime suspect" in human immunodeficiency virus (HIV/AIDS) patients?

    PubMed

    Amadi, K; Sabo, A M; Ogunkeye, O O; Oluwole, F S

    2008-01-01

    Acquired Immunodeficiency Syndrome (AIDS) is the final and most serious stage of the disease caused by human immunodeficiency virus. The Immune system is the target of AIDS. We investigate presently any possible involvement of thyroid hormone, the deficiency of which gives rise to oedema and susceptibility to nonspecific infections; with a view to finding the primary factor seeding the disease. It has been reported that circumcision reduced the incidence of HIV/AIDS infection. Beyond circumcision however there might be some constitutional factor that comprises HIV infection to clinical AIDS. It is against this background that our research team turned to possible dyshormonopoisis and to thyroid hormone as a prime suspect among other possible factors that cause clinical AIDS. Moreover the hormone has been reported to be crucial for optimum immune function. A population of 200 seropositive AIDS patients were investigated against a control of 50 subjects made up of 25 healthy circumcised males and 25 healthy females; all of who were seronegative for the disease. The parameters investigated include thyrotropin (TSH), Thyroxine (T4), Total protein (TP), Albumin (Alb), Globulin (Glob), Immune complex (IC3) and Bence Jones proteins (BJP) levels in serum or urine. All seropositive clinically HIV/AIDS patients were hypothyroid. Seronegatives had significantly higher T4, TP, and Alb levels at P < 0.001 and P < 0.05 for Glob than seropositives. Seropositive females exhibited significant (P < 0.001) higher levels of IC3 than seronegative males. The globulin levels of all HIV patients were significantly (P < 0.05) higher than control. BJP was also isolated in the urine of patients. The findings suggest that thyroid hormone deficiency is a primary culprit for the other inert or dormant factors to be activated.

  10. Stigmatization of patients with HIV/AIDS among doctors and nurses in Belize.

    PubMed

    Andrewin, Aisha; Chien, Li-Yin

    2008-11-01

    This study, conducted from August to September 2007, utilized a population-based survey to investigate stigmatizing attitudes and acts of discrimination against HIV/AIDS patients among doctors and nurses working in public hospitals in Belize. A total of 230 subjects (81.0%) completed the survey. The mean age was 36.8 years; 75% were women; 61% were nurses; 74% were Belizean. Stigmatization was greatest for "attitudes of blame/judgment"; disclosing a patient's HIV/AIDS status to colleagues was the most frequent act of discrimination (29%). Formal HIV/AIDS training was significantly associated with less stigmatization for "attitudes towards imposed measures" (p < .01); "attitudes of blame/judgment" (p < 0.05); and testing without consent (p < 0.05). Doctors showed more stigmatization in "attitudes towards imposed measures," conducted HIV tests without consent and disclosed patient status to colleagues more frequently than nurses (p < 0.05) while nurses gave differential care to patients based on HIV status more frequently (p < 0.01) than doctors. Female and religious health care workers (HCWs) were more stigmatizing in their "attitudes of blame/judgment" than male and nonreligious HCWs (p < 0.05). Cuban HCWs were more stigmatizing in their "attitudes toward imposed measures" and were less comfortable dealing with HIV/AIDS patients than their Belizean counterparts (p < 0.01). Older age was associated with less frequent disclosure of patients' HIV status (p < 0.05). HIV/AIDS training that incorporates stigma reduction strategies tailored to the target groups identified is needed. Additionally, we recommend that the effectiveness of national HIV/AIDS policies be investigated.

  11. Sleep Disturbances and Nightmares in a Patient Treated with Prazosin.

    PubMed

    Kosari, Sam; Naunton, Mark

    2016-04-15

    Prazosin is increasingly being used off-label to treat nightmares in patients with posttraumatic stress disorder. The literature about the psychiatric adverse effects of prazosin is very limited. We present a case in which low-dose prazosin was associated with nightmares and sleep disturbances in an elderly patient without previously diagnosed mental illness or coexisting environmental risk factors for nightmares. Insomnia and hallucinations are listed as some of the rare side effects of prazosin by the manufacturer. Prazosin could be associated with rare psychiatric adverse effects and sleep disturbances. Particular attention is required in identifying these adverse effects, which can be difficult to distinguish from other drug-related side effects in the elderly particularly because they are often using multiple medications.

  12. Shared Decision Aids: Increasing Patient Acceptance of Long-Acting Reversible Contraception

    PubMed Central

    George, Tracy P.; DeCristofaro, Claire; Dumas, Bonnie P.; Murphy, Pamela F.

    2015-01-01

    Unintended pregnancies are an important public health issue. Long-acting reversible contraceptive methods (LARCs) are reliable, safe, highly effective methods for most women; however they are underutilized in the United States. Shared decision aids were added to usual care in five public health family planning clinics in the Southeastern United States, staffed by advance practice nurses and registered nurses. All five sites showed an increase in the use of LARCs during the time period that shared decision aids were used (results statistically significant to p < 0.001). It is important for women to make informed choices about contraception, and shared decision aids can be utilized to support this decision making. This resource has been adopted for statewide use in all public health clinics, and implications for practice suggest that the use of shared decision aids is an effective method to support informed patient decision making and acceptance of LARC methods of contraception. PMID:27417757

  13. Osteomyelitis and skin ulcers caused by Mycobacterium szulgai in an AIDS patient.

    PubMed

    Tappe, Dennis; Langmann, Peter; Zilly, Michael; Klinker, Hartwig; Schmausser, Bernd; Frosch, Matthias

    2004-01-01

    Mycobacterium szulgai is a ubiquitious non-tuberculous mycobacterium causing infection in immunocompetent and immunocompromized patients. Clinically mimicking pulmonary tuberculosis in most cases described, rarely other manifestations occur. Here we report the case of an AIDS patient with osteomyelitis of the hand and toe, accompanied by multiple cutaneous ulcers of the chest and forearm. The case highlights the unusual combination of osteomyelitis and skin ulcers without pulmonary infection and describes the likely cutaneous route of infection in a patient who keeps tropical fish.

  14. Psychological support and counselling for patients with acquired immune deficiency syndrome (AIDS).

    PubMed Central

    Miller, D; Green, J

    1985-01-01

    The growing numbers of patients with the acquired immune deficiency syndrome (AIDS) in England had led to the development of a counselling service for patients, their sexual partners, contacts, and others. The nature of the counselling is described with reference to the primary qualitative issues arising from diagnosis. The necessity for preventative education for patients and those at risk is stressed, and guidelines for low risk sexual activities are outlined. PMID:2991121

  15. Delivering patient decision aids on the Internet: definitions, theories, current evidence, and emerging research areas

    PubMed Central

    2013-01-01

    Background In 2005, the International Patient Decision Aids Standards Collaboration identified twelve quality dimensions to guide assessment of patient decision aids. One dimension—the delivery of patient decision aids on the Internet—is relevant when the Internet is used to provide some or all components of a patient decision aid. Building on the original background chapter, this paper provides an updated definition for this dimension, outlines a theoretical rationale, describes current evidence, and discusses emerging research areas. Methods An international, multidisciplinary panel of authors examined the relevant theoretical literature and empirical evidence through 2012. Results The updated definition distinguishes Internet-delivery of patient decision aids from online health information and clinical practice guidelines. Theories in cognitive psychology, decision psychology, communication, and education support the value of Internet features for providing interactive information and deliberative support. Dissemination and implementation theories support Internet-delivery for providing the right information (rapidly updated), to the right person (tailored), at the right time (the appropriate point in the decision making process). Additional efforts are needed to integrate the theoretical rationale and empirical evidence from health technology perspectives, such as consumer health informatics, user experience design, and human-computer interaction. Despite Internet usage ranging from 74% to 85% in developed countries and 80% of users searching for health information, it is unknown how many individuals specifically seek patient decision aids on the Internet. Among the 86 randomized controlled trials in the 2011 Cochrane Collaboration’s review of patient decision aids, only four studies focused on Internet-delivery. Given the limited number of published studies, this paper particularly focused on identifying gaps in the empirical evidence base and

  16. Gastroduodenal Cryptococcus in an AIDS Patient Presenting With Melena

    PubMed Central

    Liu, Yang; Patel, Anish A.; Shaw, Janet C.; Fillman, Eric P.; Lamb, Paul B.

    2013-01-01

    Gastrointestinal cryptococcosis is extremely rare with only a few case reports found in the literature and involvement primarily identified post-mortem. This is a case of 54-year-old man with a 20-year history of poorly controlled human immunodeficiency virus presented with constitutional symptoms along with melena. Diagnostic work up with esophagogastroduodenoscopy showed 4 irregular ulcers in the stomach notable for red-pigmented lesions within the ulcers, erythematous mucosa in the antrum and patchy friable mucosa in the duodenum. H&E staining and Mucicarmine staining showed findings consistent with C. neoformans. Blood culture and cerebrospinal fluid studies also revealed C. neoformans. Cryptococcus neoformans is an AIDS defining illness that most commonly presents as meningoencephalitis and pneumonitis. Key management principles includes: induction of antifungal therapy followed by consolidation and maintenance; management of elevated intracranial pressure and immune reconstitution inflammatory syndrome. Although the organism can infect nearly all organs, gastrointestinal involvement is rarely described. Our case highlights the fact that gastrointestinal C. neoformans infection can be associated with upper gastrointestinal symptoms and may be the initial presentation of disseminated cryptococcosis. PMID:27785222

  17. Case of glioblastoma patient treated with tumor treating fields therapy at recurrence degenerating to sarcoma.

    PubMed

    Majd, Pejman; O'Connell, Daniel E; Kim, Ronald C; Bota, Daniela A; Carrillo, Jose A

    2017-03-17

    Optune(®) treatment is a US FDA-approved treatment for glioblastoma (GBM) that employs alternating electric fields. Tumor treating field (TTF) therapy can exert its effects on GBM via cell cycle mitosis disruption and cytokinesis. We describe a patient with recurrent GBM who had disease progression following standard surgical treatment and concomitant chemoradiotherapy, and was found to have sarcomatous transformation after initiation of TTF therapy with bevacizumab. Upon tumor progression, repeat surgical resection revealed transformation into a GFAP-negative, reticulin-positive sarcoma with rhabdomyoid features. The possibility of a causal connection between TTF therapy and sarcomatous transformation needs to be further evaluated. No such case of apparent sarcoma formation in the CNS following chemoradiotherapy and/or TTF treatment for GBM has been reported.

  18. Neurological Complications of AIDS

    MedlinePlus

    ... the neurological complications of AIDS. Some disorders require aggressive therapy while others are treated symptomatically. Medicines range ... certain bacterial infections, and penicillin to treat neurosyphilis. Aggressive antiretroviral therapy is used to treat AIDS dementia ...

  19. How I treat patients with advanced systemic mastocytosis.

    PubMed

    Valent, Peter; Sperr, Wolfgang R; Akin, Cem

    2010-12-23

    Advanced systemic mastocytosis (SM) is a rare myeloid neoplasm characterized by uncontrolled accumulation of neoplastic mast cells (MCs) in various organs with consecutive impairment of organ function, drug resistance, and a poor prognosis. Advanced SM may present as smoldering or slowly progressing neoplasm but may also present as rapidly progressing aggressive SM or even as MC leukemia. Approximately half of the patients have an associated hematologic non-MC-lineage disease (SM-AHNMD) or develop an AHNMD over time. Drug resistance may not only result from the KIT mutant D816V that is found in most patients, but also from KIT-independent pro-oncogenic signaling pathways that play a role in disease evolution. In patients with slow progression, advanced SM can often be kept under control for months with interferon-α or 2CdA. By contrast, in rapidly progressing aggressive SM and MC leukemia, even polychemotherapy and hematopoietic stem cell transplantation may fail, which points to the need to develop new drugs and treatment concepts for these patients. In SM-AHNMD, separate treatment plans should be established for the SM component and the AHNMD component of the disease, with recognition that the AHNMD often has to be managed and treated as a secondary and thus a high-risk neoplasm.

  20. Venetoclax in patients with previously treated chronic lymphocytic leukemia.

    PubMed

    Roberts, Andrew W; Stilgenbauer, Stephan; Seymour, John F; Huang, David C S

    2017-01-18

    Venetoclax is the first BCL2 inhibitor to enter routine clinical practice. It is an orally bioavailable small molecule that binds BCL2 very specifically. Acting as a pharmacological mimic of the proteins that initiate apoptosis (a so-called BH3-mimetic), venetoclax rapidly induces apoptosis in chronic lymphocytic leukemia (CLL) cells which express high levels of BCL2 and rely on it to maintain their survival. As a single agent, daily venetoclax treatment induced durable responses in 79% of patients with relapsed or refractory CLL or small lymphocytic lymphoma in a Phase 1 study, including complete remissions in 20% of patients. Its use was approved by the FDA in April 2016 for patients with previously treated del(17p) CLL on the basis of a single arm Phase 2 trial demonstrating a 79% response rate and an estimated 1 year progression-free survival of 72% with 400mg/day continuous therapy. This review focuses on venetoclax, its mechanism-of-action, pharmacology and clinical trial data, and seeks to place it in the context of rapid advances in therapy for patients with relapsed CLL, especially those with del(17p) CLL.

  1. [Tuberculosis in HIV-infected and AIDS patients].

    PubMed

    Rakhmanova, A G; Stepanova, E V; Romanova, E I; Evseeva, I D

    2003-01-01

    The course of the combined infection (tuberculosis plus HIV-infection) has been analysed in 41 patients. Of them, 24 patients developed tuberculosis in the presence of HIV-infection (group 1) and 17 were infected with HIV when they already had tuberculosis running up to 5 years. HIV-infection in group 1 ran a more severe course, the patients developed generalized, disseminated and complicated forms of tuberculosis with more frequent lethal outcome. 39 patients of both groups received specific antituberculous therapy including 1-5 drugs. A response to treatment was achieved in 23 (60%) patients (52 and 47.8% at early and late HIV-infection stages, respectively). Treatment failure was explained by development of severe opportunistic infections and secondary diseases (generalized cytomegalovirus infection, advanced candidiasis, toxoplasmosis), poor compliance, asocial life style, advanced tuberculosis process, late diagnosis, inadequate treatment. It is shown that in late HIV-infection positive results of treatment can be expected only in early detection of tuberculosis and active long-term treatment.

  2. A comparison of death anxiety and quality of life of patients with advanced cancer or AIDS and their family caregivers.

    PubMed

    Sherman, Deborah Witt; Norman, Robert; McSherry, Christina Beyer

    2010-01-01

    As an existential crisis, death anxiety may create suffering and impact quality of life. Based on a sample of 101 patients (63 patients with AIDS and 38 with advanced cancer) and 79 family caregivers (43 AIDS patients' caregivers and 36 cancer patients' caregivers), this study examined the death anxiety of patients with advanced cancer and patients with AIDS and that of their family caregivers and the relationship of death anxiety and quality of life. The results indicated that AIDS patients expressed greater death anxiety than cancer patients, but death anxiety was not different among family caregivers. Both AIDS and cancer patients experienced greater death anxiety than their caregivers. Greater death anxiety was associated with lower quality of life, particularly in the psychological domain for AIDS patients. There were significant correlations between the death anxiety subscales and the quality of life subscales for family caregivers, especially for AIDS caregivers. Interventions that lessen death anxiety may enhance quality of life as death approaches, particularly for AIDS patients and their family caregivers.

  3. Design and development of a decision aid to enhance shared decision making by patients with an asymptomatic abdominal aortic aneurysm

    PubMed Central

    Ubbink, Dirk T; Knops, Anouk M; Molenaar, Sjaak; Goossens, Astrid

    2008-01-01

    Objective To design, develop, and evaluate an evidence-based decision aid (DA) for patients with an asymptomatic abdominal aortic aneurysm (AAA) to inform them about the pros and cons of their treatment options (ie, surgery or watchful observation) and to help them make a shared decision. Methods A multidisciplinary team defined criteria for the desired DA as to design, medical content and functionality, particularly for elderly users. Development was according to the international standard (IPDAS). Fifteen patients with an AAA, who were either treated or not yet treated, evaluated the tool. Results A DA was developed to offer information about the disease, the risks and benefits of surgical treatment and watchful observation, and the individual possibilities and threats based on the patient’s aneurysm diameter and risk profile. The DA was improved and judged favorably by physicians and patients. Conclusion This evidence-based DA for AAA patients, developed according to IPDAS criteria, is likely to be a simple, user-friendly tool to offer patients evidence-based information about the pros and cons of treatment options for AAA, to improve patients’ understanding of the disease and treatment options, and may support decision making based on individual values. PMID:19920978

  4. Biochemical aids in the monitoring of patients with ovarian cancer.

    PubMed

    Meerwaldt, J H; Haije, W G; Cooper, E H; Pidcock, N B; v d Burg, M E

    1983-10-01

    A study of possible biochemical markers of tumor recurrence and progression was made in 93 patients with ovarian cancer followed longitudinally for up to 2 years during treatment by moderate or aggressive chemotherapy regimens. A panel of potential indicators was tested; the combination of serum albumin, C-reactive protein, alpha 1-acid glycoprotein, and phosphohexose isomerase levels was found to provide information that is useful as an adjunct to the clinical assessment of patients with advanced disease. However, the system could not detect a small tumor burden. The level of beta 2-microglobulin may have value in those patients whose tumor is associated with an increase of this analyte (77%), but it would appear to reflect a large tumor mass. Serum CEA, carcino-placental alkaline phosphatase, transferrin, and prealbumin were not found to be helpful.

  5. The changing characteristics of atrial fibrillation patients treated with warfarin.

    PubMed

    Putnam, Andrew; Gu, Xiaokui; Haymart, Brian; Kline-Rogers, Eva; Almany, Steve; Kozlowski, Jay; Krol, Gregory D; Kaatz, Scott; Froehlich, James B; Barnes, Geoffrey D

    2015-11-01

    It has been suggested that direct oral anticoagulants are being preferentially used in low risk atrial fibrillation (AF) patients. Understanding the changing risk profile of new AF patients treated with warfarin is important for interpreting the quality of warfarin delivery through an anticoagulation clinic. Six anticoagulation clinics participating in the Michigan Anticoagulation Quality Improvement Initiative enrolled 1293 AF patients between 2010 and 2014 as an inception cohort. Abstracted data included demographics, comorbidities, medication use and all INR values. Risk scores including CHADS2, CHA2DS2-VASc, HAS-BLED, SAMe-TT2R2, and Charlson comorbidity index (CCI) were calculated for each patient at the time of warfarin initiation. The quality of anticoagulation was assessed using the Rosendaal time in the therapeutic range (TTR) during the first 6 months of treatment. Between 2010 and 2014, patients initiating warfarin therapy for AF had an increasing mean CHADS2 (2.0 ± 1.1 to 2.2 ± 1.4, p = 0.02) and CCI (4.7 ± 1.8 to 5.1 ± 2.0, p = 0.03), and a trend towards increasing mean CHA2DS2-VASc, HAS-BLED, and SAMe-TT2R2 scores. The actual TTR remained unchanged over the study period (62.6 ± 18.2 to 62.7 ± 17.0, p = 0.98), and the number of INR checks did not change (18.9 ± 5.2 to 18.5 ± 5.1, p = 0.06). Between 2010 and 2014, AF patients newly starting warfarin had mild increases in risk for stroke and death with sustained quality of warfarin therapy.

  6. The changing characteristics of atrial fibrillation patients treated with warfarin

    PubMed Central

    Gu, Xiaokui; Haymart, Brian; Kline-Rogers, Eva; Almany, Steve; Kozlowski, Jay; Krol, Gregory D.; Kaatz, Scott; Froehlich, James B.; Barnes, Geoffrey D.

    2016-01-01

    It has been suggested that direct oral anticoagulants are being preferentially used in low risk atrial fibrillation (AF) patients. Understanding the changing risk profile of new AF patients treated with warfarin is important for interpreting the quality of warfarin delivery through an anticoagulation clinic. Six anticoagulation clinics participating in the Michigan Anticoagulation Quality Improvement Initiative enrolled 1293 AF patients between 2010 and 2014 as an inception cohort. Abstracted data included demographics, comorbidities, medication use and all INR values. Risk scores including CHADS2, CHA2DS2-VASc, HAS-BLED, SAMe-TT2R2, and Charlson comorbidity index (CCI) were calculated for each patient at the time of warfarin initiation. The quality of anticoagulation was assessed using the Rosendaal time in the therapeutic range (TTR) during the first 6 months of treatment. Between 2010 and 2014, patients initiating warfarin therapy for AF had an increasing mean CHADS2 (2.0 ± 1.1 to 2.2 ± 1.4, p = 0.02) and CCI (4.7 ± 1.8 to 5.1 ± 2.0, p = 0.03), and a trend towards increasing mean CHA2DS2-VASc, HAS-BLED, and SAMe-TT2R2 scores. The actual TTR remained unchanged over the study period (62.6 ± 18.2 to 62.7 ± 17.0, p = 0.98), and the number of INR checks did not change (18.9 ± 5.2 to 18.5 ± 5.1, p = 0.06). Between 2010 and 2014, AF patients newly starting warfarin had mild increases in risk for stroke and death with sustained quality of warfarin therapy. PMID:26130229

  7. Interpretation of chest radiographs in AIDS patients: usefulness of CD4 lymphocyte counts.

    PubMed

    Shah, R M; Kaji, A V; Ostrum, B J; Friedman, A C

    1997-01-01

    Specific infections and neoplasms that are complications of acquired immunodeficiency syndrome (AIDS) occur within various CD4 lymphocyte count ranges. Knowledge of how these counts correlate with radiographic appearances of these entities can limit the differential diagnosis because certain conditions are uncommon above a specific count. In patients with CD4 lymphocyte counts above 200 cells/mm3 and radiographic findings of cavitary and noncavitary consolidation, bacterial pneumonia and Mycobacterium tuberculosis are the major diagnostic considerations. As the CD4 lymphocyte count falls, these infections are still common; however, cavitation is seen less frequently with Mycobacterium tuberculosis, and unusual bacterial infections, including those caused by Rhodococcus equi and Nocardia asteroides, should be considered. In patients with counts below 200 cells/mm3, Pneumocystis carinii pneumonia is the most common infection, usually manifesting radiographically as a reticular interstitial pattern. At CD4 lymphocyte counts of 50-200 cells/mm3, disseminated fungal infection and Kaposi sarcoma become prevalent. In patients with advanced AIDS and counts below 50 cells/mm3, radiographic nodular or reticular patterns may indicate AIDS-related lymphoma and cytomegalovirus and Mycobacterium avium-intracellulare infections. When CD4 lymphocyte counts are applied to interpretation of chest radiographs in AIDS patients, the working differential diagnosis of a radiographic pattern can be tailored to the clinical situation of a given patient.

  8. Trustworthy patient decision aids: a qualitative analysis addressing the risk of competing interests

    PubMed Central

    Elwyn, Glyn; Dannenberg, Michelle; Blaine, Arianna; Poddar, Urbashi; Durand, Marie-Anne

    2016-01-01

    Objective Our aim in this study was to examine the competing interest policies and procedures of organisations who develop and maintain patient decision aids. Design Descriptive and thematic analysis of data collected from a cross-sectional survey of patient decision aid developer's competing interest policies and disclosure forms. Results We contacted 25 organisations likely to meet the inclusion criteria. 12 eligible organisations provided data. 11 organisations did not reply and 2 declined to participate. Most patient decision aid developers recognise the need to consider the issue of competing interests. Assessment processes vary widely and, for the most part, are insufficiently robust to minimise the risk of competing interests. Only half of the 12 organisations had competing interest policies. Some considered disclosure to be sufficient, while others imposed differing levels of exclusion. Conclusions Patient decision aid developers do not have a consistent approach to managing competing interests. Some have developed policies and procedures, while others pay no attention to the issue. As is the case for clinical practice guidelines, increasing attention will need to be given to how the competing interests of contributors of evidence-based publications may influence materials, especially if they are designed for patient use. PMID:27612542

  9. [Characterization of Cryptococcus neoformans strains isolated from patients with acquired immunodeficiency syndrome (AIDS)].

    PubMed

    Garza-Garza, D; Buendía-Uribe, J L; Martínez-Cruz, E; Argüero-Licea, B

    1995-01-01

    In Mexico cryptococosis ranks third in frequency among the mycoses ocurring as complications in AIDS patients. Neither the prevalence of the two varieties of C. neoformans in these patients nor the morphological and physiological changes suffered by these strains in AIDS patients are known. A total of 60 isolates were obtained from patients with AIDS from the Hospital de Infectología, Centro Médico "La Raza" IMSS. The identity of each isolate was established by: growth at 37 degrees C, colony and microscopic characteristics, urease and phenoloxidase activity, carbon sources assimilation. The canavanine glycine-bromothymol blue agar was used to distinguish C. neoformans var. neoformans and C. neoformans var. gattii. Pathogenicity in mice was also tested. Fifty one isolates of C. neoformans var. neoformans and nine of C. neoformans var. gattii were identified. All strains grew well at 37 degrees C, urease and phenoloxidase were positive, the morphology and the auxanographic profile were variable. C. neoformans var. neoformans was more virulent in mouse than C. neoformans var. gattii. This study has confirmed the presence of the two varieties of C. neoformans in Mexico with 85% prevalence of var. neoformans and 15% of var. gattii in AIDS patients. This frequency was higher than in reports from other countries.

  10. Immunologic studies in asymptomatic hemophilia patients. Relationship to acquired immune deficiency syndrome (AIDS).

    PubMed

    Landay, A; Poon, M C; Abo, T; Stagno, S; Lurie, A; Cooper, M D

    1983-05-01

    Asymptomatic hemophilia patients receiving Factor VIII concentrate were found to have normal natural killer (NK) cells and B cells, and an inverted T helper/suppressor ratio due to an increase in cells of T suppressor phenotype. In contrast, a hemophilia patient with acquired immune deficiency syndrome (AIDS) exhibited nonfunctional NK cells, low B cells, and an inverted T helper/suppressor ratio due to very low numbers of T helper cells. Hemophilia patients on cryoprecipitate therapy exhibited normal immune parameters. A high percentage of hemophilia patients on both treatments had antibody to hepatitis B virus. The isolated finding of elevated levels of T suppressor cells in hemophilia patients receiving Factor VIII concentrate has not been recognized as an early indicator of impending AIDS, and longitudinal studies will be required to determine its clinical significance.

  11. [The strategy of emergency aid to patients with botulism].

    PubMed

    Urazbakhtina, Z A; Tuktarova, R R; Ivanov, V B; Sarmanaev, S Kh

    2014-01-01

    This clinical observation demonstrates difficulty of differential diagnostics of botulism in a patient suspected to have acute pancreatitis and admitted to a multifield medical institution. Difficulties of interpretation of urgent clinical and instrumental examination are discussed. The therapeutic strategy is described.

  12. Assessment of ventricular diastolic function in AIDS patients from Congo: a Doppler echocardiographic study

    PubMed Central

    Longo-Mbenza, B; Seghers, L; Vita, E; Tonduangu, K; Bayekula, M

    1998-01-01

    Objective—To investigate the prevalence of left ventricular dysfunction in African patients infected with the human immunodeficiency virus (HIV). The hypothesis was that HIV infected patients with left ventricular dysfunction are asymptomatic.
Methods—M mode, cross sectional, and Doppler echocardiography were performed in 49 consecutive patients (30 HIV positive (HIV+) carriers and 19 AIDS patients). None of the patients or 58 controls had a medical history of cardiovascular abnormalities.
Results—Cardiac abnormalities were not suspected on physical, electrocardiographic, and radiological examination. Forty two of the HIV infected patients had left ventricular diastolic dysfunction; this was more pronounced in AIDS patients than in HIV+ carriers. Systolic function was normal in both stages of HIV infection. Left ventricular isovolumic relaxation time (mean (SD)) increased from 87.2 (12.4) ms in the carrier state to 103.9 (19.3) ms in AIDS (p < 0.05, Bonferoni correction), peak early filling velocity declined from 0.54 (0.1) to 0.44 (0.1) m/s (p < 0.05), and late velocity increased from 0.64 (0.1) to 0.69 (0.2) m/s. A restrictive filling pattern was explained by concentric hypertrophy in 23 HIV infected patients, and by systemic amyloidosis with left ventricular dilatation in 12 of 49 HIV infected patients.
Conclusions—Echocardiography is a useful technique for detecting left ventricular diastolic dysfunction in HIV infected patients with clinically unsuspected cardiac lesions. Systolic function was normal despite the presence of such cardiac abnormalities.

 Keywords: HIV infection;  AIDS;  diastolic dysfunction;  black Africans;  echocardiography PMID:9813567

  13. Searching for biomarkers of comorbidities in sera of treated HIV-infected patients by isoelectric focusing.

    PubMed

    Malvoisin, Etienne; Makhloufi, Djamila; Livrozet, Jean-Michel

    2015-06-01

    Based on their characteristics, we hypothesized that the following parameters, namely collagen IV, glutathione S-transferase, secretory component (SC), and AMP-activated protein kinase α1α2 may be useful serum markers in the detection of comorbidities in treated HIV-infected patients. These parameters were determined in 204 HIV-infected patients and 35 controls by using IEF and densitometry. Collagen IV was undetectable in controls and the majority of HIV-infected patients. Twenty-two HIV-infected patients presented significantly elevated levels of collagen IV, most of them were coinfected with hepatitis C virus and/or hepatitis B virus. SC was undetectable in controls. SC was significantly increased in 81 HIV-infected patients and significantly correlated with aspartate aminotransferase (r = 0.267, p = 0.0049), alkaline phosphatase (r = 0.309, p = 0.0011), and γ-glutamyl-transferase (r = 0.264, p = 0.0054). Glutathione S-transferase levels of HIV-infected patients were significantly higher than the controls (3779 ± 5860 vs. 785 ± 71 DU, p = 0.0007) and significantly correlated with serum urea (r = 0.204, p = 0.0038), triglycerides (r = 0.209, p = 0.0033), and lipase (r = 0.219, p = 0.0025). AMP-activated protein kinase α1α2 levels of HIV-infected patients were significantly higher than the controls (5676 ± 6248 vs. 1189 ± 6248 DU, p = 0.0009). Further studies are needed to demonstrate the relevance of these results to diagnose non-AIDS-related illnesses in HIV-infected patients.

  14. Disseminated toxoplasmosis presenting as sepsis in two AIDS patients.

    PubMed

    Barbosa, Carlos José Dornas Gonçalves; Molina, Rodrigo Juliano; de Souza, Murilo Barcelos; Silva, Ana Cristina A; Micheletti, Adilha Rua; dos Reis, Marlene Antonia; de Paula Antunes Teixeira, Vicente; Silva-Vergara, Mario León

    2007-01-01

    This report describes two patients who presented acute disseminated and severe toxoplasmosis as the first opportunistic disease related to acquired immunodeficiency syndrome. At admission, clinical and laboratory findings were similar to sepsis or septic shock and a fast evolutive course to death occurred in both cases. At necropsy, an inflammatory reaction and presence of a great number of Toxoplasma gondii cysts and tachyzoites were observed in most organs examined.

  15. Incidental finding of a microsporidian parasite from an AIDS patient.

    PubMed Central

    McDougall, R J; Tandy, M W; Boreham, R E; Stenzel, D J; O'Donoghue, P J

    1993-01-01

    Light microscopic examination of feces from a human immunodeficiency virus-positive patient with chronic diarrhea, anorexia, and lethargy revealed the presence of numerous refractile bodies resembling microsporidian spores. They were subsequently identified as belonging to the genus Nosema on the basis of their ultrastructural characteristics. However, the microsporidia were enclosed within striated muscle cells, suggesting that they were probably ingested in food; thus, this represented an incidental finding rather than a true infection. Images PMID:8432833

  16. Lingual ulcer as the only sign of recurrent mycobacterial infection in an HIV/AIDS-infected patient.

    PubMed

    Ramírez-Amador, Velia; Anaya-Saavedra, Gabriela; González-Ramírez, Imelda; Mosqueda-Gómez, Juan Luis; Esquivel-Pedraza, Lilly; Reyes-Gutiérrez, Edgardo; Sierra-Madero, Juan

    2005-01-01

    The report describes an HIV/AIDS patient seen at a referral center in Mexico City, in whom a mycobacterial infection in the oral mucosa, probably tuberculosis (TB) was identified. The purpose is to describe the clinical and histological findings in an HIV-infected patient, who after being treated successfully for tuberculous lymphangitis 4 years ago, presented with a lingual ulcer as the only suggestive sign of recurrence of mycobacterial infection, probably M. tuberculosis. A 39-year-old man seen in the HIV clinic of the Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" in Mexico City since 1991 for HIV infection. In 1999 the patient developed tuberculous lymphangitis; he was managed with a 4-drug regimen for 12 months, with improvement of local and systemic symptoms. In May of 2003, the patient presented a painful superficial lingual ulcer, 0.7 cm in diameter, well circumscribed, crateriform with slightly elevated, irregular and indurated borders, of 4 months duration. The histopathological examination showed chronic granulomatous inflammation with giant multinucleated cells, suggestive of mycobacterial infection, and recurrence of TB was considered. Rifampin, isoniazide, pyrazinamide, ethambutol and streptomycin were administered. The lingual lesion improved with partial healing at the first week and total remission at 45 days after the beginning of the antituberculous treatment. In June, 2003, the patient began highly active antiretroviral therapy (HAART) that included two NRTIs and one NNRTI. At 7 months of follow-up, the patient remains free of lingual lesions. The particularity of the present case is that the lingual ulcer was the only sign of infection by mycobacteria, suggestive of TB, in an HIV/AIDS patient that probably represented a recurrence of a previous episode.

  17. Assessing the impact of HAART on the incidence of defining and non-defining AIDS cancers among patients with HIV/AIDS: a systematic review.

    PubMed

    Cobucci, Ricardo Ney Oliveira; Lima, Paulo Henrique; de Souza, Pollyana Carvalho; Costa, Vanessa Viana; Cornetta, Maria da Conceição de Mesquita; Fernandes, José Veríssimo; Gonçalves, Ana Katherine

    2015-01-01

    After highly active antiretroviral therapy (HAART) became widespread, several studies demonstrated changes in the incidence of defining and non-defining AIDS cancers among HIV/AIDS patients. We conducted a systematic review of observational studies evaluating the incidence of malignancies before and after the introduction of HAART in people with HIV/AIDS. Eligible studies were searched up to December 2012 in the following databases: Pubmed, Embase, Scielo, Cancerlit and Google Scholar. In this study, we determined the cancer risk ratio by comparing the pre- and post-HAART eras. Twenty-one relevant articles were found, involving more than 600,000 people with HIV/AIDS and 10,891 new cases of cancers. The risk for the development of an AIDS-defining cancer decreased after the introduction of HAART: Kaposi's sarcoma (RR=0.30, 95% CI: 0.28-0.33) and non-Hodgkin's lymphoma (RR=0.52, 95% CI: 0.48-0.56), in contrast to invasive cervical cancer (RR=1.46, 95% CI: 1.09-1.94). Among the non-AIDS-defining cancers, the overall risk increased after the introduction of HAART (RR=2.00, 95% CI: 1.79-2.23). The incidence of AIDS-defining cancers decreased and the incidence of non-AIDS-defining cancers increased after the early use of HAART, probably due to better control of viral replication, increased immunity and increased survival provided by new drugs.

  18. Access to antiretroviral therapy among HIV/AIDS patients in Chiang Mai province, Thailand

    PubMed Central

    Himakalasa, Woraluck; Grisurapong, Siriwan; Phuangsaichai, Sasipen

    2013-01-01

    The objective of this study is to investigate the access to antiretroviral treatment among human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients in Chiang Mai province, Thailand. Access to antiretroviral treatment is defined in terms of availability, affordability, and acceptability. The data for the study were collected during the period of April 1, 2012–May 31, 2012 from a sample of 380 HIV/AIDS patients in eight hospitals who had received antiretroviral treatment for more than 6 months at the time of data collection. The results of the study show that for most patients, the average traveling time to access health care was acceptable, but the nearly half day waiting time caused them to be absent from their work. In particular, it took longer for patients in the rural and lower income groups to access the treatment than the other groups. Their travel times and food costs relating to the treatment were found to be relatively high and therefore these patients had a higher tendency to borrow or seek financial assistance from their relatives. However, due to improvements in the access to treatment, most patients were satisfied with the services they received. The results imply that policy should be implemented to raise the potential of subdistrict hospitals where access to antiretroviral treatment is available, with participating HIV/AIDS patients acting as volunteers in providing services and other forms of health promotion to new patients. Privacy issues could be reduced if the antiretroviral treatment was isolated from other health services. Additionally, efforts to educate HIV/AIDS patients and society at large should be made. PMID:23986652

  19. Assessing Riverside Community College Nursing Student Attitudes toward Exposure to AIDS/HIV-Positive Patients.

    ERIC Educational Resources Information Center

    Kross, Carolyn Sue

    In fall 1990, a study was conducted to assess the attitudes of nursing students who were attending Riverside Community College (RCC), in California, toward exposure to Acquired Immune Deficiency Syndrome/Human Immunodeficiency Virus (AIDS/HIV) positive patients in a hospital setting. All students enrolled in RCC's associate degree nursing program…

  20. Both IgA subclasses are reduced in parotid saliva from patients with AIDS.

    PubMed Central

    Müller, F; Frøland, S S; Hvatum, M; Radl, J; Brandtzaeg, P

    1991-01-01

    Secretory IgA (SIgA), the isotypes IgA1 and IgA2, and IgM were measured by ELISA in stimulated parotid saliva from patients with AIDS (n = 16), subjects with asymptomatic HIV infection (n = 28), and HIV-seronegative healthy controls (n = 19). SIgA was significantly reduced in the AIDS group (10.4 micrograms/ml) compared with the asymptomatic HIV-infected subjects (17.1 micrograms/ml) and the controls (23.0 micrograms/ml). This decrease comprised both IgA1 and IgA2 to a similar extent on a relative basis. The SIgA decrease in AIDS patients was in striking contrast to their serum IgA level, which was significantly increased (6.9 g/l) compared with the asymptomatic HIV-infected subjects (2.9 g/l) as well as the controls (2.8 g/l). Low parotid output of SIgA in patients with HIV infection was associated with low numbers of CD4+ lymphocytes in peripheral blood as well as the presence of oral infections. The parotid output of IgM was similar in all groups. A low level of SIgA in the external secretions of patients with AIDS may well contribute to their frequent mucosal infections of opportunistic microorganisms. PMID:1899629

  1. INTESTINAL AND PULMONARY INFECTION BY Cryptosporidium parvum IN TWO PATIENTS WITH HIV/AIDS

    PubMed Central

    REINA, Fábio Tadeu Rodrigues; RIBEIRO, Camila Aparecida; de ARAÚJO, Ronalda Silva; MATTÉ, Maria Helena; CASTANHO, Roberto Esteves Pires; TANAKA, Ioshie Ibara; VIGGIANI, Ana Maria Ferreira Sornas; MARTINS, Luciamáre Perinetti Alves

    2016-01-01

    We describe two patients with HIV/AIDS who presented pulmonary and intestinal infection caused by Cryptosporidium parvum, with a fatal outcome. The lack of available description of changes in clinical signs and radiographic characteristics of this disease when it is located in the extra-intestinal region causes low prevalence of early diagnosis and a subsequent lack of treatment. PMID:27007564

  2. Predictors of Medication Adherence in an AIDS Clinical Trial: Patient and Clinician Perceptions

    ERIC Educational Resources Information Center

    Cox, Lisa E.

    2009-01-01

    This article presents data from an AIDS clinical trial that evaluated 238 (60 percent nonwhite) patients infected with HIV and their clinician's perceptions of medication adherence and visit attendance in relationship to lifestyle, psychosocial, and health belief model (HBM) variables. Twelve sites collected data via a prospective, multisite…

  3. 21 CFR 801.420 - Hearing aid devices; professional and patient labeling.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Hearing aid devices; professional and patient... a waiver statement declining the medical evaluation for religious or personal beliefs that preclude... strongly discouraged. children with hearing loss In addition to seeing a physician for a medical...

  4. 21 CFR 801.420 - Hearing aid devices; professional and patient labeling.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Hearing aid devices; professional and patient... a waiver statement declining the medical evaluation for religious or personal beliefs that preclude... strongly discouraged. children with hearing loss In addition to seeing a physician for a medical...

  5. 21 CFR 801.420 - Hearing aid devices; professional and patient labeling.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hearing aid devices; professional and patient... a waiver statement declining the medical evaluation for religious or personal beliefs that preclude... strongly discouraged. children with hearing loss In addition to seeing a physician for a medical...

  6. Anti-chlamydophila pneumoniae antibodies as associated factor for carotid atherosclerosis in patients with AIDS.

    PubMed

    Gaona-Flores, Verónica; García-Elorriaga, Guadalupe; Valerio-Minero, Maricela; González-Veyrand, Emma; Navarrete-Castro, Rogelio; Palacios-Jiménez, Norma; Del Rey-Pineda, Guillermo; González-Bonilla, César; Monasta, Lorenzo

    2008-05-01

    Atherosclerosis is a multifactor disease. Lately, infectious factors such as C. pneumoniae have been found to be involved. To determine whether the infection by C. pneumoniae is a risk factor for atherosclerosis in patients with AIDS. Case-control study on 43 patients with AIDS under HAART (16 cases and 27 controls). To document atherosclerosis, a carotid and transcranial Doppler ultrasound was performed. Anti-C pneumoniae antibodies were searched using a microimmunofluorescence test for IgM and IgG levels. To study the associations with risk of atherosclerosis, Odds Ratios were calculated for each IgG anti-C. pneumoniae antibody titre. A titre of 1:64 significantly increased the risk of atherosclerosis. These results suggest that hypertriglyceridemia and C. pneumoniae infection coexistence significantly increases the risk of atherosclerosis. The inverse geometric average of the antibodies titre against C. pneumoniae in individuals with atheromatous plaque fell to 64, two titres above the controls. This difference turned out to be statistically significant. Exposure to C. pneumoniae with antibodies (IgG) should be considered in any HIV diagnosed patient as a risk factor for atherosclerosis, having found that the inverse geometric averages of antibodies titre are significantly different comparing cases and controls, especially in patients with dyslipidemia, hypertriglyceridemia or in patients whose treatments could cause these conditions. In patients with concomitant hypertriglyceridemia, the association increases up to three times. It is advisable that AIDS patients take a serological test to determine exposure to C. pneumoniae, and to assess treatment options.

  7. [Organization of therapeutic aid to patients with hereditary neuromuscular diseases].

    PubMed

    Kalinin, V A; Temin, P A; Arkhipov, B A; Zavadenko, N N

    1989-01-01

    The paper summarizes experience gained for many years by the All-Union Research Methodological Center for Study of Hereditary Neuromuscular Diseases. The specialists of the Center render counselling and therapeutic assistance to patients afflicted with neuromuscular diseases. The counselling and diagnostic services are characterized by the fact that it is based on the activity of a large hospital intended for the treatment of various diseases. The problems which are being solved by the out- and inpatient services of the Center are considered in detail. The advantages of the setting up of the common in- and outpatient complex on the basis of the hospital intended for the treatment of various diseases are described.

  8. Scurvy in an alcoholic patient treated with intravenous vitamins.

    PubMed

    Ong, John; Randhawa, Rabinder

    2014-04-11

    Vitamin C deficiency is rare in developed countries but there is an increased prevalence in chronic alcohol abusers. In the UK, it is common practice to treat patients with chronic alcoholism who are admitted to hospital with intravenous vitamins B1, B2, B3, B6 and C for 2-3 days, followed by oral thiamine and vitamin B-compound tablets. This is a case of a 57-year-old man with a history of chronic alcoholism and chronic obstructive lung disease who was admitted to the intensive care unit for pneumonia requiring ventilatory support. He was given high doses of intravenous vitamins B1, B2, B3, B6 and C for 3 days then oral thiamine and vitamin B compound tablets but developed scurvy 4 days later. He was restarted on oral vitamin C supplementation and showed signs of improvement within 3 days of treatment.

  9. Eye examination for early diagnosis of disseminated tuberculosis in patients with AIDS.

    PubMed

    Heiden, David; Saranchuk, Peter; Keenan, Jeremy D; Ford, Nathan; Lowinger, Alan; Yen, Michael; McCune, Joseph; Rao, Narsing A

    2016-04-01

    Choroidal tuberculosis is present in 5-20% of patients with disseminated tuberculosis, and point-of-care dilated binocular indirect ophthalmoscopy eye examination can provide immediate diagnosis. In geographical areas of high tuberculosis prevalence and in susceptible patients (CD4 counts less than 200 cells per μL) detection of choroidal granulomas should be accepted as evidence of disseminated tuberculosis. With training and proper support, eye screening can be done by HIV/AIDS clinicians, allowing early tuberculosis treatment. In regions with a high burden of tuberculosis, we recommend that eye screening be a standard part of the initial assessment of susceptible patients, including at a minimum all patients with HIV/AIDS with CD4 less than 100 cells per μL with or without eye symptoms, and with or without suspicion of disseminated tuberculosis.

  10. Severe hypercalcemia and hypernatremia in a patient treated with canagliflozin

    PubMed Central

    Winters, Stephen J

    2015-01-01

    Summary Drugs that inhibit the sodium-glucose co-transporter-2 (SGLT2) are an exciting novel, insulin-independent treatment for diabetes that block glucose reabsorption from the proximal tubules of the kidney, leading to increased glucose excretion and lower blood glucose levels. Inhibition of SGLT2 activity also reduces sodium reabsorption, which together with glycosuria produces a mild diuretic effect with the potential for dehydration and hyperkalemia. We report on a 60-year-old man with uncontrolled type 2 diabetes treated with insulin, glimepiride, metformin and canagliflozin, who was admitted with altered mental status after a syncopal episode. He had a 1-week history of ingestion of Tums for heartburn followed by poor appetite and lethargy. Laboratory work-up showed acute kidney injury, diabetic ketoacidosis (DKA), and parathyroid hormone-independent severe hypercalcemia of 17.4 mg/dl. DKA resolved with insulin treatment, and saline hydration led to improvement in hypercalcemia and renal function over 48 h, but was accompanied by a rapid increase in the serum sodium concentration from 129 to 162 mmol/l despite changing fluids to 0.45% saline. Urine studies were consistent with osmotic diuresis. Hypernatremia was slowly corrected with hypotonic fluids, with improvement in his mental status over the next 2 days. This is the first report of hypercalcemia associated with the use of a SLGT2 inhibitor. Although the exact mechanism is unknown, canagliflozin may predispose to hypercalcemia in patients ingesting excessive calcium because of dehydration from osmotic diuresis, with reduced calcium excretion and possible increased intestinal calcium absorption. Saline therapy and osmotic diuresis may lead to hypernatremia from electrolyte-free water loss. Learning points Canagliflozin, an SGLT2 inhibitor, may cause hypercalcemia in susceptible patients.Although the exact mechanisms are unknown, dehydration from osmotic diuresis and increased intestinal calcium

  11. Disseminated cryptococcosis and fluconazole resistant oral candidiasis in a patient with acquired immunodeficiency syndrome (AIDS).

    PubMed

    Kothavade, Rajendra J; Oberai, Chetan M; Valand, Arvind G; Panthaki, Mehroo H

    2010-10-28

    Disseminated cryptococcosis and recurrent oral candidiasis was presented in a-heterosexual AIDS patient. Candida tropicalis (C.tropicalis) was isolated from the oral pseudomembranous plaques and Cryptococcus neoformans (C. neoformans) was isolated from maculopapular lesions on body parts (face, hands and chest) and body fluids (urine, expectorated sputum, and cerebrospinal fluid). In vitro drug susceptibility testing on the yeast isolates demonstrated resistance to fluconazole acquired by C. tropicalis which was a suggestive possible root cause of recurrent oral candidiasis in this patient.

  12. Varicella-Zoster Virus Infections in Patients Treated With Fingolimod

    PubMed Central

    Arvin, Ann M.; Wolinsky, Jerry S.; Kappos, Ludwig; Morris, Michele I.; Reder, Anthony T.; Tornatore, Carlo; Gershon, Anne; Gershon, Michael; Levin, Myron J.; Bezuidenhoudt, Mauritz; Putzki, Norman

    2017-01-01

    IMPORTANCE Varicella-zoster virus (VZV) infections increasingly are reported in patients with multiple sclerosis (MS) and constitute an area of significant concern, especially with the advent of more disease-modifying treatments in MS that affect T-cell-mediated immunity. OBJECTIVE To assess the incidence, risk factors, and clinical characteristics of VZV infections in fingolimod-treated patients and provide recommendations for prevention and management. DESIGN, SETTING, AND PARTICIPANTS Rates of VZV infections in fingolimod clinical trials are based on pooled data from the completed controlled phases 2 and 3 studies (3916 participants) and ongoing uncontrolled extension phases (3553 participants). Male and female patients aged 18 through 55 years (18–60 years for the phase 2 studies) and diagnosed as having relapsing-remitting MS were eligible to participate in these studies. In the postmarketing setting, reporting rates since 2010 were evaluated. INTERVENTIONS In clinical trials, patients received fingolimod at a dosage of 0.5 or 1.25 mg/d, interferon beta-1a, or placebo. In the postmarketing setting, all patients received fingolimod, 0.5 mg/d (total exposure of 54 000 patient-years at the time of analysis). MAIN OUTCOMES AND MEASURES Calculation of the incidence rate of VZV infection per 1000 patient-years was based on the reporting of adverse events in the trials and the postmarketing setting. RESULTS Overall, in clinical trials, VZV rates of infection were low but higher with fingolimod compared with placebo (11 vs 6 per 1000 patient-years). A similar rate was confirmed in the ongoing extension studies. Rates reported in the postmarketing settings were comparable (7 per 1000 patient-years) and remained stable over time. Disproportionality in reporting herpes zoster infection was higher for patients receiving fingolimod compared with those receiving other disease-modifying treatments (empirical Bayes geometric mean, 2.57 [90% CI, 2.26–2.91]); the proportion

  13. Occupational Risk of HIV, HBV and HSV-2 Infections in Health Care Personnel Caring for AIDS Patients.

    ERIC Educational Resources Information Center

    Kuhls, Thomas L.; And Others

    1987-01-01

    Female health care workers with exposure to AIDS patients were studied. Two of the 246 workers showed evidence of opportunistic infections. This analysis confirms the low risk of occupationally acquired HIV infection when hospital infection control practices are employed around AIDS patients. (Author/VM)

  14. Professional centred shared decision making: Patient decision aids in practice in primary care

    PubMed Central

    Burges Watson, Duika; Thomson, Richard G; Murtagh, Madeleine J

    2008-01-01

    Background Patient decision aids are increasingly regarded as important components of clinical practice that enable shared decision making (SDM) and evidence based patient choice. Despite broad acceptance of their value, there remains little evidence of their successful implementation in primary care settings. Methods Health care practitioners from five general practice surgeries in northern England participated in focus group sessions around the themes of patient decision aids, patient and practitioner preferences and SDM. Participants included general practitioners (n = 19), practice nurses (n = 5) and auxiliary staff (n = 3). Transcripts were analysed using a framework approach. Results We report a) practitioners' discussion of the current impetus towards sharing decisions and their perspectives on barriers to SDM, and b) the implementation of patient decision aids in practice and impediments such as lack of an evidence base and time available in consultations. Conclusion We demonstrate two orientations to sharing decisions: practitioner-centred and patient-centred with the former predominating. We argue that it is necessary to rethink the changes required in practice for the implementation of SDM. PMID:18190683

  15. [Disseminated mycobacterial infections in patients with HIV/AIDS. Evaluation of blood cultures].

    PubMed

    Coitinho, C; Brandes, E; Pardiñas, M; Rivas, C

    2005-01-01

    One thousand-forty blood cultures corresponding to 451 Uruguayan patients with AIDS and clinic diagnosis of disseminated mycobacterial infection were evaluated between 1999 and 2003. Samples were processed in the National Reference Center for Mycobacteria (Montevideo, Uruguay), using the automated blood culture system for mycobacteria MB-BacT (BioMérieux). Forty-five positive samples were detected (4.3%) corresponding to 26 patients with AIDS (average 2.3 samples per patient). In 10/26 patients M. avium complex (MAC) was identified and in 13/26 the isolated germ was M. tuberculosis. The average time of incubation was of 12.4 days (range 6-19 days) for MAC and of 22.6 days (range 7-35 days) for M. tuberculosis. Blood culture has demonstrated to be the best sample for the bacteriological confirmation of the disseminated mycobacterial infections when at least 2 samples by patient are studied. The frequency of isolates of M. tuberculosis and MAC in AIDS patients is according with a moderate prevalence of tuberculosis in Uruguay.

  16. Scintigraphic pattern of pneumothorax complicating Pneumocystis carinii pneumonia in patients with AIDS.

    PubMed

    Finestone, H; Goldfarb, C R; Ongseng, F; Wasserman, I; Garcia, H

    1990-08-01

    Spontaneous pneumothorax is a serious though infrequently reported pulmonary complication of AIDS. An unsuspected lung collapse was discovered via gallium scintigraphy for the study of Pneumocystis carinii pneumonia. Neither the pneumonia nor the pneumothorax were apparent on the most recent chest roentgenogram. In evaluating gallium images during the work-up of AIDS patients with associated pulmonary pathology, the possible complication of lung collapse should be considered. If pneumothorax is suspected on gallium imaging, a chest roentgenogram in expiration must be obtained for prompt delineation of this serious, yet correctable, condition.

  17. Roles of nurse aides and family members in acute patient care in Taiwan.

    PubMed

    Tzeng, Huey-Ming

    2004-01-01

    To improve the nursing care quality in acute care hospitals in Taiwan after the 2003 SARS epidemic, the Taipei City Government Department of Health has allocated about US dollars 6 million for nurse aides' salaries and costs for recruitment, training, and administration of this program. Yet, there have been no corresponding changes in payments for nursing services by the National Health Insurance system in Taiwan such as increasing nurse fees for inpatient services. This article examines the roles of nurse aides and family members in providing acute patient care in Taiwan and discusses issues of nursing care quality as related to nurse staffing in acute care hospitals.

  18. Scintigraphic pattern of pneumothorax complicating Pneumocystis carinii pneumonia in patients with AIDS

    SciTech Connect

    Finestone, H.; Goldfarb, C.R.; Ongseng, F.; Wasserman, I.; Garcia, H. )

    1990-08-01

    Spontaneous pneumothorax is a serious though infrequently reported pulmonary complication of AIDS. An unsuspected lung collapse was discovered via gallium scintigraphy for the study of Pneumocystis carinii pneumonia. Neither the pneumonia nor the pneumothorax were apparent on the most recent chest roentgenogram. In evaluating gallium images during the work-up of AIDS patients with associated pulmonary pathology, the possible complication of lung collapse should be considered. If pneumothorax is suspected on gallium imaging, a chest roentgenogram in expiration must be obtained for prompt delineation of this serious, yet correctable, condition.

  19. Cutaneous gallium uptake in patients with AIDS with mycobacterium avium-intracellulare septicemia

    SciTech Connect

    Allwright, S.J.; Chapman, P.R.; Antico, V.F.; Gruenewald, S.M.

    1988-07-01

    Gallium imaging is increasingly being used for the early detection of complications in patients with AIDS. A 26-year-old homosexual man who was HIV antibody positive underwent gallium imaging for investigation of possible Pneumocystis carinii pneumonia. Widespread cutaneous focal uptake was seen, which was subsequently shown to be due to mycobacterium avium-intracellulare (MAI) septicemia. This case demonstrates the importance of whole body imaging rather than imaging target areas only, the utility of gallium imaging in aiding the early detection of clinically unsuspected disease, and shows a new pattern of gallium uptake in disseminated MAI infection.

  20. Application of stereotactic biopsy for diagnosing intracranial lesions in patients with AIDS in China

    PubMed Central

    Zhang, Ji-bo; Fu, Kai; Gong, Rui; Liu, Xue-meng; Chen, Li-dao; Zhang, Yong-xi; Yang, Gui-fang; Zhang, Jie

    2016-01-01

    Abstract Rationale: The aim of the study was to evaluate stereotactic biopsy for diagnosing intracranial lesions in patients with AIDS. Patient concerns: Seven AIDS patients with an intracranial lesion who underwent stereotactic biopsy were included in this retrospective study (4 males and 3 females, 15 to 49 years old). The patients’ disease history ranged from 1 month to 1 year. The samples were examined by hematoxylin-eosin (HE) staining and immunohistochemical examination. Diagnoses, interventions and outcomes: All patients were successfully sampled, and the histological results showed inflammation in 4 cases, toxoplasma gondii infection in 1 case, astrocytoma in 1 case, and abscess in 1 case. The clinical diagnosis included toxoplasma encephalitis (TE) in 2 cases, cryptococcus encephalitis in 2 cases, cytomegalovirus (CMV) encephalitis in 2 case, tubercular abscess in 1 case, astrocytoma in 1 case, and co-infection of TE with Cryptococcus infection in 1 patient. The clinical diagnosis was made according to the plasma and cerebrospinal fluid (CSF) laboratory testing, the imaging data and the histological findings. The diagnostic yield was 100%, and the post-operation morbidity was 14.3% (1/7) with an asymptomatic haemorrhage and seizure in 1 case. There was no operation-related mortality. Patients were followed up for 6 months to 6 years; 1 case fully recovered, 4 cases significantly improved in symptoms, and 2 died. Lessons: Stereotactic biopsy is a safe and effective way of diagnosing intracranial lesions in patient with AIDS. It is helpful for the differential diagnosis and for choosing a suitable therapy. Due to the broad spectrum of nervous system abnormalities in AIDS, histological findings are very valuable. However, histology is not a unique tool for making a definite diagnosis, whereas the combination of molecular pathology and stereotactic biopsy should play a more important role in the future. PMID:27930545

  1. Antibody to hepatitis E virus in HIV-infected individuals and AIDS patients.

    PubMed

    Balayan, M S; Fedorova, O E; Mikhailov, M I; Rytick, P G; Eremin, V F; Danilova, T I; Shevelev, B I; Gorbacheva, E C; Pankova, G Y

    1997-07-01

    Antibody to hepatitis E virus of IgG class (anti-HEV IgG) is regularly detected in industrialized countries, where HEV is non-endemic, at levels not exceeding 2-3%; seropositive individuals are often found in certain groups of patients and professionals exposed to an increased risk of blood-borne infections. The present study was aimed at the identification of anti-HEV IgG in patients with human immunodeficiency virus (HIV) infection, including acquired immune deficiency syndrome (AIDS), living in Russia and Belarus, an area of low anti-HEV prevalence with a moderate spread of HIV infection and AIDS. In Russia, 13 out of 117 HIV-infected patients (11.1%) were found to be anti-HEV seropositive. This differed significantly from the frequency observed in the normal population (1.7%) but not from the frequency in a matching control, high-risk group consisting of male prisoners (8.0%). No difference in the frequency of anti-HEV IgG seropositivity was found between groups of HIV-infected men subdivided by sexual orientation. The rate of anti-HEV seropositivity increased with the progression of HIV infection, reaching 43.3% in AIDS patients and 38.1% in those who died from AIDS. In Belarus, anti-HEV IgG seropositivity was not found among 20 HIV-infected subjects nor among individuals from the control risk group, which consisted of 25 intravenous drug users. In conclusion, HEV infection may have common transmission mechanisms (risk factors) with HIV infection rather than represent an additional opportunistic infection in AIDS.

  2. The influence of gender and of AIDS on the immunity of autopsied patients' esophagus.

    PubMed

    Rocha, Laura Penna; de Melo E Silva, Ana Teresa; Gomes, Nayara Cândida; Faria, Humberto Aparecido; Silva, Renata Beatriz; Olegário, Janaínna Grazielle Pacheco; Corrêa, Rosana Rosa Miranda; de Paula Antunes Teixeira, Vicente; Cavellani, Camila Lourencini

    2011-05-01

    Previous studies have shown that males who have AIDS are more frequently affected by infectious diseases than females. The esophagus is the organ in the digestive tube that is more commonly affected by opportunistic infections during the syndrome. The aim of this study was to assess the influence of AIDS and of gender on local immunity of the esophageal epithelium. Fragments of the esophagus from 29 autopsied women and 37 autopsied men were collected at a university hospital from 1980 to 2009 and were divided in groups with and without AIDS. The IgA-, IgG-, and IgM-positive cells and Langerhans cells (LCs) were immunostained, respectively, with anti-IgA, anti-IgG, anti-IgM, and anti-S100. The software Image J was used to measure the esophageal epithelium and to count the epithelium cellular layers. Patients with AIDS, apart from gender, showed an increase in IgA-, IgG-, and IgM-positive cells and a reduction of Langerhans cells, in thickness and in number of cellular layers in the esophageal epithelium. However, among individuals with AIDS, men presented lower secretory expression of IgA-, IgG-, and IgM-positive cells than women and more intense reduction of LCs. Women have naturally presented better local esophageal immunity than men. Although AIDS possibly causes immunological and morphological alterations in the esophageal epithelium in both genders, women have better esophageal immunity, which may explain a greater frequency of hospital admissions due to infection of men with AIDS when compared with women.

  3. Detection of HTLV-III RNA in lungs of patients with AIDS and pulmonary involvement

    SciTech Connect

    Chayt, K.J.; Harper, M.E.; Marselle, L.M.; Lewin, E.B.; Rose, R.M.; Oleske, J.M.; Epstein, L.G.; Wong-Staal, F.; Gallo, R.C.

    1986-11-07

    A majority of pediatric patients and rare adult patients with the acquired immunodeficiency syndrome (AIDS) develop a chronic respiratory disorder referred to as lymphocytic interstitial pneumonitis (LIP). Efforts to identify an infectious agent responsible for this process so far have failed. In this study, frozen sections of lungs from patients with AIDS and pulmonary disease were tested by in situ molecular hybridization for the presence of cells infected with human T-cell lymphotropic virus type III (HTLV-III) and expressing viral RNA. In the case of an infant with LIP, a relatively high frequency (0.1%) of cells in the lung were found to be positive for HTLV-III RNA. This number is the lower limit of total cells infected since the in situ hybridization technique as applied in this study depends on expression of HTLV-III genes, and previous evidence indicates that a proportion of cells infected with HTLV-III may not express viral RNA. Moreover, this degree of infection of the lung is likely limited to LIP, since in ten patients with AIDS and pulmonary diseases other than LIP, only 0% to 0.002% of cells in lung were positive for viral RNA expression. Thus, HTLV-III may play a direct causal role in the development of LIP in infected patients, implicating its involvement in yet another of the diverse clinical diseases associated with this virus.

  4. Shared Decision Making and Patient Decision Aids: Knowledge, Attitudes, and Practices Among Hawai‘i Physicians

    PubMed Central

    Friend, John; Chun, Maria BJ

    2013-01-01

    Background: As the health care field moves toward patient-centered care (PCC), increasing emphasis has been placed on the benefits of patient decision aids for promoting shared decision making (SDM). This study provides a baseline measure of knowledge, attitudes, and practices (KAP) among Hawai‘i's physicians with respect to patient decision aids (DAs). Physicians throughout the State of Hawai‘i were invited to complete a survey assessing their knowledge, attitudes, and practices with respect to the clinical use of DAs. One hundred and seventy four valid surveys were analyzed. Reported awareness and use of DAs were low, but recognition of the benefits of SDM and openness to the use of DAs were very high. The leading perceived barriers to the implementation of DAs were lack of awareness, lack of resources, and limited physician time to learn about DA technology. However, a significant majority of the respondents reported that DAs could empower patients by improving knowledge (88%), increasing satisfaction with the consultation process (81%), and increasing compliance (74%). Among physicians currently employing DAs, use of brochures or options matrix sheets was the most common aid tool. However, leading recommended DA formats were paper-based brochures for clinic use (75%) and interactive online website programs for outside clinic use (73.5%). Given growing emphasis on the PCC model and the recognized desire of many patients to participate in the medical decision making process, positive responses toward SDM and the use of DAs by Hawai‘i physicians are promising. PMID:24251086

  5. Hypertrophic herpes simplex simulating anal neoplasia in AIDS patients: report of five cases.

    PubMed

    Nadal, Sidney R; Calore, Edenilson E; Manzione, Carmen R; Horta, Sergio C; Ferreira, Aurea F; Almeida, Lis V

    2005-12-01

    Five patients (4 males; mean age, 46.4 years) with painful verrucous perianal lesions caused by herpes simplex virus are described. All patients had had AIDS for a long time and were using highly active antiretroviral therapy. CD4+ counts ranged from 73 to 370/mm3. All lesions were submitted to resection under subdural anesthesia. Histologic examinations revealed epithelial hyperplasia and dense inflammatory process, composed mainly of lymphocytes and plasma cells, extended just to the hypodermis. Immunohistochemistry was positive for herpes simplex virus Type 2 in four patients and for herpes simplex virus Type 1 in one patient, and did not detect human papillomavirus antigens. Three patients had recurrences after 3, 10, and 12 months. Resection was performed on two patients; one had a new recurrence after three months. Oral acyclovir eliminated the lesion in the third patient. The analysis of our patients suggests that herpes simplex virus, Types 1 and 2, may cause verrucous lesions simulating neoplasia in patients with AIDS using antiretroviral therapy.

  6. Do personal stories make patient decision aids more effective? A critical review of theory and evidence

    PubMed Central

    2013-01-01

    Background Patient decision aids support people to make informed decisions between healthcare options. Personal stories provide illustrative examples of others’ experiences and are seen as a useful way to communicate information about health and illness. Evidence indicates that providing information within personal stories affects the judgments and values people have, and the choices they make, differentially from facts presented in non-narrative prose. It is unclear if including narrative communications within patient decision aids enhances their effectiveness to support people to make informed decisions. Methods A survey of primary empirical research employing a systematic review method investigated the effect of patient decision aids with or without a personal story on people’s healthcare judgements and decisions. Searches were carried out between 2005-2012 of electronic databases (Medline, PsycINFO), and reference lists of identified articles, review articles, and key authors. A narrative analysis described and synthesised findings. Results Of 734 citations identified, 11 were included describing 13 studies. All studies found participants’ judgments and/or decisions differed depending on whether or not their decision aid included a patient story. Knowledge was equally facilitated when the decision aids with and without stories had similar information content. Story-enhanced aids may help people recall information over time and/or their motivation to engage with health information. Personal stories affected both “system 1” (e.g., less counterfactual reasoning, more emotional reactions and perceptions) and “system 2” (e.g., more perceived deliberative decision making, more stable evaluations over time) decision-making strategies. Findings exploring associations with narrative communications, decision quality measures, and different levels of literacy and numeracy were mixed. The pattern of findings was similar for both experimental and real

  7. Antiretroviral drugs and acute pancreatitis in HIV/AIDS patients: is there any association? A literature review

    PubMed Central

    Oliveira, Natalia Mejias; Ferreira, Felipe Augusto Yamauti; Yonamine, Raquel Yumi; Chehter, Ethel Zimberg

    2014-01-01

    ABSTRACT In HIV-seropositive individuals, the incidence of acute pancreatitis may achieve 40% per year, higher than the 2% found in the general population. Since 1996, when combined antiretroviral therapy, known as HAART (highly active antiretroviral therapy), was introduced, a broad spectrum of harmful factors to the pancreas, such as opportunistic infections and drugs used for chemoprophylaxis, dropped considerably. Nucleotide analogues and metabolic abnormalities, hepatic steatosis and lactic acidosis have emerged as new conditions that can affect the pancreas. To evaluate the role of antiretroviral drugs to treat HIV/AIDS in a scenario of high incidence of acute pancreatitis in this population, a systematic review was performed, including original articles, case reports and case series studies, whose targets were HIV-seropositive patients that developed acute pancreatitis after exposure to any antiretroviral drugs. This association was confirmed after exclusion of other possible etiologies and/or a recurrent episode of acute pancreatitis after re-exposure to the suspected drug. Zidovudine, efavirenz, and protease inhibitors are thought to lead to acute pancreatitis secondary to hyperlipidemia. Nucleotide reverse transcriptase inhibitors, despite being powerful inhibitors of viral replication, induce a wide spectrum of side effects, including myelotoxicity and acute pancreatitis. Didanosine, zalcitabine and stavudine have been reported as causes of acute and chronic pancreatitis. They pose a high risk with cumulative doses. Didanosine with hydroxyurea, alcohol or pentamidine are additional risk factors, leading to lethal pancreatitis, which is not a frequent event. In addition, other drugs used for prophylaxis of AIDS-related opportunistic diseases, such as sulfamethoxazole-trimethoprim and pentamidine, can produce necrotizing pancreatitis. Despite comorbidities that can lead to pancreatic involvement in the HIV/AIDS population, antiretroviral drug

  8. Antiretroviral drugs and acute pancreatitis in HIV/AIDS patients: is there any association? A literature review.

    PubMed

    Oliveira, Natalia Mejias; Ferreira, Felipe Augusto Yamauti; Yonamine, Raquel Yumi; Chehter, Ethel Zimberg

    2014-01-01

    In HIV-seropositive individuals, the incidence of acute pancreatitis may achieve 40% per year, higher than the 2% found in the general population. Since 1996, when combined antiretroviral therapy, known as HAART (highly active antiretroviral therapy), was introduced, a broad spectrum of harmful factors to the pancreas, such as opportunistic infections and drugs used for chemoprophylaxis, dropped considerably. Nucleotide analogues and metabolic abnormalities, hepatic steatosis and lactic acidosis have emerged as new conditions that can affect the pancreas. To evaluate the role of antiretroviral drugs to treat HIV/AIDS in a scenario of high incidence of acute pancreatitis in this population, a systematic review was performed, including original articles, case reports and case series studies, whose targets were HIV-seropositive patients that developed acute pancreatitis after exposure to any antiretroviral drugs. This association was confirmed after exclusion of other possible etiologies and/or a recurrent episode of acute pancreatitis after re-exposure to the suspected drug. Zidovudine, efavirenz, and protease inhibitors are thought to lead to acute pancreatitis secondary to hyperlipidemia. Nucleotide reverse transcriptase inhibitors, despite being powerful inhibitors of viral replication, induce a wide spectrum of side effects, including myelotoxicity and acute pancreatitis. Didanosine, zalcitabine and stavudine have been reported as causes of acute and chronic pancreatitis. They pose a high risk with cumulative doses. Didanosine with hydroxyurea, alcohol or pentamidine are additional risk factors, leading to lethal pancreatitis, which is not a frequent event. In addition, other drugs used for prophylaxis of AIDS-related opportunistic diseases, such as sulfamethoxazole-trimethoprim and pentamidine, can produce necrotizing pancreatitis. Despite comorbidities that can lead to pancreatic involvement in the HIV/AIDS population, antiretroviral drug-induced pancreatitis

  9. Sexually Transmitted Infections Among Hospitalized Patients With Human Immunodeficiency Virus Infection and Acquired Immune Deficiency Syndrome (HIV/AIDS) in Zahedan, Southeastern Iran

    PubMed Central

    Hashemi-Shahri, Seyed Mohammad; Sharifi-Mood, Batool; Kouhpayeh, Hamid-Reza; Moazen, Javad; Farrokhian, Mohsen; Salehi, Masoud

    2016-01-01

    Background Studies show that nearly 40 million people are living with human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) around the world and since the beginning of the epidemic, about 35 million have died from AIDS. Heterosexual intercourse is the most common route for transmission of HIV infection (85%). People with a sexually transmitted infection (STI), such as syphilis, genital herpes, chancroid, or bacterial vaginosis, are more likely to obtain HIV infection during sex. On the other hand, a patient with HIV can acquire other infections such as hepatitis C virus (HCV) and hepatitis B virus (HBV) and also STIs. Co-infections and co-morbidities can affect the treatment route of patients with HIV/AIDs. Sometimes, physicians should treat these infections before treating the HIV infection. Therefore, it is important to identify co-infection or comorbidity in patients with HIV/AIDS. Objectives This study was conducted in order to understand the prevalence of HIV/AIDS/STI co-infection. Patients and Methods In this cross-sectional study, we evaluated all HIV/AIDS patients who were admitted to the infectious wards of Boo-Ali hospital (Southeastern Iran) between March 2000 and January 2015. All HIV/AIDS patients were studied for sexually transmitted infections (STI) such as syphilis, gonorrhea, hepatitis B virus (HBV) and genital herpes. A questionnaire including data on age, sex, job, history of vaccination against HBV, hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc), hepatitis B surface antigen (anti-HBs), HCV-Ab, venereal disease research laboratory (VDRL) test, fluorescent treponemal antibody absorption (FTA-Abs) test, and urine culture was designed. Data was analyzed by the Chi square test and P values of < 0.05 were considered significant. Results Among the 41 patients with HIV/AIDS (11 females and 30 males; with age range of 18 to 69 years) five cases (12.1%) had a positive test (1:8 or more) for

  10. Detection of the microsporidian parasite Enterocytozoon bieneusi in specimens from patients with AIDS by PCR.

    PubMed Central

    Velásquez, J N; Carnevale, S; Guarnera, E A; Labbé, J H; Chertcoff, A; Cabrera, M G; Rodríguez, M I

    1996-01-01

    Microsporidia are protozoa parasites responsible for significant gastrointestinal disease in patients infected with human immunodeficiency virus. We evaluated a PCR assay of stool samples, duodenal aspirates, and biopsy specimens from patients with Enterocytozoon bieneusi infection. A 210-bp DNA fragment of the unique rRNA intergenic spacer could be amplified from all samples infected with E. bieneusi, but no amplification was seen by using DNA purified from samples with Septata intestinalis or other parasites and from negative control human cells. These results suggest that the PCR in stool samples may be a useful tool for the diagnosis of intestinal microsporidiosis in patients with AIDS. PMID:8940480

  11. Cutaneous adverse events in multiple sclerosis patients treated with daclizumab

    PubMed Central

    Cortese, Irene; Ohayon, Joan; Fenton, Kaylan; Lee, Chyi-Chia; Raffeld, Mark; Cowen, Edward W.; DiGiovanna, John J.

    2016-01-01

    Objective: To analyze the spectrum and mechanisms of cutaneous adverse events (AEs) in patients with multiple sclerosis treated with daclizumab high-yield process (DAC-HYP). Methods: A total of 31 participants in an institutional review board–approved open-label phase I study of DAC-HYP (NCT01143441) were prospectively evaluated over 42 months for development of cutaneous AEs. Participants provided written informed consent. Fifteen participants were naive to anti-CD25 therapy (cohort B), while 16 had received daclizumab (Zenapax; Hoffmann-La Roche) IV for 4–9 years (mean 5.8 years) prior to enrollment (cohort A). Immunohistochemistry was performed on pretreatment and posttreatment skin biopsies of normal-appearing skin (cohort B only) and on lesional biopsies in participants presenting with rash (both cohorts). Results: Cutaneous AEs occurred in 77% of patients, the majority presenting with patches of eczema requiring no treatment. Moderate to severe rash developed in 6 participants (19%) and required discontinuation of DAC-HYP in 4 (13%). More severe rashes presented psoriasiform phenotype, but lesional biopsies lacked features of either psoriasis or drug hypersensitivity eruptions. Instead, irrespective of clinical severity, lesional biopsies showed nonspecific features of eczematous dermatitis, but with prominent CD56+ lymphocytic infiltrates. Pretreatment and posttreatment biopsies of normal-appearing skin demonstrated no histopathologic changes. Conclusions: Observed cutaneous AEs are likely related to the immunomodulatory effects DAC-HYP exerts on innate lymphoid cells, including natural killer cells. Vigilance and timely management of skin reactions may prevent treatment discontinuation in participants with severe rash. PMID:26843560

  12. Effectiveness of Two Topical Anaesthetic Agents used along with Audio Visual Aids in Paediatric Dental Patients

    PubMed Central

    Dhawan, Jayata; Kumar, Dipanshu; Anand, Ashish; Tangri, Karan

    2017-01-01

    Abstract Introduction Topical anaesthetic agents enable pain free intraoral procedures, symptomatic pain relief for toothache, superficial mucosal lesions and pain related to post extraction time. Most common anxiety provoking and fearful experience for children in dental operatory is administration of local anaesthesia because on seeing the needle, children usually become uncooperative. One of recent trend of behaviour management technique is using non-aversive techniques out of which audiovisual distraction has emerged as a very successful technique for managing children in dental settings. Audio visual distraction could decrease the procedure related anxiety of patients undergoing dental treatment and can be very relaxing for highly anxious patients. Aim The aim of the present study was to compare the efficacy of topical anaesthetics EMLA (Eutectic Mixture of Local Anaesthetics) cream and benzocaine (20%) gel in reducing the pain during the needle insertion with and without the use of Audio Visual (AV) aids. Materials and Methods The study was conducted on 120 children, the age range of 3-14 years attending the outpatient department for their treatment. EMLA and benzocaine gel (20%) were assessed for their effectiveness in reducing the pain on needle insertion during local anaesthesia administration. Based on the inclusion and the exclusion criteria, children requiring local anaesthesia for the dental treatment were randomly divided into four equal groups of 30 children based upon whether AV aids were used or not. AV aids were given using Sony Vaio laptop with earphones with nursery rhymes and cartoon movies DVD. The pain assessment was done by using the Visual Analogue Scale (VAS) scale and measurement of the physiological responses of pulse rate and oxygen saturation were done by pulse oximeter. Results There was a statistically significant difference in the mean pain score, pulse rate and mean oxygen saturation rate when it was compared between the four

  13. Quality of life of oropharyngeal cancer patients treated with brachytherapy.

    PubMed

    Teguh, David N; Levendag, Peter C; Kolkman-Deurloo, Inger-Karine; van Rooij, Peter; Schmitz, Paul I M

    2009-03-01

    Brachytherapy (BT) is a highly conformal (accurate clinical target volume delineation, no planning target volume margin) radiotherapy technique; the radioactive source, guided by afterloading catheters, is implanted into the heart of the tumor. The localized high dose of radiation enables high tumor control rates and, because of rapid dose fall-off, sparing of the adjacent normal tissues. At the Erasmus Medical Center, excellent results were observed: 5-year local regional control of 84%, 5-year disease-free survival of 59%, and 5-year overall survival of 64%. Therefore, in the case of moderately sized tumors, for well-trained, skillful physicians, BT is the therapy of choice (if technically feasible). However, side effects are not totally negligible, partly because of the cumulative dose of BT and the first series of 46/2 Gy. However, patients treated with BT still have a better swallowing-related quality of life, which might improve further if summation of BT and the first series of 46/2 Gy, as well as autocontouring of the neck levels, are realized. So far, there is no significant relationship between the -quality index of the BT implants and local control/overall survival and/or quality of life.

  14. Evaluation of seroepidemiological toxoplasmosis in HIV/AIDS patients in the south of Brazil.

    PubMed

    Xavier, Graciela Augusto; Cademartori, Beatris Gonzalez; Cunha Filho, Nilton Azevedo da; Farias, Nara Amélia da Rosa

    2013-01-01

    Toxoplasmosis is considered one of the opportunistic infections for individuals with the Acquired Immunodeficiency Syndrome (AIDS), and is also a major cause of morbidity and mortality. The aim of this study was to evaluate the prevalence of neurotoxoplasmosis, ocular toxoplasmosis and antibodies for Toxoplasma gondii in HIV-positive patients attending the SAE (Specialized Assistance Service for HIV/AIDS), as well as to associate their serological profile with epidemiological and clinical data. A total of 250 patients participated in the study from December, 2009 to November, 2010. Serological analysis was performed using the indirect immunofluorescent technique; epidemiological data were gathered by a questionnaire, and clinical history was based on the analysis of medical charts. Prevalence of seropositivity was 80%, with history of neurotoxoplasmosis in 4.8% and of ocular toxoplasmosis in 1.6% of the patients. The Highly Active Antiretroviral Treatment (HAART) was not used by 32% of the patients, 18.4% of the patients had CD4+ T- lymphocyte count less than 200 cells/mm³ and 96.8% of them were not aware of the modes of disease transmission. These findings led us to conclude that the study population is at high risk of clinical toxoplasmosis, because of both reactivation of infection in the seropositive patients who do not make a regular use of HAART, and primo-infection in seronegative patients worsened by an unawareness of the modes of infection reported in this study.

  15. Cerebral Toxoplasmosis in a Patient with AIDS on F-18 FDG PET/CT.

    PubMed

    Kim, Hae Won; Won, Kyoung Sook; Choi, Byung Wook; Zeon, Seok Kil

    2010-04-01

    The distinction between primary central nervous system (CNS) lymphoma and nonmalignant lesions due to opportunistic infections, in particular cerebral toxoplasmosis, is important because of the different treatments involved. A 32-year-old patient with AIDS was hospitalized for intermittent headaches. Brain magnetic resonance imaging (MRI) showed a small well-enhanced nodular lesion in the right frontal lobe. A fluorine-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography (PET)/computed tomography (CT) scan showed moderate FDG uptake in the nodular lesion of the right frontal lobe. We present a case of cerebral toxoplasmosis in a patient with acquired immunodeficiency syndrome (AIDS) and the usefulness of F-18 FDG PET/CT in the differential diagnosis of the cerebral toxoplasmosis will be discussed.

  16. Pathogenic Nocardia isolated from clinical specimens including those of AIDS patients in Thailand.

    PubMed

    Poonwan, N; Kusum, M; Mikami, Y; Yazawa, K; Tanaka, Y; Gonoi, T; Hasegawa, S; Konyama, K

    1995-10-01

    Forty strains of nocardioform microorganisms were isolated as clinical specimens including several from AIDS patients in Thailand. Among them, 37 strains were found to belong to the genus Nocardia. Our identification studies revealed that most of the strains (25 strains) belong to the N. asteroides group, i.e., N. asteroides sensu stricto and N. farcinica. Three strains were identified as N. otitidiscaviarum and two strains N. brasiliensis. In addition, 7 strains of rare pathogenic N. transvalensis were also isolated.

  17. Isolated Kaposi sarcoma of the finger pulp in an AIDS patient.

    PubMed

    Aïm, F; Rosier, L; Dumontier, C

    2012-02-01

    A 63-year-old woman with long-standing AIDS and previous Kaposi sarcomas of the lower limb presented to our consultation complaining of a painful left ring finger with pulp enlargement. X-rays revealed an osteolytic lesion of the distal phalanx. We suspected an isolated osseous Kaposi sarcoma and at surgery we found a hemorrhagic lesion with bone extension into the phalanx. Bone involvement is rare in Kaposi sarcoma and even rarer in patients without a cutaneous location.

  18. Autochthonous disseminated dermal and visceral leishmaniasis in an AIDS patient, southern Thailand, caused by Leishmania siamensis.

    PubMed

    Bualert, Lertwut; Charungkiattikul, Wiwat; Thongsuksai, Paramee; Mungthin, Mathirut; Siripattanapipong, Suradej; Khositnithikul, Rommanee; Naaglor, Tawee; Ravel, Christophe; El Baidouri, Fouad; Leelayoova, Saovanee

    2012-05-01

    We report the first establishment of in vitro cultivation and genotypic characterization of Leishmania siamensis isolated from an autochthonous disseminated dermal and visceral leishmaniasis in a Thai acquired immunodeficiency syndrome (AIDS) patient. The molecular identification has shown that the parasite was identical to L. siamensis, a recently described Leishmania species reported in the southern provinces of Thailand. The phylogenetic analysis has confirmed L. siamensis as closely related to the zoonotic Leishmania species L. enrietti.

  19. Isolation of the newly described species Mycobacterium celatum from AIDS patients.

    PubMed Central

    Tortoli, E; Piersimoni, C; Bacosi, D; Bartoloni, A; Betti, F; Bono, L; Burrini, C; De Sio, G; Lacchini, C; Mantella, A

    1995-01-01

    Mycobacterium celatum is a recently described species which, on the basis of conventional tests, may be misidentified as Mycobacterium xenopi or as belonging to the Mycobacterium avium complex. Only genomic sequencing or high-performance liquid chromatography of cell wall mycolic acids can presently allow a correct identification of this mycobacterium. Two cases of infection due to M. celatum, in AIDS patients, are described here. The quantitative susceptibility pattern of the isolates to a wide spectrum of drugs is also reported. PMID:7699029

  20. Microbial translocation is associated with increased monocyte activation and dementia in AIDS patients.

    PubMed

    Ancuta, Petronela; Kamat, Anupa; Kunstman, Kevin J; Kim, Eun-Young; Autissier, Patrick; Wurcel, Alysse; Zaman, Tauheed; Stone, David; Mefford, Megan; Morgello, Susan; Singer, Elyse J; Wolinsky, Steven M; Gabuzda, Dana

    2008-06-25

    Elevated plasma lipopolysaccharide (LPS), an indicator of microbial translocation from the gut, is a likely cause of systemic immune activation in chronic HIV infection. LPS induces monocyte activation and trafficking into brain, which are key mechanisms in the pathogenesis of HIV-associated dementia (HAD). To determine whether high LPS levels are associated with increased monocyte activation and HAD, we obtained peripheral blood samples from AIDS patients and examined plasma LPS by Limulus amebocyte lysate (LAL) assay, peripheral blood monocytes by FACS, and soluble markers of monocyte activation by ELISA. Purified monocytes were isolated by FACS sorting, and HIV DNA and RNA levels were quantified by real time PCR. Circulating monocytes expressed high levels of the activation markers CD69 and HLA-DR, and harbored low levels of HIV compared to CD4(+) T-cells. High plasma LPS levels were associated with increased plasma sCD14 and LPS-binding protein (LBP) levels, and low endotoxin core antibody levels. LPS levels were higher in HAD patients compared to control groups, and were associated with HAD independently of plasma viral load and CD4 counts. LPS levels were higher in AIDS patients using intravenous heroin and/or ethanol, or with Hepatitis C virus (HCV) co-infection, compared to control groups. These results suggest a role for elevated LPS levels in driving monocyte activation in AIDS, thereby contributing to the pathogenesis of HAD, and provide evidence that cofactors linked to substance abuse and HCV co-infection influence these processes.

  1. Pneumocystis carinii mutations are associated with duration of sulfa or sulfone prophylaxis exposure in AIDS patients.

    PubMed

    Kazanjian, P; Armstrong, W; Hossler, P A; Burman, W; Richardson, J; Lee, C H; Crane, L; Katz, J; Meshnick, S R

    2000-08-01

    This study was conducted to determine whether Pneumocystis carinii dyhydropteroate synthase (DHPS) gene mutations in AIDS patients with P. carinii pneumonia (PCP) are affected by duration of sulfa or sulfone prophylaxis and influence response to sulfa or sulfone therapy. The P. carinii DHPS genes from 97 AIDS patients with PCP between 1991 and 1999 from 4 medical centers were amplified, using polymerase chain reaction (PCR), and sequenced. Mutations were observed in 76% of isolates from patients exposed to sulfa or sulfone prophylaxis compared with 23% of isolates from patients not exposed (P=.001). Duration of prophylaxis increased the risk of mutations (relative risk [RR] for each exposure month, 1.06; P=.02). Twenty-eight percent of patients with mutations failed sulfa or sulfone treatment; mutations increased the risk of sulfa or sulfone treatment failure (RR, 2.1; P=0.01). Thus, an increased duration of sulfa or sulfone prophylaxis increases the chance of developing a P. carinii mutation. The majority of patients with mutations respond to sulfa or sulfone therapy.

  2. Design and fabrication of facial prostheses for cancer patient applying computer aided method and manufacturing (CADCAM)

    NASA Astrophysics Data System (ADS)

    Din, Tengku Noor Daimah Tengku; Jamayet, Nafij; Rajion, Zainul Ahmad; Luddin, Norhayati; Abdullah, Johari Yap; Abdullah, Abdul Manaf; Yahya, Suzana

    2016-12-01

    Facial defects are either congenital or caused by trauma or cancer where most of them affect the person appearance. The emotional pressure and low self-esteem are problems commonly related to patient with facial defect. To overcome this problem, silicone prosthesis was designed to cover the defect part. This study describes the techniques in designing and fabrication for facial prosthesis applying computer aided method and manufacturing (CADCAM). The steps of fabricating the facial prosthesis were based on a patient case. The patient was diagnosed for Gorlin Gotz syndrome and came to Hospital Universiti Sains Malaysia (HUSM) for prosthesis. The 3D image of the patient was reconstructed from CT data using MIMICS software. Based on the 3D image, the intercanthal and zygomatic measurements of the patient were compared with available data in the database to find the suitable nose shape. The normal nose shape for the patient was retrieved from the nasal digital library. Mirror imaging technique was used to mirror the facial part. The final design of facial prosthesis including eye, nose and cheek was superimposed to see the result virtually. After the final design was confirmed, the mould design was created. The mould of nasal prosthesis was printed using Objet 3D printer. Silicone casting was done using the 3D print mould. The final prosthesis produced from the computer aided method was acceptable to be used for facial rehabilitation to provide better quality of life.

  3. Use of the Diabetes Medication Choice Decision Aid in patients with type 2 diabetes in Greece: a cluster randomised trial

    PubMed Central

    Karagiannis, Thomas; Liakos, Aris; Branda, Megan E; Athanasiadou, Eleni; Mainou, Maria; Boura, Panagiota; Goulis, Dimitrios G; LeBlanc, Annie; Montori, Victor M

    2016-01-01

    Objective To assess the efficacy of the Diabetes Medication Choice Decision Aid among patients with type 2 diabetes in Greece. Design Open-label cluster randomised controlled trial. Setting Primary and secondary care practices across Greece. Participants 5 sites allocated to the decision aid (n=101 patients) and 4 sites to control (n=103 patients). Intervention Clinicians and patients in the intervention arm used a decision aid, based on outcomes that both consider important when choosing among antihyperglycaemic medications. Patients in the control arm received usual care. Outcome measures The primary outcome was patient's level of decisional comfort after the initial clinical encounter. Secondary outcomes included patient's knowledge about type 2 diabetes and medications, and patient's and clinician's satisfaction. Adherence to prescribed antihyperglycaemic medication and change in glycated haemoglobin were assessed at 24 weeks. Results Patients in both arms had similar scores in overall decisional comfort (mean difference between the usual care and decision aid arms −6.9, 95% CI −21.5 to 7.7) and its subscales. Patients' knowledge was high in both arms (mean difference 2.3%, 95% CI −15.7% to 20.4%). Patients and clinicians in both groups were equally satisfied with the decision-making. No significant difference in medication adherence and glycaemic control was found across arms. Clinicians found the decision aid useful and reported that its integration in their daily routine was easy. Conclusions The decision aid was implemented and positively received in the clinical setting in Greece, in line with the patient-centred approach endorsed by current guidelines. However, this trial yielded imprecise results in terms of patient outcomes. Further research is needed to investigate the interaction between the patient and the clinician in order to clarify the association between the use of decision aids and implementation of shared decision-making. Trial

  4. Diagnosing and treating renal disease in cirrhotic patients.

    PubMed

    Wong, Florence

    2016-09-01

    Renal dysfunction in cirrhosis is mostly related to the development of acute kidney injury (AKI), precipitated by either an acute disturbance of hemodynamics, or acute structural damage to the kidneys. The incidence of chronic renal failure is rising, due to increasing prevalence of conditions such as diabetes, viral hepatitis, which can be associated with renal damage. AKI is defined as a rise in serum creatinine of 0.3 mg/dL in <48 hours or by 50% from baseline within the past 3 months without setting a threshold for the final serum creatinine. Stages 1, 2, and 3 of AKI are defined as 150%, 200% and 300% of baseline serum creatinine respectively, which allows for assessment of AKI progression. Chronic kidney disease (CKD) is defined as an estimated glomerular filtration rate of <60 mL/min for >3 months. Treatment of AKI consists of removal of precipitating factors and replenishment of the intravascular volume using colloids such as albumin. Frequently, AKI can be reversed using these measures alone. Non-responders to removal of precipitating factors and volume challenge can receive vasoconstrictors such as terlipressin or norepinephrine together with albumin. Midodrine is inferior in efficacy as a vasoconstrictor when compared to terlipressin. Liver transplantation is the definitive treatment for type 1 hepatorenal syndrome with liver failure. Delay in receiving a liver transplant can result in non-recovery of renal function post transplant. Treatment of CKD in cirrhosis is unsatisfactory, mostly aimed at optimizing management of comorbid conditions, or treating the underlying refractory ascites in patients with type 2 hepatorenal syndrome.

  5. A Study of the Attitudes of Nursing Students toward Caring for AIDS Patients. Law, Politics, and Economics of Higher Education.

    ERIC Educational Resources Information Center

    Malloy, Suzanne E.

    This study examined the attitudes of undergraduate and graduate nursing students (N=282) towards caring for Acquired Immune Deficiency Syndrome (AIDS) patients. A 57-item Likert type AIDS attitude questionnaire focused on the following questions: (1) Is there a difference in the comfort level of juniors, seniors, or graduate students caring for…

  6. [Nursing consultation in an HIV/AIDS outpatient clinic: patients' perception].

    PubMed

    de Macêdo, Simara Moreira; Sena, Márcia Cristina dos Santos; Miranda, Karla Corrêa Lima

    2012-09-01

    The study aims to understand the patients' perception regarding the nursing consultation at an outpatient clinic for Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in the city of Fortaleza-CE (State of Ceará). This is an exploratory and descriptive qualitative approach. Data was collected through semi-structured interviews with fifteen patients of this institution and analyzed with the support of content analysis. The nursing consultation was reported by patients as a learning moment, focused onproviding information. The trust and emotional support provided by the professional act as a support to the conflicts experienced by the patients, allowing the construction of a new perspective of the disease. We believe that the implementation of the nursing consultation in a dialogic perspective can provide a new meaning to the conflicts surrounding the patients' illness.

  7. [Expectations of hospitalized patients with HIV/AIDS regarding nursing care].

    PubMed

    da Costa, Juliana Palhano; da Silva, Lucilane Maria Sales; da Silva, Maria Rocineide Ferreira; Miranda, Karla Corrêa Lima

    2006-01-01

    This study aimed at verifying the expectations of patients with HIV serum-positive patients, regarding to nursing care. This is a study with qualitative approach developed in the inpatient unit of a state public hospital in the municipal district of Fortaleza, CE. Data were collected in the period of September to October of 2003 through semi-structured interview, applied to 12 patients, randomly selected among the patients with diagnosis of HIV/AIDS. For data analysis it was used the Collective Subject's Speech (DSC) through emission of central ideas and/or key-expression. It was conclude that the patients expectations are for a more human care, more attention, contact verbal, more affectivity of the nursing team, a qualified and worthy attention. Besides their needs they should be informed daily about the vulnerabilities that they are submitted during the hospitalization.

  8. Computer-aided design and computer-aided manufacture (CAD/CAM) system for construction of spinal orthosis for patients with adolescent idiopathic scoliosis.

    PubMed

    Wong, M S

    2011-01-01

    ABSTRACT Spinal orthoses are commonly prescribed to patients with moderate adolescent idiopathic scoliosis (AIS) for prevention of further curve deterioration. In conventional manufacturing method, plaster bandages are used to obtain the patient's body contour and then the plaster cast is rectified manually. With computer-aided design and computer-aided manufacture (CAD/CAM) system, a series of automated processes from body scanning to digital rectification and milling of the positive model can be performed in a fast and accurate fashion. The purpose of this manuscript is to introduce the application of CAD/CAM system to the construction of spinal orthosis for patients with AIS. Based on evidence within the literature, CAD/CAM method can achieve similar clinical outcomes but with higher efficiency than the conventional fabrication method. Therefore, CAD/CAM method should be considered a substitute to the conventional method in fabrication of spinal orthoses for patients with AIS.

  9. Excess mortality in patients with AIDS in the era of highly active antiretroviral therapy: Temporal changes and risk factors

    PubMed Central

    Puhan, Milo A.; Van Natta, Mark L.; Palella, Frank J.; Addessi, Adrienne; Meinert, Curtis

    2010-01-01

    Background Excess mortality has declined among HIV infected patients but without evidence of a decline in patients with AIDS. We assessed temporal changes in excess mortality and elucidated risk factors for excess mortality in patients with AIDS diagnosed in the era of highly active antiretroviral therapy (HAART). Methods We included 1,188 patients of the Longitudinal Study of Ocular Complications in AIDS who were between 25-64 years old at enrollment and diagnosed with AIDS after 1995. We calculated excess mortality as the age-, year- and sex-adjusted difference in mortality rates between patients with AIDS and persons in the US general population, between 1999 and 2007, and used a relative survival model to identify risk factors for excess mortality. Results There were an average of 50 excess deaths (95% CI 44-57) per 1,000 person years between 1999 and 2007. Excess mortality almost halved with an annual decline of 8.0% per year (3.0-12.7 p=0.002) but remained high at 36 excess deaths per 1,000 person years in 2007. Viral load >400 vs. ≤400 copies/mL (risk ratio 3.4 [2.3-5.0]), CD4+ count <200 vs. ≥200 cells/μL (2.7 [1.9-3.9]) and cytomegalovirus retinitis (1.6 [1.2-2.1]) were the strongest risk factors for excess mortality. Conclusions Excess mortality among patients with AIDS was nearly halved in the HAART era and most strongly linked to stage of HIV disease. These results reflect the continuing improvements in AIDS management but also highlight that excess mortality remains about five times higher in patients with AIDS than in patients with HIV-infection but no AIDS. PMID:20825306

  10. [Avascular osteonecrosis of femoral head and neck in an AIDS patient].

    PubMed

    Villafañe, Maria F; Corti, Marcelo E; Candela, Miguel; Perez Bianco, Raul; Tezanos Pinto, Miguel

    2004-01-01

    Avascular osteonecrosis (AON) has increased in the last few years in patients infected with the human immunodeficiency virus type-1 (HIV-1). The most commonly affected bone is the femoral head and neck. Frequently these bilateral and clinical findings include moderate to severe pain and functional impotence of the affected joints. The etiology is multifactorial and highly active antiretroviral therapy (HAART) with protease inhibitors (PI) is probably related to its development. In the evolution, a total hip replacement may be needed. We present an hemophilic patient with AIDS, who developed a bilateral AON of the femoral head and neck during HAART.

  11. Tuberculoid leprosy and cytomegalovirus retinitis as immune restoration disease in a patient with AIDS.

    PubMed

    Kumar, Shishir; Ghosh, Manab Kumar; Sarkar, Somenath; Mallik, Sudeshna; Biswas, Pradyot Narayan; Saha, Bibhuti

    2012-02-01

    Here we report a unique case of tuberculoid leprosy and cytomegalovirus retinitis in a 27-year-old female patient with AIDS, suggestive of highly active antiretroviral therapy (HAART)-induced immune restoration disease. After initiation of HAART, the patient presented with decreased visual acuity, hypoesthetic patch with local nerve thickening, and an increase in her CD4+ T cell count. On further investigations cytomegalovirus retinitis and tuberculoid leprosy were confirmed. To our knowledge no case with such a co-existence has previously been reported.

  12. A computer-aided program for helping patients with moderate Alzheimer's disease engage in verbal reminiscence.

    PubMed

    Lancioni, Giulio E; Singh, Nirbhay N; O'Reilly, Mark F; Sigafoos, Jeff; Ferlisi, Gabriele; Zullo, Valeria; Schirone, Simona; Prisco, Raffaella; Denitto, Floriana

    2014-11-01

    This study assessed a simple computer-aided program for helping patients with moderate Alzheimer's disease engage in verbal reminiscence. In practice, the program was aimed at fostering the patient's verbal engagement on a number of life experiences/topics previously selected for him or her and introduced in the sessions through a friendly female, who appeared on the computer screen. The female asked the patient about the aforementioned experiences/topics, and provided him or her with positive attention, and possibly verbal guidance (i.e., prompts/encouragements). Eight patients were involved in the study, which was carried out according to non-concurrent multiple baseline designs across participants. Seven of them showed clear improvement during the intervention phase (i.e., with the program). Their mean percentages of intervals with verbal engagement/reminiscence ranged from close to zero to about 15 during the baseline and from above 50 to above 75 during the intervention. The results were discussed in relation to previous literature on reminiscence therapy, with specific emphasis on the need for (a) replication studies and (b) the development of new versions of the technology-aided program to improve its impact and reach a wider number of patients.

  13. Why are some HIV/AIDS patients reluctant to receive antiviral therapy as soon as possible in China?

    PubMed

    Sun, Yang; Lu, Hongzhou

    2014-06-01

    In more than 20 years of medical practice, a surprising phenomenon has often occurred: some patients with acquired immunodeficiency syndrome (AIDS) decide not to go to the hospital and they do not let others know that they are suffering from the disease unless they believe that they are dieing. Zhang Shan (a pseudonym) is one such patient with human immunodeficiency virus (HIV)/AIDS who was reluctant to receive antiviral therapy as soon as possible, and this paper shares Zhang's story as he related it. Clearly, there are numerous views as to why patients in China behave as Zhang did. Presented here are several reasons, including society, history, morality and ideology, family, and education. Although all of these reasons do play a role, the patient's mindset and behavior is the most significant reason for a patient's reluctance to seek treatment or disclose his/her status. If the individual patient's mindset and behavior are not dealt with effectively, then HIV/AIDS can continue to spread and threaten additional lives and even the fabric of society. This paper analyzes the reasons why patients are hesitant to receive antiviral therapy, but this paper also suggests steps healthcare personnel can take to encourage patients to seek treatment. Such steps can save the lives of current patients with HIV/AIDS. In addition, sound public health measures and a rational approach to treatment are important to helping potential patients with HIV/AIDS.

  14. Exploring salivary microbiota in AIDS patients with different periodontal statuses using 454 GS-FLX Titanium pyrosequencing

    PubMed Central

    Zhang, Fang; He, Shenghua; Jin, Jieqi; Dong, Guangyan; Wu, Hongkun

    2015-01-01

    Patients with acquired immunodeficiency syndrome (AIDS) are at high risk of opportunistic infections. Oral manifestations have been associated with the level of immunosuppression, these include periodontal diseases, and understanding the microbial populations in the oral cavity is crucial for clinical management. The aim of this study was to examine the salivary bacterial diversity in patients newly admitted to the AIDS ward of the Public Health Clinical Center (China). Saliva samples were collected from 15 patients with AIDS who were randomly recruited between December 2013 and March 2014. Extracted DNA was used as template to amplify bacterial 16S rRNA. Sequencing of the amplicon library was performed using a 454 GS-FLX Titanium sequencing platform. Reads were optimized and clustered into operational taxonomic units for further analysis. A total of 10 bacterial phyla (106 genera) were detected. Firmicutes, Bacteroidetes, and Proteobacteria were preponderant in the salivary microbiota in AIDS patients. The pathogen, Capnocytophaga sp., and others not considered pathogenic such as Neisseria elongata, Streptococcus mitis, and Mycoplasma salivarium but which may be opportunistic infective agents were detected. Dialister pneumosintes, Eubacterium infirmum, Rothia mucilaginosa, and Treponema parvum were preponderant in AIDS patients with periodontitis. Patients with necrotic periodontitis had a distinct salivary bacterial profile from those with chronic periodontitis. This is the first study using advanced sequencing techniques focused on hospitalized AIDS patients showing the diversity of their salivary microbiota. PMID:26191508

  15. Comparison of protein profiles between acetonitrile- and non-acetonitrile-treated sera from patients with nasopharyngeal carcinomas.

    PubMed

    Huang, Yuan-Jiao; Deng, Kai-Feng; Xuan, Chao; Zhang, Bei-Bei; Zhou, Yi; Yang, Xiaoli; He, Ming

    2011-05-01

    Serum proteins may be abnormally increased or decreased during the occurrence and development of nasopharyngeal carcinoma (NPC). However, currently there are no simple or effective methods to collect and differentiate these abnormally secreted proteins from abundant serum proteins. In this study, acetonitrile was used to remove the majority of high-abundance proteins from serum samples obtained from patients with NPC. The samples were subjected to surface-enhanced laser desorption/ionization time-of-flight mass spectrometry with a CM10 (weak cation exchange) ProteinChip, and the resulting protein profiles were compared with those of non-acetonitrile-treated serum samples. The results showed that the protein profiles differed between the acetonitrile- and non-acetonitrile-treated sera from patients with NPC. A large proportion of the non-acetonitrile-treated NPC serum protein peaks were <6000 kDa, while the detection rate of protein peaks >6000 kDa was relatively higher in the acetonitrile-treated NPC sera, accounting for more than half of all protein peaks (26.2+37.5%). Few differentially upregulated proteins were lost, and the peak value density increased after acetonitrile treatment. In conclusion, acetonitrile treatment of serum samples is effective in removing high-abundance macromolecular proteins. Therefore, acetonitrile treatment can be applied for the investigation of serum proteomics and may aid in the identification of differentially expressed proteins.

  16. [Treating mentally wounded patients within the French armed forces].

    PubMed

    Raffray, Pierre; Rio, Anaïck; Lahutte, Bertrand; Boisseaux, Humbert

    2012-12-01

    The French army has put in place a doctrine aimed at treating mentally wounded soldiers. A real treatment pathway comprising different specialised medical staff, places and time frames supports the soldier from the theatre of operations to France.

  17. Mycobacterium kansasii causing chronic monoarticular synovitis in a patient with HIV/AIDS

    PubMed Central

    Menashe, Leo; Kerr, Leslie Dubin; Hermann, George

    2015-01-01

    Mycobacterium kansasii is a nontuberculous mycobacterium that primarily causes pulmonary disease in AIDS patients, however it has also been known, rarely, to result in skeletal infection. When skeletal infection occurs, the time from onset of symptoms to diagnosis is up to 5 years in previously reported cases. We describe a 48-year-old woman with HIV/AIDS who presented with chronic, isolated left knee pain and swelling of over two decades which had recently worsened. Radiographs and magnetic resonance imaging demonstrated marked subarticular erosions, synovial thickening, and bone marrow edema, which had progressed compared with prior imaging done seven years earlier. Synovial biopsy grew Mycobacterium kansasii. Following the presentation of our case, clinical and imaging findings, including the differential diagnosis, of monoarticular arthritis caused by Mycobacterium kansasii are reviewed and discussed. PMID:26629306

  18. Effects of Smoking on Non-AIDS-Related Morbidity in HIV-Infected Patients

    PubMed Central

    Shirley, Daniel K.; Kaner, Robert J.; Glesby, Marshall J.

    2013-01-01

    Tobacco smoking has many adverse health consequences. Patients with human immunodeficiency virus (HIV) infection smoke at very high rates, and many of the comorbidities associated with smoking in the general population are more prevalent in this population. It is likely that a combination of higher smoking rates along with an altered response to cigarette smoke throughout the body in persons with HIV infection leads to increased rates of the known conditions related to smoking. Several AIDS-defining conditions associated with smoking have been reviewed elsewhere. This review aims to summarize the data on non-AIDS-related health consequences of smoking in the HIV-infected population and explore evidence for the potential compounding effects on chronic systemic inflammation due to HIV infection and smoking. PMID:23572487

  19. Mycobacterium kansasii causing chronic monoarticular synovitis in a patient with HIV/AIDS.

    PubMed

    Menashe, Leo; Kerr, Leslie Dubin; Hermann, George

    2015-09-01

    Mycobacterium kansasii is a nontuberculous mycobacterium that primarily causes pulmonary disease in AIDS patients, however it has also been known, rarely, to result in skeletal infection. When skeletal infection occurs, the time from onset of symptoms to diagnosis is up to 5 years in previously reported cases. We describe a 48-year-old woman with HIV/AIDS who presented with chronic, isolated left knee pain and swelling of over two decades which had recently worsened. Radiographs and magnetic resonance imaging demonstrated marked subarticular erosions, synovial thickening, and bone marrow edema, which had progressed compared with prior imaging done seven years earlier. Synovial biopsy grew Mycobacterium kansasii. Following the presentation of our case, clinical and imaging findings, including the differential diagnosis, of monoarticular arthritis caused by Mycobacterium kansasii are reviewed and discussed.

  20. Personality Disorders in Substance Abusers: A Comparison of Patients Treated in a Prison Unit and Patients Treated in Inpatient Treatment

    ERIC Educational Resources Information Center

    Stefansson, Ragnar; Hesse, Morten

    2008-01-01

    A large body of literature has shown a high prevalence of personality disorders in substance abusers. We compared a sample of substance abusers treated in a prison setting with substance abusers treated in a non-prison inpatient setting rated with the Millon Clinical Multiaxial Inventory-III. Base-rate scores indicated a prevalence of 95% of…

  1. Successful administration of aggressive chemotherapy concomitant to tuberculostatic and highly active antiretroviral therapy in a patient with AIDS-related Burkitt's lymphoma.

    PubMed

    Lehmann, C; Wyen, C; Hoffmann, C; Fätkenheuer, G

    2005-01-01

    Treatment of AIDS-related malignant lymphoma (ARL) remains a therapeutic challenge. There are concerns not only about infectious and haematological complications in HIV-infected patients during intensive chemotherapy, but also about potential interactions between chemotherapy and highly active antiretroviral therapy (HAART). Current data on patients treated concomitantly with intensive chemotherapy and HAART are limited, and no data exist on patients with ARL suffering from active opportunistic infections. We report the case of a 38-year-old man with advanced HIV-1 infection, pulmonary tuberculosis and Burkitt's lymphoma. Intensive chemotherapy was administered in parallel with tuberculostatic therapy and HAART. Six months later, the patient achieved not only a complete remission of Burkitt's lymphoma and sustained viral suppression, but also a full recovery from tuberculosis. This case report provides some useful observations on the successful application of intensive chemotherapy in addition to tuberculostatic therapy and HAART in HIV-infected patients.

  2. Prevention of AIDS and living together with an HIV-infected patient.

    PubMed

    Fahik, F T; Reichert, M C; Gabriel, R; Marin, H F

    1995-01-01

    In Brazil, approximately 45 thousand cases had been reported until the end of 1993, with an estimated 50% underreport. According to the Ministry of Health, until the year 2,000 from 2 to 8 million Brazilians citizens will be infected with HIV. The basic aspect of the educational campaigns regarding AIDS does not refer only to information on forms of transmission and prevention measures, but also attempts to fight against the mystification and the enormous resistance of the public to definitely accept the fact that transmission does not occur by simple means such as having a drink from the same glass, independently of its socioeconomic and cultural level. In addition to the lack of information, prejudice and discrimination appear strongly rooted in the population to the point of a tendency of social and effective rejection of the HIV-infected patient. Fighting against prejudice, against which there is also no vaccine, is a task as gigantic as fighting against the virus. For both, investments in education of and information to the population in general, is very important. Development of a software which would fulfill the function of explaining, and providing the correct information about AIDS, would be extremely valuable for any part of the society and could also be used as a complementary element by health professionals. The objective was to develop an interactive software in order to demonstrate prevention measures and universal precaution in AIDS; to inform about the necessary care to people that are living together an HIV-infected patient. To develop this software with animation and elucidating text regarding AIDS for the general population, we are using the Storyboard live to be run in Windows environment.

  3. Palliative care for patients with HIV/AIDS admitted to intensive care units

    PubMed Central

    Souza, Paola Nóbrega; de Miranda, Erique José Peixoto; Cruz, Ronaldo; Forte, Daniel Neves

    2016-01-01

    Objective To describe the characteristics of patients with HIV/AIDS and to compare the therapeutic interventions and end-of-life care before and after evaluation by the palliative care team. Methods This retrospective cohort study included all patients with HIV/AIDS admitted to the intensive care unit of the Instituto de Infectologia Emílio Ribas who were evaluated by a palliative care team between January 2006 and December 2012. Results Of the 109 patients evaluated, 89% acquired opportunistic infections, 70% had CD4 counts lower than 100 cells/mm3, and only 19% adhered to treatment. The overall mortality rate was 88%. Among patients predicted with a terminally ill (68%), the use of highly active antiretroviral therapy decreased from 50.0% to 23.1% (p = 0.02), the use of antibiotics decreased from 100% to 63.6% (p < 0.001), the use of vasoactive drugs decreased from 62.1% to 37.8% (p = 0.009), the use of renal replacement therapy decreased from 34.8% to 23.0% (p < 0.0001), and the number of blood product transfusions decreased from 74.2% to 19.7% (p < 0.0001). Meetings with the family were held in 48 cases, and 23% of the terminally ill patients were discharged from the intensive care unit. Conclusion Palliative care was required in patients with severe illnesses and high mortality. The number of potentially inappropriate interventions in terminally ill patients monitored by the palliative care team significantly decreased, and 26% of the patients were discharged from the intensive care unit. PMID:27737420

  4. A Therapeutic Confrontation Approach to Treating Patients with Factitious Illness

    ERIC Educational Resources Information Center

    Wedel, Kenneth R.

    1971-01-01

    Patients suffering from factitious illness present complex problems for themselves and hospital personnel. This article describes a multidisciplinary intervention through confrontation approach that has proved to be successful with such patients. (Author)

  5. [Recurrent diarrhea due to Cystoisopora belli in HIV/AIDS patients receiving HAART].

    PubMed

    Montalvo, Raúl; Ticona, Eduardo; Ñavincopa, Marcos; García, Yuri; Chávez, Gonzalo; Chávez, Víctor; Arévalo, Jorge; Soria, Jaime; Huiza, Alina

    2013-04-01

    The Cystoisospora belli, before denominated as Isospora belli, is the etiologic agent of cystoisosoporiasis, an opportunistic infection affecting immunocompromised patients, characterized by chronic diarrhea and weight loss. The incidence of chronic diarrhea for this agent, in HIV patients, has decreased considerably. This thanks to the advent of highly active antiretroviral therapy (HAART), which has improved the patient's immune response and decrease viral load. We present six cases of cystoisosoporiasis recurrent and refractory to treatment in HIV patients, who was being treated with with trimethoprim / sulfamethoxazole (TMP / SMX) orally as a prophylaxis. Five of these patients passed away due to the infection, despite of the fact that they had a good response to HAART (adequate increase in CD4 and viral load undetectable) and they had been treated with second line drugs.

  6. Cryptosporidiosis in HIV/AIDS Patients in Kenya: Clinical Features, Epidemiology, Molecular Characterization and Antibody Responses

    PubMed Central

    Wanyiri, Jane W.; Kanyi, Henry; Maina, Samuel; Wang, David E.; Steen, Aaron; Ngugi, Paul; Kamau, Timothy; Waithera, Tabitha; O'Connor, Roberta; Gachuhi, Kimani; Wamae, Claire N.; Mwamburi, Mkaya; Ward, Honorine D.

    2014-01-01

    We investigated the epidemiological and clinical features of cryptosporidiosis, the molecular characteristics of infecting species and serum antibody responses to three Cryptosporidium-specific antigens in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients in Kenya. Cryptosporidium was the most prevalent enteric pathogen and was identified in 56 of 164 (34%) of HIV/AIDS patients, including 25 of 70 (36%) with diarrhea and 31 of 94 (33%) without diarrhea. Diarrhea in patients exclusively infected with Cryptosporidium was significantly associated with the number of children per household, contact with animals, and water treatment. Cryptosporidium hominis was the most prevalent species and the most prevalent subtype family was Ib. Patients without diarrhea had significantly higher serum IgG levels to Chgp15, Chgp40 and Cp23, and higher fecal IgA levels to Chgp15 and Chgp40 than those with diarrhea suggesting that antibody responses to these antigens may be associated with protection from diarrhea and supporting further investigation of these antigens as vaccine candidates. PMID:24865675

  7. Mechanisms of motor recovery in chronic and subacute stroke patients following a robot-aided training.

    PubMed

    Mazzoleni, S; Puzzolante, L; Zollo, L; Dario, P; Posteraro, F

    2014-01-01

    The aim of this article is to propose a methodology for analyzing different recovery mechanisms in subacute and chronic patients through evaluation of biomechanical parameters. Twenty-five post-stroke subjects, eight subacute and seventeen chronic, participated in the study. A 2-DoF robotic system was used for upper limb training. Two clinical scales were used for assessment. Forces and velocities at the robot's end-effector during the execution of upper limb planar reaching movements were measured. Clinical outcome measures show a significant decrease in motor impairment after the treatment both in chronic and subacute patients (MSS-SE, p<0.001; FM, p<0.05). Movement velocity increases after the robot-aided treatment in both groups. Mean values of forces exerted by subacute patients are lower than those observed in chronic patients, both at the beginning and at the end of robotic treatment, as in the latter the pathological pattern is already structured. Our results demonstrate that the monitoring of the forces exerted on the end-effector during robot-aided treatment can identify the specific motor recovery mechanisms at different stages. If the pathological pattern is not yet structured, rehabilitative interventions should be addressed toward the use of motor re-learning procedures; on the other hand, if the force analysis shows a strong pathological pattern, mechanisms of compensation should be encouraged.

  8. Prevalence and lethality among patients with histoplasmosis and AIDS in the Midwest Region of Brazil.

    PubMed

    Silva, Thaísa C; Treméa, Carolina M; Zara, Ana Laura S A; Mendonça, Ana Flávia; Godoy, Cássia S M; Costa, Carolina R; Souza, Lúcia K H; Silva, Maria R R

    2017-01-01

    Histoplasmosis is a systemic mycosis that is considered an important public health problem. In this work, we performed a descriptive, observational, cross-sectional and retrospective study with a secondary data analysis of medical records from 2000 to 2012 at a tertiary hospital. The study sample consisted of 275 patients with laboratory-confirmed Disseminated Histoplasmosis (DH)/AIDS. The results showed that the prevalence of DH associated with AIDS was 4.4%. The majority of patients were young adult men with fever in 84.2%, cough in 63.4%, weight loss in 63.1%, diarrhoea in 44.8% and skin manifestations in 27.6% of patients. In the overall cohort, the CD4 counts were low, but not significantly different in survivors and non-survivors. Higher levels of urea and lower levels of haemoglobin and platelets were observed in non-survivor patients (<.05). The global lethality was 71.3% (196/275). The results with high prevalence and lethality highlight the need to adopt measures to facilitate early diagnosis, proper treatment and improved prognosis.

  9. Impact of Individual-Level Social Capital on Quality of Life among AIDS Patients in China

    PubMed Central

    Ma, Ying; Qin, Xia; Chen, Ruoling; Li, Niannian; Chen, Ren; Hu, Zhi

    2012-01-01

    Background With growing recognition of the social determinants of health, social capital is an increasingly important construct in international health. However, the application of social capital discourse in response to HIV infection remains preliminary. The aim of this study was to assess the impact of social capital on quality of life (QoL) among adult patients with acquired immune deficiency syndrome (AIDS). Methods A convenient sample of 283 patients receiving antiretroviral treatment (ART) was investigated in Anhui province, China. QoL data were collected using the Medical Outcomes Study HIV Survey (MOS-HIV) questionnaire. Social capital was measured using a self-developed questionnaire. Logistic regression models were used to explore associations between social capital and QoL. Results The study sample had a mean physical health summary (PHS) score of 50.13±9.90 and a mean mental health summary (MHS) score of 41.64±11.68. Cronbach's α coefficients of the five multi-item scales of social capital ranged from 0.44 to 0.79. When other variables were controlled for, lower individual levels of reciprocity and trust were associated with a greater likelihood of having a poor PHS score (odds ratio [OR] = 2.02) or PHS score (OR = 6.90). Additionally, the factors of social support and social networks and ties were associated positively with MHS score (OR = 2.30, OR = 4.17, respectively). Conclusions This is the first report to explore the effects of social capital on QoL of AIDS patients in China. The results indicate that social capital is a promising avenue for developing strategies to improve the QoL of AIDS patients in China, suggesting that the contribution of social capital should be fully exploited, especially with enhancement of QoL through social participation. Social capital development policy may be worthy of consideration. PMID:23139823

  10. Optimize patient health by treating literacy and language barriers.

    PubMed

    Dreger, Vicki; Tremback, Tom

    2002-02-01

    More than 90 million Americans have limited literacy skills. Almost two million US residents cannot speak English, and millions more speak it poorly. The stigma of illiteracy or the inability to speak a country's predominant language keep patients from disclosing their limitations. Recognizing these facts is an important first step in improving health education for this vulnerable population. By adapting teaching techniques to patients' special needs, nurses can ensure that patients understand their health problems and plan of care. Statistics dramatically demonstrate the high cost of neglecting these needs. Patients who do not understand their plan of care do not comply with instructions and, therefore, suffer unnecessary complications. Health care providers who can communicate with their patients through multilingual, low literacy patient education materials and with the use of qualified interpreters markedly improve the quality of care for their patients and the resulting outcomes.

  11. [Prevalence of oral lesions by Candida sp.: Their varieties and serotypes in a population of patients with AIDS under a highly active antiretroviral therapy.].

    PubMed

    Ceballos Salobreña, A; Gaitán Cepeda, L A; Ruesga, M T; Ceballos García, L; Quindós, G

    1998-09-01

    The aim of this study has been to determine the prevalence of oral candidiasis and oral Candida carriers in an AIDS population under highly active antiretroviral therapy. Eighty-six AIDS patients treated with an antiretroviral combination (indinavir o ritonavir o saquinavir + zidovudine [AZT] + lamivudine [3TC]). Patients were grouped attending the predisposing factors for HIV infection in: intravenous drug users (IDU), heterosexuals, homosexuals, patients using hematological products or having unknown factors. Oral cavity was examined and an oral specimen was inoculated in a chromogenic culture medium (Albicans ID, bioMérieux, France). The prevalence of oral Candida lesions was 30.2% and Candida was isolated from 54.7% of patients. The predominant species was C. albicans serotype A in all the groups with the exception of homosexual patients, were C. albicans serotype B was the predominant. The IDU group showed the higher prevalence of Candida lesions and oral yeasts colonization, followed by the group of heterosexuals and homosexuals. An association was found between the presence of lesions and/or Candida spp. and the clinical stage or the viral concentration. The species Candida dubliniensis was isolated in the oral samples of two patients with candidosis and in two individuals without oral candidosis. The finding of this species in Spanish patients can be added to the data obtained in epidemiological studies in other countries.

  12. Human immunodeficiency virus (HIV) is highly associated with giant idiopathic esophageal ulcers in acquired immunodeficiency syndrome (AIDS) patients

    PubMed Central

    Lv, Bei; Cheng, Xin; Gao, Jackson; Zhao, Hong; Chen, Liping; Wang, Liwei; Huang, Shaoping; Fan, Zhenyu; Zhang, Renfang; Shen, Yinzhong; Li, Lei; Liu, Baochi; Qi, Tangkai; Wang, Jing; Cheng, Jilin

    2016-01-01

    Objective: This study aimed to determine whether the human immunodeficiency virus (HIV) exists in giant idiopathic esophageal ulcers in the patients with acquired immune deficiency syndrome (AIDS). Methods: 16 AIDS patients with a primary complaint of epigastric discomfort were examined by gastroscopy. Multiple and giant esophageal ulcers were biopsied and analyzed with pathology staining and reverse transcription-polymerase chain reaction (RT-PCR) to determine the potential pathogenic microorganisms, including HIV, cytomegalovirus (CMV) and herpes simplex viruses (HSV). Results: HIV was detected in ulcer samples from 12 out of these 16 patients. Ulcers in 2 patients were infected with CMV and ulcers in another 2 patients were found HSV positive. No obvious cancerous pathological changes were found in these multiple giant esophageal ulcer specimens. Conclusion: HIV may be one of the major causative agents of multiple benign giant esophageal ulcers in AIDS patients. PMID:27830031

  13. An overview and discussion of the Patient-Centered Outcomes Research Institute's decision aid portfolio.

    PubMed

    Gayer, Christopher C; Crowley, Matthew J; Lawrence, William F; Gierisch, Jennifer M; Gaglio, Bridget; Williams, John W; Myers, Evan R; Kendrick, Amy; Slutsky, Jean; Sanders, Gillian D

    2016-07-01

    Decision aids (DAs) help patients make informed healthcare decisions in a manner consistent with their values and preferences. Despite their promise, DAs developed with public research dollars are not being implemented and adopted in real-world patient care settings at a rate consistent with which they are being developed. To appraise the sum of the parts of the portfolio and create a strategic imperative surrounding future funding, the Patient-Centered Outcomes Research Institute (PCORI) tasked the Duke Evidence Synthesis Group with evaluating its DA portfolio. This paper describes PCORI's portfolio of DAs according to the Duke Evidence Synthesis Group's analysis in the context of PCORI's mission and the field of decision science. The results revealed a diversity within PCORI's portfolio of funded DA projects. Findings support the movement toward more rigorous DA development, assessment and maintenance. PCORI's funding priorities related to DAs are clarified and comparative questions of interest are posed.

  14. Tardive dyskinesia in 2 patients treated with ziprasidone

    PubMed Central

    Ananth, Jambur; Burgoyne, Karl S.; Niz, David; Smith, Michael

    2004-01-01

    Ziprasidone is an atypical antipsychotic drug that is believed to have a low propensity for inducing extrapyramidal symptoms, including tardive dyskinesia (TD). Two of our patients developed TD after 23 months and 34 months of ziprasidone monotherapy, respectively. One of the patients had had earlier exposure to typical antipsychotic drugs, but no other predisposing factors for TD were noted. Therefore, patients on long-term therapy with atypical antipsychotic drugs should be screened periodically for TD. PMID:15644988

  15. A diverse population of Cryptococcus gattii molecular type VGIII in southern Californian HIV/AIDS patients.

    PubMed

    Byrnes, Edmond J; Li, Wenjun; Ren, Ping; Lewit, Yonathan; Voelz, Kerstin; Fraser, James A; Dietrich, Fred S; May, Robin C; Chaturvedi, Sudha; Chatuverdi, Sudha; Chaturvedi, Vishnu; Chatuverdi, Vishnu; Heitman, Joseph

    2011-09-01

    Cryptococcus gattii infections in southern California have been reported in patients with HIV/AIDS. In this study, we examined the molecular epidemiology, population structure, and virulence attributes of isolates collected from HIV/AIDS patients in Los Angeles County, California. We show that these isolates consist almost exclusively of VGIII molecular type, in contrast to the VGII molecular type isolates causing the North American Pacific Northwest outbreak. The global VGIII population structure can be divided into two molecular groups, VGIIIa and VGIIIb. Isolates from the Californian patients are virulent in murine and macrophage models of infection, with VGIIIa significantly more virulent than VGIIIb. Several VGIII isolates are highly fertile and produce abundant sexual spores that may serve as infectious propagules. The a and α VGIII MAT locus alleles are largely syntenic with limited rearrangements compared to the known VGI (a/α) and VGII (α) MAT loci, but each has unique characteristics including a distinct deletion flanking the 5' VGIII MATa alleles and the α allele is more heterogeneous than the a allele. Our studies indicate that C. gattii VGIII is endemic in southern California, with other isolates originating from the neighboring regions of Mexico, and in rarer cases from Oregon and Washington state. Given that >1,000,000 cases of cryptococcal infection and >620,000 attributable mortalities occur annually in the context of the global AIDS pandemic, our findings suggest a significant burden of C. gattii may be unrecognized, with potential prognostic and therapeutic implications. These results signify the need to classify pathogenic Cryptococcus cases and highlight possible host differences among the C. gattii molecular types influencing infection of immunocompetent (VGI/VGII) vs. immunocompromised (VGIII/VGIV) hosts.

  16. A Diverse Population of Cryptococcus gattii Molecular Type VGIII in Southern Californian HIV/AIDS Patients

    PubMed Central

    Lewit, Yonathan; Voelz, Kerstin; Fraser, James A.; Dietrich, Fred S.; May, Robin C.; Chatuverdi, Sudha; Chatuverdi, Vishnu; Heitman, Joseph

    2011-01-01

    Cryptococcus gattii infections in southern California have been reported in patients with HIV/AIDS. In this study, we examined the molecular epidemiology, population structure, and virulence attributes of isolates collected from HIV/AIDS patients in Los Angeles County, California. We show that these isolates consist almost exclusively of VGIII molecular type, in contrast to the VGII molecular type isolates causing the North American Pacific Northwest outbreak. The global VGIII population structure can be divided into two molecular groups, VGIIIa and VGIIIb. Isolates from the Californian patients are virulent in murine and macrophage models of infection, with VGIIIa significantly more virulent than VGIIIb. Several VGIII isolates are highly fertile and produce abundant sexual spores that may serve as infectious propagules. The a and α VGIII MAT locus alleles are largely syntenic with limited rearrangements compared to the known VGI (a/α) and VGII (α) MAT loci, but each has unique characteristics including a distinct deletion flanking the 5′ VGIII MATa alleles and the α allele is more heterogeneous than the a allele. Our studies indicate that C. gattii VGIII is endemic in southern California, with other isolates originating from the neighboring regions of Mexico, and in rarer cases from Oregon and Washington state. Given that >1,000,000 cases of cryptococcal infection and >620,000 attributable mortalities occur annually in the context of the global AIDS pandemic, our findings suggest a significant burden of C. gattii may be unrecognized, with potential prognostic and therapeutic implications. These results signify the need to classify pathogenic Cryptococcus cases and highlight possible host differences among the C. gattii molecular types influencing infection of immunocompetent (VGI/VGII) vs. immunocompromised (VGIII/VGIV) hosts. PMID:21909264

  17. [Personality and emesis in the patient treated with antineoplastic chemotherapy].

    PubMed

    Llorca, G; Martín, T; Derecho, J; Gómez, M J

    1991-01-01

    A sample of twenty cancer patients following chemotherapy realize MMPI questionnaire, and another one for valuation of emetic and anticipatory phenomena in relation to said therapy. The authors came to the conclusion that 36.8% of the sample had anticipatory nausea and vomiting, 63.6% anticipatory dysphoria, and 66% emetic incidents after chemotherapy. The conclusion, through comparison of personality variables, is that all patients showed neuroticism and depression scales increased, in relation to healthy population. Depression variable increased especially in patients that didn't present anticipatory nausea and vomiting. Likewise, patients with anticipatory symptoms or emetic incidents after chemotherapy present an increased social introversion variable.

  18. Ixabepilone in Treating Young Patients With Refractory Solid Tumors

    ClinicalTrials.gov

    2014-11-13

    Adult Rhabdomyosarcoma; Adult Synovial Sarcoma; Alveolar Childhood Rhabdomyosarcoma; Childhood Synovial Sarcoma; Embryonal Childhood Rhabdomyosarcoma; Previously Treated Childhood Rhabdomyosarcoma; Recurrent Adult Soft Tissue Sarcoma; Recurrent Childhood Rhabdomyosarcoma; Recurrent Childhood Soft Tissue Sarcoma; Recurrent Ewing Sarcoma/Peripheral Primitive Neuroectodermal Tumor; Recurrent Neuroblastoma; Recurrent Osteosarcoma; Recurrent Wilms Tumor and Other Childhood Kidney Tumors

  19. Cixutumumab in Treating Patients With Relapsed or Refractory Solid Tumors

    ClinicalTrials.gov

    2015-03-18

    Adult Rhabdomyosarcoma; Adult Synovial Sarcoma; Childhood Hepatoblastoma; Childhood Synovial Sarcoma; Previously Treated Childhood Rhabdomyosarcoma; Recurrent Adrenocortical Carcinoma; Recurrent Adult Soft Tissue Sarcoma; Recurrent Childhood Liver Cancer; Recurrent Childhood Rhabdomyosarcoma; Recurrent Childhood Soft Tissue Sarcoma; Recurrent Ewing Sarcoma/Peripheral Primitive; Neuroectodermal Tumor; Recurrent Neuroblastoma; Recurrent Osteosarcoma; Recurrent Retinoblastoma; Recurrent Wilms Tumor and Other Childhood Kidney Tumors

  20. Heart attack first aid

    MedlinePlus

    First aid - heart attack; First aid - cardiopulmonary arrest; First aid - cardiac arrest ... of patients with unstable angina/non-ST-elevation myocardial infarction (updating the 2007 guideline and replacing the 2011 ...

  1. Neurological Complications of AIDS

    MedlinePlus

    ... Patient & Caregiver Education » Fact Sheets Neurological Complications of AIDS Fact Sheet Table of Contents (click to jump ... Where can I get more information? What is AIDS? AIDS (acquired immune deficiency syndrome) is a condition ...

  2. The relationship between hearing aid frequency response and acceptable noise level in patients with sensorineural hearing loss

    PubMed Central

    Jalilvand, Hamid; Pourbakht, Akram; Jalaee, Shohreh

    2015-01-01

    Background: When fitting hearing aid as a compensatory device for an impaired cochlea in a patient with sensorineural hearing loss (HL), it is needed to the effective and efficient frequency response would be selected regarding providing the patient's perfect speech perception. There is not any research about the effects of frequency modifications on speech perception in patients with HL regarding the cochlear desensitization. The effect (s) of modifications in frequency response of hearing aid amplification on the results of acceptable noise level (ANL) test is the main aim of this study. Materials and Methods: The amounts of ANL in two conditions of linear amplification (high frequency emphasis [HFE] and mid frequency emphasis [MFE]) were measured. Thirty-two male subjects who participated in this study had the moderate to severe sensorineural HL. Results: There was not any significant difference between ANL in linear amplification of hearing aid with HFE frequency response and ANL in linear amplification of hearing aid with MFE frequency response. Conclusion: The gain modification of frequency response not only does not affect the patient's performance of speech intelligibility in ANL test. This indicates that we need to note to the cochlear desensitization phenomenon when fitting hearing aid as a compensatory device for an impaired cochlea in a patient. The cochlear desensitization has not been considered properly in hearing aid fitting formula which is needed to be explored more about the bio-mechanisms of impaired cochlea. PMID:26918238

  3. Computer-aided diagnosis of pneumonia in patients with chronic obstructive pulmonary disease

    PubMed Central

    Sánchez Morillo, Daniel; León Jiménez, Antonio; Moreno, Sonia Astorga

    2013-01-01

    Background Early diagnosis of pneumonia and discrimination between this disease and chronic obstructive pulmonary disease (COPD) exacerbations in patients with COPD are crucial for optimal clinical management and treatment. Objectives To examine the use of computerized analysis of respiratory sounds, a hybrid system based on principal component analysis (PCA) and probabilistic neural networks (PNNs), to aid the detection of coexisting pneumonia in patients with COPD. Methods and materials A convenience sample of 58 patients with COPD (25 patients hospitalized for community-acquired pneumonia and 33 owing to acute exacerbation of COPD) was studied. Auscultations were performed by the patients themselves on their suprasternal notch. Short-time Fourier transform analysis was used to extract features from the recorded respiratory sounds, PCA was selected for dimensionality reduction and a PNN was trained as classifier. 10-Fold cross-validation and receiver operating characteristic curve analysis were used to estimate the system performance. Results Based on the cross-validation results, a sensitivity and a specificity of 72% and 81.8%, respectively, were achieved in validation data. The operating point was selected to maximize the specificity and sensitivity pair in the training set. Discussion The results strongly suggest that electronic self-auscultation at a single location (suprasternal notch) can support diagnosis of pneumonia in patients with COPD. Conclusions A simple, cost-effective method has been proposed to aid decision-making in areas with no radiological facilities available and in resource-constrained settings, and could have a great diagnostic impact on telemedicine applications. PMID:23396513

  4. Quality of Life Outcomes of Antiretroviral Treatment for HIV/AIDS Patients in Vietnam

    PubMed Central

    Tran, Bach Xuan

    2012-01-01

    Objective This study assessed health-related quality of life (HRQOL) and its related factors in HIV/AIDS patients taking antiretroviral treatment (ART) in Vietnam. Methods A cross-sectional study was conducted with 1016 patients (36.2% women, mean age = 35.4) in three epicenters of Vietnam, including Hanoi, Hai Phong, and Ho Chi Minh City. HRQOL was assessed using the Vietnamese version of the WHOQOL-HIV BREF. Factor analysis classified measure items into six HRQOL dimensions, namely Physical, Morbidity, Social, Spirituality, Performance, and Environment. Tobit censored regression models were applied to determine associations of patient’s characteristics and HRQOL domain scores. Results Internal consistency reliability of the six domains ranged from 0.69 to 0.89. The WHOQOL-HIV BREF had a good discriminative validity with patient’s disease stages, CD4 cell counts, and duration of ART. In a band score of (4, 20), six domains were moderate; “Environment” had the highest score (13.8±2.8), and “Social” had the lowest score (11.2±3.3). Worse HRQOL were observed in patients at provincial and district clinics. Those patients who were male, had higher educational attainment, and are employed, reported better HRQOL. In reduced regression models, poorer HRQOL was found in patients who had advanced HIV infection and had CD4 cell count <200 cells/mL. Patients reported significantly poorer Physical and Social in the 1st year ART, but moderately better Performance, Morbidity, Spirituality, and Environment from the 2nd year ART, compared to those not-yet-on ART. Conclusion Strengthening the quality of ART services at the provincial and district levels, gender-specific impact mitigation, and early treatment supports are recommended for further expansion of ART services in Vietnam. Regular assessments of HRQOL may provide important indicators for monitoring and evaluating HIV/AIDS services. PMID:22911742

  5. Effect of host genetics on incidence of HIV neuroretinal disorder in patients with AIDS

    PubMed Central

    Sezgin, Efe; Hendrickson, Sher L.; Jabs, Douglas A.; Van Natta, Mark L.; Lewis, Richard A.; Troyer, Jennifer L.; O’Brien, Stephen J.

    2010-01-01

    Approximately 10 to 15% of patients with AIDS but without ocular opportunistic infections will have a presumed neuroretinal disorder (HIV-NRD), manifested by reduced contrast sensitivity and abnormal visual fields. The loss of contrast sensitivity often is sufficient to impair reading speed. To evaluate the effect of host genetics on HIV-NRD, we explored validated AIDS restriction gene variants CCR5Δ32, CCR2-64I, CCR5 P1, SDF-3`A, IL-10-5`A, RANTES -403A, RANTES -28G, RANTES-In1.1C, CX3CR1-249I, CX3CR1-280M, IFNG-179T, MDR1-3435T, and MCP-1364G, each of which has been implicated previously to influence HIV-1 infection, AIDS progression, therapy response, and antiviral drug metabolism, and an IL-10 receptor gene, IL-10R1, in the Longitudinal Study of the Ocular Complications of AIDS (LSOCA) cohort. In European Americans (cases=55, controls=290), IL-10-5`A variant and its promoter haplotype (HR=2.09, CI: 1.19–3.67, P = 0.01); in African Americans (cases=54, controls=180) RANTES-In1.1C and the associated haplotype (HR=2.72, CI: 1.48–5.00, P = 0.001), showed increased HIV-NRD susceptibility. While sample sizes are small and P values do not pass a strict Bonferroni correction, our results suggest that, in European Americans, an IL-10-related pathway, and, in African Americans, chemokine receptor ligand polymorphisms in RANTES are risk factors for HIV- NRD development. Clearly, further studies are warrented. PMID:20531015

  6. Long-term survival of an AIDS patient with a tuberculous cerebral abscess.

    PubMed Central

    Gettler, J. F.; Garner, B. F.

    1996-01-01

    Unlike other forms of tuberculosis, tuberculous cerebral abscess is a rare complication of human immunodeficiency virus (HIV) infection and usually presents at a late stage of the disease. This article describes a case of tuberculous cerebral abscess in an HIV-infected patient that was effectively treated with surgery and chemotherapy. The patient has survived more than 5 1/2 years since being diagnosed and remains in good health. PMID:8855653

  7. Long-term survival of an AIDS patient with a tuberculous cerebral abscess.

    PubMed

    Gettler, J F; Garner, B F

    1996-09-01

    Unlike other forms of tuberculosis, tuberculous cerebral abscess is a rare complication of human immunodeficiency virus (HIV) infection and usually presents at a late stage of the disease. This article describes a case of tuberculous cerebral abscess in an HIV-infected patient that was effectively treated with surgery and chemotherapy. The patient has survived more than 5 1/2 years since being diagnosed and remains in good health.

  8. Challenges in Treating Older Patients with Acute Myeloid Leukemia

    PubMed Central

    Eleni, Lagadinou D.; Nicholas, Zoumbos C.; Alexandros, Spyridonidis

    2010-01-01

    Whereas in younger patients diagnosed with acute myeloid leukemia (AML) treatment is straightforward and the goal is cure, the optimal treatment decision for older adults remains highly controversial. Physicians need to determine whether palliation, “something” beyond palliation, intensive therapy, or an investigational therapy is the most appropriate treatment option. This requires understanding of the biology and risk profile of the AML, clinical judgment in evaluating the functional status of the patient, communication skills in understanding the patient's wishes and social background, and medical expertise in available therapies. The physician has to accurately inform the patient about (a) the unique biological considerations of his leukemia and his prognosis; (b) the risks and benefits of all available treatment options; (c) novel therapeutic approaches and how the patient can get access to these treatments. Last but not least, he has to recommend a treatment. This paper tries to discuss each of these issues. PMID:20628485

  9. Laser radiation of blood in treating patients with postinfarction heart

    NASA Astrophysics Data System (ADS)

    Tashchuk, V.; Polyanskaya, O.; Chaplinsky, R.; Ilashchuk, I.; Kulyk, T.

    1999-11-01

    168 patients on the postclinical stage of treatment of acute myocardial infarction were examined by means of the use of basic antiischemic therapy and intravenous laser radiation of blood (LRB). All patients were studied with the help of transesophageal electrocardiostimulation, bicycle ergometry, echocardiography and Holter ECG monitoring in the dynamics of prolonged observation and treatment. The analysis of efficiency of the LRB has shown that the most minimal degree of myocardial ischemization was marked in patients after intravenous LRB. The patients before LRB had the greater reduction of coronary reserve. The use of LRB has given the possibility to the optimization of therapy in patients on the stage of the forming of `the postinfarction heart'.

  10. Adverse Drug Reactions in HIV/AIDS Patients at a Tertiary Care Hospital in Penang, Malaysia.

    PubMed

    Khan, Kashifullah; Khan, Amer Hayat; Sulaiman, Syed Azhar; Soo, Chow Ting; Akhtar, Ali

    2016-01-01

    In the current study we explored the occurrence of adverse drug reactions (ADRs) to antiretroviral therapy among human immune-deficiency virus (HIV)/AIDS patients. We concluded an observational retrospective study in all patients who were diagnosed with HIV infection and were receiving highly active antiviral therapy from Jan. 2007 to Dec. 2012 at Hospital Pulau Pinang, Malaysia. Patient socio-demographic details along with clinical features and susceptible ADRs were observed during the study period. Out of 743 patients, 571 (76.9%) were men, and 172 (23.1%) were women. Overall 314 (42.2%) patients experienced ADRs. A total of 425 ADRs were reported, with 311 (73.1%) occurring in men and 114 (26.8%) in women, with a significant statistical relationship (P value (P) = 0.02, OR = 1.21). Overall 239 (56.2%) ADRs were recorded among Chinese, 94 (22.1%) in Malay, and 71 (16.7%) in Indian patients, which had a statistically significant association with ADRs (P = 0.05, OR = 1.50). Out of a total 425 among ADRs, lipodystrophy was recorded in 151 (35.5%) followed by skin rashes in 80 (18.8%), anemia in 74 (17.4%), and peripheral neuropathy in 27 (6.3%) patients. These findings suggest a need of intensive monitoring of ADRs in HIV treatment centres across Malaysia.

  11. How I treat influenza in patients with hematologic malignancies

    PubMed Central

    Casper, Corey; Englund, Janet

    2010-01-01

    The 2009 H1N1 influenza pandemic has heightened the interest of clinicians for options in the prevention and management of influenza virus infection in immunocompromised patients. Even before the emergence of the novel 2009 H1N1 strain, influenza disease was a serious complication in patients with hematologic malignancies receiving chemotherapy or undergoing hematopoietic cell transplantation. Here we review the clinical manifestations of seasonal and 2009 H1N1 influenza and discuss current diagnosis, antiviral treatment, and prophylaxis options. We also summarize infection control and vaccination strategies for patients, family members, and caregivers. PMID:20009037

  12. Benefits of treating highly disabled migraine patients with zolmitriptan while pain is mild.

    PubMed

    Klapper, J; Lucas, C; Røsjø, Ø; Charlesworth, B

    2004-11-01

    Clinical trials of migraine therapy often require treatment when migraine pain intensity is moderate or severe, but many physicians find this practice artificial and patients often prefer to treat while pain is mild. This randomized, placebo-controlled study assessed the efficacy of zolmitriptan 2.5 mg in treating migraine while pain is mild, in patients who typically experience migraine attacks that are initially mild, but progress to moderate or severe. The intent-to-treat population comprised 280 patients (138 zolmitriptan; 148 placebo), with mean MIDAS grades of 29.6 (zolmitriptan) and 27.6 (placebo). Zolmitriptan 2.5 mg provided a significantly higher pain-free rate at 2 h (43.4% vs. 18.4% placebo; P < 0.0001). Significantly fewer zolmitriptan patients reported progression of headache pain to moderate or severe intensity 2 h postdose (53.7% vs. 70.4% placebo; P < 0.01), or required further medication within 24 h (46.4% vs. 71.1% placebo; P < 0.0001). The efficacy of zolmitriptan was more pronounced in patients treating during the first 15 min following pain onset. Adverse events were reported in 31.2% of patients treated with zolmitriptan (vs. 11.3% for placebo), and the incidence was lower in patients who treated early after attack onset. Zolmitriptan provides high efficacy when treating migraine while pain is mild, with the clinical benefits being more pronounced when treating early after migraine onset.

  13. Patient heal thyself: modeling and treating neurological disorders using patient-derived stem cells.

    PubMed

    Ess, Kevin C

    2013-03-01

    Disorders of the brain and spinal cord are common worldwide problems but have remained very difficult to treat. As a group they have diverse etiologies and can be due to trauma, infection, tumors, genetic mutations and environmental insults. Though distinct in etiology, neurological disorders share an overall intractability as current therapies are largely limited to treatment of symptoms. Improved outcomes are further constrained by the minimal endogenous capacity of the brain and spinal cord for repair. Spectacular recent scientific advances, however, suggest that new stem cell-based approaches may change this undesirable situation. In this review, I will broadly outline the challenges of studying and treating disorders of the brain and spinal cord. I will review ongoing attempts to use stem cell-based therapies to both model and treat neurological disorders. While this field is in its infancy, expected advances and needed breakthroughs point to a future where patient-derived stem cells will be the basis for the emerging discipline of regenerative neurology.

  14. Patient heal thyself: modeling and treating neurological disorders using patient-derived stem cells

    PubMed Central

    Ess, Kevin C

    2013-01-01

    Disorders of the brain and spinal cord are common worldwide problems but have remained very difficult to treat. As a group they have diverse etiologies and can be due to trauma, infection, tumors, genetic mutations and environmental insults. Though distinct in etiology, neurological disorders share an overall intractability as current therapies are largely limited to treatment of symptoms. Improved outcomes are further constrained by the minimal endogenous capacity of the brain and spinal cord for repair. Spectacular recent scientific advances, however, suggest that new stem cell-based approaches may change this undesirable situation. In this review, I will broadly outline the challenges of studying and treating disorders of the brain and spinal cord. I will review ongoing attempts to use stem cell-based therapies to both model and treat neurological disorders. While this field is in its infancy, expected advances and needed breakthroughs point to a future where patient-derived stem cells will be the basis for the emerging discipline of regenerative neurology. PMID:23598977

  15. Administering ziconotide and monitoring patients treated with ziconotide: expert opinions.

    PubMed

    Mitchell, Alisia A; Sapienza-Crawford, Anne J; Hanley, Kari L; Lokey, Kristi J; Wells, Linda; McDowell, Gladstone C; Stanton-Hicks, Michael

    2013-09-01

    Some patients with chronic pain who are intolerant of or refractory to treatment with systemic analgesics may benefit from intrathecal therapy. Ziconotide is the first nonopioid analgesic approved by the United States Food and Drug Administration for intrathecal administration. Several randomized, double-blind, placebo-controlled clinical trials have demonstrated the efficacy and safety of ziconotide. However, the maximum recommended dosing and titration schedule provided in the prescribing information may be too aggressive for some patients, and experience has demonstrated that ziconotide is better tolerated with slower titration to a lower maximum dose. Efficacy can be assessed by an evaluation of changes in pain, functionality, and quality of life. Cognitive adverse events may be subtle; therefore, it is important that health care professionals not only monitor patients for signs and symptoms of cognitive adverse events, but also teach family members how to do the same. Careful patient assessment and monitoring can help optimize the potential benefit from treatment with ziconotide.

  16. Serial thyroid iodine content in hyperthyroid patients treated with radioiodine

    SciTech Connect

    Lee, G.S.; Sandler, M.P.; Patton, J.A.; Brill, A.B.

    1986-02-01

    X-ray fluorescent scanning was used to measure initial thyroidal iodine content in 64 patients diagnosed as being hyperthyroid and selected for I-131 therapy, and serially in 48 of these patients after therapy in an attempt to determine those patients that were at high risk of becoming hypothyroid. Iodine content fell rapidly after therapy, reaching a nadir at about three months. Based on the population studied, the chance of early hypothyroidism (within 12 months) is about 80% if the iodine content measured at three months is less than 2 mg. If the iodine content is greater than 2 mg, the chance is only about 14%. The serial measurement of thyroidal iodine content (with x-ray fluorescent scanning) may allow early identification of those patients at high risk of developing permanent hypothyroidism following a therapeutic dose of I-131.

  17. Treating Patients with High-Risk Smoldering Myeloma

    Cancer.gov

    In this phase III clinical trial, patients with smoldering myeloma classified as high risk for progression will be randomly assigned to undergo standard observation or six 4-week courses of treatment with the drug lenalidomide.

  18. Gallium scans of the thorax in patients with acquired immune deficiency syndrome (AIDS): Description and utilization

    SciTech Connect

    Le, G.; Chen, D.C.P.; Siegel, M.E.

    1984-01-01

    The pattern of distribution of gallium uptake in the thorax was investigated in patients (pts) with AIDS. Eleven pts (ages 18-53), all active homosexual males suspected of having acute pulmonary infection were studied. Ga lung scans were performed at 24-48 and/or 72 hrs. post injection. The diagnosis of AIDS was based on appropriate clinical and laboratory findings. The Ga activity in the lung was graded from zero = background to 4+ which is > liver activity. Eight of eleven pts have positive Ga scan while seven of eleven pts had positive CXR. Six pts had both positive CXR and Ga scan. One pt had a positive Ga scan with negative CXR, and one with positive CXR and negative Ga scan. The positive Ga scans included 3 pts with 4+ diffuse uptake, two pts with 2+ diffuse uptake, two pts with 1+ diffuse uptake, and two with hilar node uptake. Three pts have focal increased uptake superimposed on diffuse uptake. Two pts with 4+ diffuse uptake had mild abnormality on their CXR. One pt with 4+ uptake in the initial scan shows decreased activity on follow-up with clinical improvement after therapy. Thus, all but two pts with positive Ga scans had diffuse lung uptake. These two patients alone had B cell immunoblastic sarcoma and oral candidiasis. The pattern of Ga lung uptake in pts with AIDS reveal that a majority of positive scans are diffuse (6/8) and the intensity may suggest more active disease than CXR (2 normal) and, thus, the study may be useful in detecting changes from atypical pulmonary infection in this population.

  19. Relation of activation-induced deaminase (AID) expression with antibody response to A(H1N1)pdm09 vaccination in HIV-1 infected patients.

    PubMed

    Cagigi, Alberto; Pensieroso, Simone; Ruffin, Nicolas; Sammicheli, Stefano; Thorstensson, Rigmor; Pan-Hammarström, Qiang; Hejdeman, Bo; Nilsson, Anna; Chiodi, Francesca

    2013-04-26

    The relevance of CD4+T-cells, viral load and age in the immunological response to influenza infection and vaccination in HIV-1 infected individuals has previously been pointed out. Our study aimed at assessing, in the setting of 2009 A(H1N1)pdm09 influenza vaccination, whether quantification of activation-induced deaminase (AID) expression in blood B-cells may provide additional indications for predicting antibody response to vaccination in HIV-1 infected patients with similar CD4+T-cell counts and age. Forty-seven healthy controls, 37 ART-treated and 17 treatment-naïve HIV-1 infected patients were enrolled in the study. Blood was collected prior to A(H1N1)pdm09 vaccination and at 1, 3 and 6 months after vaccination. Antibody titers to A(H1N1)pdm09 vaccine were measured by hemagglutination inhibition (HI) assay while the mRNA expression levels of AID were measured by quantitative real time PCR. Upon B-cell activation in vitro, AID increase correlated to antibody response to the A(H1N1)pdm09 vaccine at 1 month after vaccination in all individuals. In addition, the maximum expression levels of AID were significantly higher in those individuals who still carried protective levels of A(H1N1)pdm09 antibodies after 6 months from vaccination. No correlation was found between CD4+T-cell counts or age at vaccination or HIV-1 viral load and levels of A(H1N1)pdm09 antibodies. Assessing AID expression before vaccination may be an additional useful tool for defining a vaccination strategy in immune-compromised individuals at risk of immunization failure.

  20. A locally produced nutritional supplement in community-based HIV and AIDS patients.

    PubMed

    Oguntibeju, Oluwafemi; van den Heever, Wilhelmina Maria Jacoba; Van Schalkwyk, Frances Elizabeth

    2007-04-01

    This study examined the potential effect of a nutritional supplement on the anthropometric profiles (body measurements such as body mass index [BMI], fat percentage and waist-hip ratio) of HIV-positive/AIDS patients and the correlation between anthropometric profile, CD4+T cell count and viral load. At baseline, of the 35 patients recruited into the study, 32 (94.1%) showed a fat percentage below normal range. Twenty-four of the patients (68.6%) had a BMI within normal range, while a greater percentage of the patients had a normal waist-hip ratio. Of the 28 patients that completed the study, 26 (96.3%) reported a fat percentage of below 18.5%. The results showed that 19 (67.9%) of the 28 patients had a BMI within the normal range after nutrient intervention. There was a significant positive correlation between the BMI and fat percentage. At the end of the study the CD4+T cell count showed no correlation with any of the anthropometric indices while the viral load showed a significant negative correlation with the lean body mass and BMI. The short duration of the study probably limited the positive trend of the supplement.

  1. Opportunistic infections in patients with AIDS admitted to an university hospital of the Southeast of Brazil.

    PubMed

    Nobre, Vandack; Braga, Emanuella; Rayes, Abdunnabi; Serufo, José Carlos; Godoy, Pérsio; Nunes, Nívea; Antunes, Carlos Maurício; Lambertucci, José Roberto

    2003-01-01

    Opportunistic diseases in HIV-infected patients have changed since the introduction of highly active anti-retroviral therapy (HAART). This study aims at evaluating the frequency of associated diseases in patients with AIDS admitted to an university hospital of Brazil, before and after HAART. The medical records of 342 HIV-infected patients were reviewed and divided into two groups: group 1 comprised 247 patients before HAART and, group 2, 95 patients after HAART. The male-to-female rate dropped from 5:1 to 2:1for HIV infection. There was an increase in the prevalence of tuberculosis and toxoplasmosis, with a decrease in Kaposi's sarcoma, histoplasmosis and cryptococcosis. A reduction of in-hospital mortality (42.0% vs. 16.9%; p = 0.00002) has also occurred. An agreement between the main clinical diagnoses and autopsy findings was observed in 10 out of 20 cases (50%). Two patients with disseminated schistosomiasis and 2 with paracoccidioidomycosis are reported. Overall, except for cerebral toxoplasmosis, it has been noticed a smaller proportion of opportunistic conditions related to severe immunosuppression in the post HAART group. There was also a significant reduction in the in-hospital mortality, possibly reflecting improvement in the treatment of the HIV infection.

  2. An evaluation of community nursing services for HIV/AIDS patients in Lothian, Scotland.

    PubMed

    Atkinson, F I; Grant, I; Lewis, R; Sherval, J

    1996-10-01

    This paper reports on a postal questionnaire survey of district nurses' work with HIV positive patients. Each nurse was asked to provide information about their contact with HIV positive patients and the level of training they had received in HIV/AIDS care. The nature of nursing activities carried out for these patients was established along with levels of confidence the nurses had in being able to provide a high standard of care. Where the nurses indicated less than full confidence they were asked to indicate what factors predisposed their response. Questionnaires were completed by 101 district nurses. On average, each nurse made 1.25 visits to HIV-infected patients in the two weeks preceding the study. The nursing activities most commonly carried out for these patients were providing advice/counselling, carer support, general nursing care and specialist treatments. The activities least commonly carried out were technical procedures, tests and assessments. Nurses were most confident in providing a high standard in relation to general nursing care and least confident that high standards were being achieved in providing specialist treatments. The most frequently encountered explanations offered by the district nurses for their lack of confidence in achieving a high standard were a lack of specialist training and a lack of experience with HIV-infected patients.

  3. Detection of human cytomegalovirus in plasma of AIDS patients during acute visceral disease by DNA amplification.

    PubMed Central

    Spector, S A; Merrill, R; Wolf, D; Dankner, W M

    1992-01-01

    By using the polymerase chain reaction (PCR) amplification procedure, 19 (83%) of 23 plasma specimens obtained from individuals with AIDS and human cytomegalovirus (HCMV) visceral disease were found to be positive for plasma viremia as detected by PCR (PV-PCR), whereas 78% of cultures of peripheral blood leukocytes from the same samples were found to be positive. All 11 specimens prospectively obtained from individuals with acute HCMV disease were positive by PV-PCR. Plasma specimens from patients who received ganciclovir therapy rapidly became both culture and PV-PCR negative, and there was an excellent correlation between the two procedures. DNA detected by PV-PCR was unaffected by filtering plasma through a 0.2-microns-pore-size filter, although a conserved cellular gene, HLA-DQ alpha, was undetectable by PCR following filtration. HCMV DNA in plasma could be quantitated by PV-PCR by using endpoint serial dilutions, with detectable virus being present in 10(1) to 10(-2) microliters of plasma. A low titer of infectious virus could be detected in 2 of 11 plasma samples. The detection of HCMV DNA in plasma by PV-PCR promises to be a useful procedure for monitoring patients with AIDS suspected of having impending, acute, or recurrent HCMV visceral disease and suggests an additional route by which virus may disseminate in the immunocompromised host. Images PMID:1328287

  4. The acute care physical therapy HIV/AIDS patient population: a descriptive study.

    PubMed

    Kinirons, Stacy A; Do, Sandy

    2015-01-01

    This study was based on an analysis of an existing database compiled from 475 medical records of people living with HIV/AIDS admitted to an acute-care hospital in New York City in 2004. The characteristics of patients with HIV infection that received physical therapy were determined. Differences between patients with HIV infection that did and did not receive physical therapy, as well as predictors of receipt of physical therapy, were identified. The physical therapy subgroup (n = 69) had a mean age of 48.3 years, consisted of more men than women, and was predominately black, with public health insurance. Admissions were commonly due to non-AIDS-defining illness as the primary diagnoses, accompanied by several comorbidities. Admissions often presented with functional deficits, incurred a prolonged length of stay, and required assistance at discharge. Differences existed between the physical therapy subgroup and the non-physical therapy subgroup (n = 406). Predictors of receipt of physical therapy were functional status on admission and length of stay.

  5. Detection of abnormalities in febrile AIDS patients with In-111-labeled leukocyte and Ga-67 scintigraphy

    SciTech Connect

    Fineman, D.S.; Palestro, C.J.; Kim, C.K.; Needle, L.B.; Vallabhajosula, S.; Solomon, R.W.; Goldsmith, S.J.

    1989-03-01

    Thirty-six patients with acquired immunodeficiency syndrome (AIDS), who were febrile but without localizing signs, underwent indium-111 leukocyte scintigraphy 24 hours after injection of labeled white blood cells (WBCs) and were restudied 48 hours after injection of gallium-67 citrate. Fifty-six abnormalities were identified as possible sources of the fever; 27 were confirmed with biopsy. Of these 27, 15 were identified only on In-111 WBC scans (including colitis, sinusitis, and focal bacterial pneumonia); six, only on Ga-67 scans (predominantly Pneumocystis carinii pneumonia and lymphadenopathy); and six, on both studies (predominantly pulmonary lesions). In-111 WBC scanning revealed 21 of 27 abnormalities (78%) and gallium scanning, 12 of 27 (44%). If only one scintigraphic study has been performed, particularly with Ga-67, a significant number of lesions would not have been detected. The authors believe radionuclide evaluation of the febrile AIDS patient without localizing signs should begin with In-111 WBC scintigraphy. Gallium scanning may be used depending on results of In-111 WBC scans or if there is a high index of suspicion for P carinii pneumonia.

  6. Evaluation of Oxidative Status in Patients Treated with Electroconvulsive Therapy

    PubMed Central

    Şenyurt, Mahmut; Aybek, Hulya; Herken, Hasan; Kaptanoglu, Bunyamin; Korkmaz, Ali

    2017-01-01

    Objective Electroconvulsive therapy (ECT) is used in the treatment of many psychiatric diseases and this therapy may be effective on antioxidant defence system. In this study, we aimed to evaluate the effects of ECT on oxidative stress. Methods Fourteen major depression, 11 schizophrenia and 8 bipolar affective disorder patients diagnosed and received ECT treatment, and 37 healthy volunteers enrolled in the study. ECT was applied to all patients. Before ECT, after the first and last ECTs, serum samples were obtained. Serum total antioxidant status (TAS), total oxidant status (TOS), and calculated oxidative stress index (OSI) were measured in patients before and after ECTs. Results TOS values before ECT were higher in major depression (p=0.005) and schizophrenia (p=0.001) groups compared to the control group. TAS values were lower in major depression (p=0.0001), schizophrenia (p=0.004), bipolar affective disorder (p=0.004) groups compared to the controls. Also OSI values were higher in major depression (p=0.0001), schizophrenia (p=0.001), bipolar affective disorder (p=0.009) groups compared to healthy group. After the last ECT, TOS values were significantly lower compared to TOS values before ECT in major depression (p=0.004) and schizophrenia patients (p=0.004). TAS values after the first ECT were higher compared to values before ECT in major depression patients (p=0.004). After last ECT, OSI values were significantly lower compared to before ECT in schizophrenia patients (p=0.006). Conclusion As a result, it can be said that ECT did not increase oxidative stress. However, further studies with more patients are needed. PMID:28138109

  7. Endotracheal Intubation in Patients Treated for Prehospital Status Epilepticus

    PubMed Central

    Miller, Joseph B.; Nicholas, Katherine S.; Varelas, Panayiotis N.; Harsh, Donna M.; Durkalski, Valerie; Silbergleit, Robert; Wang, Henry E.

    2015-01-01

    Introduction Limited data describe the frequency, timing, or indications for endotracheal intubation (ETI) in patients with status epilepticus. A better understanding of the characteristics of patients with status epilepticus requiring airway interventions could inform clinical care. We sought to characterize ETI use in patients with prehospital status epilepticus. Methods This study was a secondary analysis of the Rapid Anticonvulsant Medication Prior to Arrival Trial, a multi-center, randomized trial comparing intravenous lorazepam to intramuscular midazolam for prehospital status epilepticus treatment. Subjects received ETI in the prehospital, Emergency Department (ED), or inpatient setting at the discretion of caregivers. Results Of 1023 enrollments, 218 (21 %) received ETI. 204 (93.6 %) of the ETIs were performed in the hospital and 14 (6.4 %) in the prehospital setting. Intubated patients were older (52 vs 41 years, p < 0.001), and men underwent ETI more than women (26 vs 21 %, p = 0.047). Patients with ongoing seizures on ED arrival had a higher rate of ETI (32 vs 16 %, p < 0.001), as did those who received rescue anti-seizure medication (29 vs 20 %, p = 0.004). Mortality was higher for intubated patients (7 vs 0.4 %, p < 0.001). Most ETI (n = 133, 62 %) occurred early (prior to or within 30 min after ED arrival), and late ETI was associated with higher mortality (14 vs 3 %, p = 0.002) than early ETI. Conclusions ETI is common in patients with status epilepticus, particularly among the elderly or those with refractory seizures. Any ETI and late ETI are both associated with higher mortality. PMID:25623785

  8. T-cell lymphoma of the rectum in a patient with AIDS and hepatitis C: a case report and discussion.

    PubMed

    Tisdale, Gus; Mahadevan, Anand; Matthews, Richard H

    2005-04-01

    Primary T-cell non-Hodgkin's lymphoma (NHL) occurring in the context of acquired immune deficiency syndrome (AIDS) is uncommon. Here, we report and discuss such a case presenting in the rectum, and review relevant literature. Although typical in some respects, the case is, in other ways, somewhat unusual for an AIDS-related NHL (ARL); ARL tends to be B cell and advanced stage and our case was T cell and stage IE. In addition, the patient suffered from concomitant cirrhosis related to hepatitis C. Chemotherapeutic options for ARL were limited early in the AIDS epidemic due to poor tolerability. Although this has largely been mitigated by the advent of highly active antiretroviral therapy, our patient eventually suffered complications of chemotherapy, apparently related more to his liver disease than to either his lymphoma or AIDS, that ultimately brought about his demise.

  9. Design, development, and evaluation of visual aids for communicating prescription drug instructions to nonliterate patients in rural Cameroon.

    PubMed

    Ngoh, L N; Shepherd, M D

    1997-03-01

    In this study, culturally sensitive visual aids designed to help convey drug information to nonliterate female adults who had a prescription for a solid oral dosage form of antibiotic medications were developed and evaluated. The researchers conceptualized the educational messages while a local artist produced the visual aids. Seventy-eight female ambulatory patients were evaluated for comprehension and compliance with antibiotic prescription instructions. The study was conducted in three health centers in Cameroon, West Africa and followed a pre-test, post-test, and follow-up format for three groups: two experimental, and one control. All participants were randomly assigned to either experimental or control groups, 26 patients to each group. Subjects in the experimental groups received visual aids alone or visual aids plus an Advanced Organizer. A comparison of the three groups showed that subjects in the experimental groups scored significantly higher than the control group in both the comprehension and compliance measures.

  10. Use of NSAIDs in treating patients with arthritis

    PubMed Central

    2013-01-01

    Patients with rheumatic diseases, including rheumatoid arthritis and osteoarthritis, almost universally describe pain and stiffness as important contributors to reduced health-related quality of life. Of the treatment options available, NSAIDs are the most widely used agents for symptomatic treatment. NSAIDs are effective anti-inflammatory and analgesic drugs by virtue of their ability to inhibit biosynthesis of prostaglandins at the level of the cyclooxygenase enzyme. However, many of the adverse effects of NSAIDs are also related to inhibition of prostaglandin production, making their use problematic in some patient populations. For the clinician, understanding the biology of prostaglandin as it relates to gastrointestinal, renal, and cardiovascular physiology and the pharmacologic properties of specific NSAIDs is key to using these drugs safely. Of particular importance is the recognition of co-morbid conditions and concomitant drugs that may increase the risk of NSAIDs in particular patients. In patients with risk factors for NSAID toxicity, using the lowest dose of a drug with a short half-life only when it is needed is likely to be the safest treatment option. For those patients whose symptoms cannot be managed with intermittent treatment, using protective strategies is essential. PMID:24267197

  11. Muscle function in rheumatic disease patients treated with corticosteroids.

    PubMed

    Rothstein, J M; Delitto, A; Sinacore, D R; Rose, S J

    1983-02-01

    Clinical and experimental data indicate that long-term corticosteroid use leads to atrophy of the type 2 muscle fibers. The purpose of this study was to characterize and quantify the nature of muscle function in rheumatic disease patients who have been on long-term corticosteroid therapy. Quadriceps function (i.e., peak torque and power) in 19 patients (11 with rheumatoid arthritis, five with systemic lupus erythematosis, and 3 other) and 11 age- and activity-matched normal controls was measured with an isokinetic dynamometer (Cybex II), during four constant velocity movements. Power was significantly lower for the patients at all speeds. At the higher speeds the patients' deficit in power production increased as indicated by a difference in the slopes of power-velocity regression lines. Measures of peak torque could not be consistently used to differentiate the groups. Patients with rheumatic diseases receiving corticosteroids have a decreased ability to generate muscle power. The method described allows for quantification of these deficits in a clinical setting.

  12. Identifying and treating pregnant patients at risk from alcohol.

    PubMed Central

    Rosett, H. L.; Weiner, L.

    1981-01-01

    Heavy alcohol consumption during pregnancy has been associated with retardation of fetal growth and abnormal fetal development. Pregnant women whose offspring are at risk because of alcohol abuse can be identified and counselled by health professional providing prenatal care. Offspring born to women who had been drinking heavily and subsequently abstained from or reduced their intake of alcohol before the third trimester demonstrated improvements in growth and in regulation of sleep-awake states. The existing health care delivery system can be modified in a cost-effective manner to treat pregnant women who are problem drinkers. Physicians' attitudes and behaviour are critical for the success of this strategy. PMID:7272865

  13. Neutrophil activation in ivermectin-treated onchocerciasis patients.

    PubMed Central

    Njoo, F L; Hack, C E; Oosting, J; Stilma, J S; Kijlstra, A

    1993-01-01

    Ivermectin is a safe and effective drug for onchocerciasis treatment. In certain individuals, however, therapy is accompanied by adverse reactions. The mechanisms underlying these reactions are not yet known. The aim of the present study was to investigate whether neutrophils are involved in the development of these adverse reactions. Elastase and lactoferrin, two markers for the release of neutrophil azurophilic and specific granule contents respectively, were measured by radioimmunoassays in plasma of onchocerciasis patients with varying degrees of side effects, as well as in control subjects before and 1 and 2 days after ivermectin treatment. A considerable increase of elastase levels after treatment was observed, whereas lactoferrin levels did not change. The percentage of patients with elevated elastase levels was significantly correlated with the degree of side effects. These findings suggest that neutrophil activation may be involved in the development of adverse reactions in these patients. PMID:8222324

  14. St John's Wort treating patients with autistic disorder.

    PubMed

    Niederhofer, Helmut

    2009-11-01

    Problems of eye contact and expressive language limit the effectiveness of educational and behavioral interventions in patients suffering from pervasive developmental disorders. For that reason, additive psychopharmacological interventions are sometimes needed to improve symptomatology. In our preliminary open trial, three male patients with autistic disorder, diagnosed by ICD-10 criteria, completed an open trial of St John's Wort. Subjects were included in the study if their eye contact and expressive language was inadaequate for their developmental level and if they had not tolerated or responded to other psychopharmacologic treatments (methylphenidate, clonidine or desipramine). Parent and mentor ratings on the Aberrant Behavior Checklist, irritability, stereotypy, and inappropriate speech factors improved slightly during treatment with St John's Wort. Clinician ratings (Psychiatric Rating Scale Autism, Anger and Speech Deviance factors; Global Assessment Scale; Clinical Global Impressions efficacy) did not improve significantly. St John's Wort was only modestly effective in the short-term treatment of irritability in some patients with autistic disorder.

  15. [Hypoglycemia in patients treated with an external insulin pump].

    PubMed

    Laurent, Jean-Christophe; Waeber, Gerard; Ruiz, Juan; Carron, Pierre-Nicolas

    2011-01-19

    Hypoglycemia is a potentially serious complication of insulin therapy. Some insulin-dependent diabetic patients can benefit from continuous subcutaneous insulin infusion therapy (an "insulin pump"), which in most case improves glycemia control and decreases the occurrence of hypoglycemic episodes. However, such events may occur, particularly during initial treatment phases or pregnancy. Severe hypoglycemia is mainly managed by stopping the insulin pump and insuring an adequate carbohydrate intake. Patients with insulin pumps and their entourage should receive specific instruction in the adjustment of pump flow in the presence of dysglycemia-inducing circumstances (illness, physical exertion), as well as in anticipation of high-risk situations, such as motor-vehicle driving.

  16. Bone scan alterations in aromatase inhibitor-treated patients.

    PubMed

    De Geeter, Frank; Van den Bruel, Annick; De Cuypere, Eveline; Langlois, Michel

    2015-01-01

    We report bone scan changes in 3 patients receiving aromatase inhibitors as adjuvant treatment for postmenopausal hormone receptor-positive breast cancer. Compared with bone scans before treatment, repeated scans after at least 10 months of aromatase inhibitor treatment showed increased activity in the peripheral skeleton and the skull. In 2 patients, these alterations could be correlated with increased markers of bone turnover. They probably result from high bone turnover induced by estrogen depletion caused by aromatase inhibitors. This effect should be taken into account in the differential diagnosis of a bone scan pattern suggestive of hyperparathyroidism, which was ruled out.

  17. Ginkgo biloba treating patients with attention-deficit disorder.

    PubMed

    Niederhofer, Helmut

    2010-01-01

    Various medications such as clonidine facilitate calming, enhance frustration tolerance and reduce aggression in attention-deficit disorder (ADD) patients. The use of Ginkgo biloba was studied as an herbal alternative. Six psychiatric outpatients diagnosed with ADD were rated at baseline and while taking Ginkgo biloba to determine its efficacy as a treatment for ADD. Comparisons of Wender Utah ratings within subject were used to measure behavioral changes in the subjects. During Ginkgo biloba treatment, the patients' mean scores improved significantly overall and in hyperactivity, inattention, and immaturity factors. This preliminary study indicates that Ginkgo biloba might be a beneficial and useful treatment of ADD, with minimal side effects.

  18. Exercise in Treating Hypertension: Tailoring Therapies for Active Patients.

    ERIC Educational Resources Information Center

    Chintanadilok, Jirayos

    2002-01-01

    Exercise can be definitive therapy for some, and adjunctive therapy for many, people with hypertension, though people with secondary hypertension may not derive as much benefit. Low-to- moderate-intensity aerobic exercise can help with mild hypertension and reduce drug dosages in more severe cases. For active patients requiring medication,…

  19. Cellular phagocytic studies in rheumatoid arthritis patients treated with levamisole.

    PubMed Central

    Wynne, K M; Dieppe, P A; Scott, J; Huskisson, E C

    1981-01-01

    A simple method is described which allows sequential monitoring of the endocytic activity of blood and synovial fluid cells from rheumatoid arthritis patients undergoing therapy with levamisole. Evidence of immediate (24 hours) and long-term (5-7 weeks) cellular phagocytic enhancement is presented. Images PMID:7259330

  20. Gerontology & Policies for Not Treating Terminally Ill Patients.

    ERIC Educational Resources Information Center

    Jarrett, William H.

    Proposals have been developed to clarify physician responsibility in withholding treatment to terminally ill patients. These proposals seek to provide a legal shield against malpractice proceedings and to reduce confusion over how to resolve high medical costs through standardizing procedures for withholding treatment. When first published,…

  1. Long term evolution of patients treated in a TIA unit

    PubMed Central

    2013-01-01

    Background Transient ischemic attacks (TIA) entail a high risk of stroke recurrence, which depends on the etiology. New organizational models have been created, but there is not much information about the long-term evolution of patients managed according to these premises. Our aim is to refer the follow-up of patients attended according to our model of TIA Unit. Methods TIA Unit is located in the Emergency Department and staffed by vascular neurologists. Patients admitted during the Neurology night shift stayed in such Unit <48h with complete etiological study. Preventive treatment is instituted in patients discharged to a high resolution Neurology consult, in order to review in <2 weeks and subsequent follow-up. Results During a year 161 patients were attended, being admitted to the hospital 8.6%. A total of 1470 hospital days were avoided. Recurrence at 90 days was of 0.6%. Mean follow-up was 18.14 ± 8.02 months (0–34), total recurrence 6.2% (70% cardioembolic strokes). There were no complications derived from treatment. Cardiological events were recorded in 10.6%, neoplastic in 5%, cognitive impairment in 11%. There were 3 deaths unrelated nor to the stroke or its treatment. Conclusions This model allows an early diagnosis and treatment of TIA, preventing recurrences of stroke in a long term. It detects atherothrombotic strokes, most of them admitted to the hospital, and it shows a greater difficulty for detecting all cardioembolic strokes. TIA Unit appeared to be safe in using anticoagulation therapy, as the follow-up shows. It shows the same quality of management than hospital admission, with a significant saving in hospital stays. PMID:23635082

  2. Lower corneal temperature in neuroleptic-treated vs. drug-free schizophrenia patients.

    PubMed

    Shiloh, Roni; Bodinger, Liron; Katz, Nachum; Sigler, Maianit; Stryjer, Rafael; Hermesh, Haggai; Munitz, Hanan; Weizman, Abraham

    2003-01-01

    Antipsychotic drugs (APDs) can decrease core body temperature in schizophrenia patients. Core temperature may correlate with corneal temperature and thus, we hypothesized that neuroleptic-treated schizophrenia patients would display lower corneal temperature compared with drug-free patients. Corneal temperature of 12 typical APD-treated and 9 drug-free male schizophrenia patients was assessed using a FLIR thermal imaging camera. The APD-treated patients exhibited substantially and significantly lower corneal temperature compared with the drug-free patients (31.57 +/- 0.98 degrees C vs. 34.55 +/- 1.65 degrees C; p < 0.0001). Our results suggest that APDs may decrease corneal/core temperature in schizophrenia patients. The relevance of this finding to the pathophysiology of schizophrenia or to the antipsychotic effect of neuroleptics merit further investigation.

  3. Health prevention in the era of biosocieties: a critical analysis of the 'Seek-and-Treat' paradigm in HIV/AIDS prevention.

    PubMed

    Foth, Thomas; O'Byrne, Patrick; Holmes, Dave

    2016-06-01

    On 18 November 2014, the United Nations launched an urgent new campaign to end AIDS as a global health threat by 2030. With its proposed strategy, the UN follows leading scientists who had declared the failure of former prevention strategies and now were promoting a 'Seek and Treat for Optimal Prevention' (STOP) approach as the most cost-effective response to the pandemic to meet the goal of 'an AIDS-free generation'. STOP combines antiretroviral therapy and routine HIV screening to find persons unaware that they are HIV-positive, because research has shown that people consistently change their behaviour (i.e. increase condom use, have fewer partners) after an HIV diagnosis. AIDS activists have broadly criticized this strategy on different levels. In this article, we go beyond these criticisms and try to analyse the political rationalities behind this 'new' strategy. We believe that it is necessary to put the rationale underpinning the STOP programme into the context of broader societal transformations that can best be captured as the development of advanced liberal societies and the new emphasis on self-controlling or self-responsibility rather than on disciplining behaviour.

  4. Rasburicase and Allopurinol in Treating Patients With Hematologic Malignancies

    ClinicalTrials.gov

    2015-05-28

    Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities; Adult Acute Myeloid Leukemia With Del(5q); Adult Acute Myeloid Leukemia With Inv(16)(p13;q22); Adult Acute Myeloid Leukemia With t(15;17)(q22;q12); Adult Acute Myeloid Leukemia With t(16;16)(p13;q22); Adult Acute Myeloid Leukemia With t(8;21)(q22;q22); Blastic Phase Chronic Myelogenous Leukemia; Contiguous Stage II Adult Burkitt Lymphoma; de Novo Myelodysplastic Syndromes; Noncontiguous Stage II Adult Burkitt Lymphoma; Previously Treated Myelodysplastic Syndromes; Recurrent Adult Acute Lymphoblastic Leukemia; Recurrent Adult Acute Myeloid Leukemia; Recurrent Adult Burkitt Lymphoma; Stage I Adult Burkitt Lymphoma; Stage III Adult Burkitt Lymphoma; Stage IV Adult Burkitt Lymphoma; Untreated Adult Acute Lymphoblastic Leukemia; Untreated Adult Acute Myeloid Leukemia

  5. Chemotherapy Plus Sargramostim in Treating Patients With Refractory Myeloid Cancer

    ClinicalTrials.gov

    2013-01-08

    Accelerated Phase Chronic Myelogenous Leukemia; Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities; Adult Acute Myeloid Leukemia With Del(5q); Adult Acute Myeloid Leukemia With Inv(16)(p13;q22); Adult Acute Myeloid Leukemia With t(15;17)(q22;q12); Adult Acute Myeloid Leukemia With t(16;16)(p13;q22); Adult Acute Myeloid Leukemia With t(8;21)(q22;q22); Blastic Phase Chronic Myelogenous Leukemia; Chronic Myelomonocytic Leukemia; Chronic Phase Chronic Myelogenous Leukemia; Paroxysmal Nocturnal Hemoglobinuria; Previously Treated Myelodysplastic Syndromes; Recurrent Adult Acute Myeloid Leukemia; Refractory Anemia; Refractory Anemia With Ringed Sideroblasts; Relapsing Chronic Myelogenous Leukemia; Thrombocytopenia; Untreated Adult Acute Myeloid Leukemia

  6. Dysphagia in head and neck cancer patients treated with chemoradiotherapy.

    PubMed

    Platteaux, Nele; Dirix, Piet; Dejaeger, Eddy; Nuyts, Sandra

    2010-06-01

    Dysphagia is a very common complaint of head and neck cancer patients and can exist before, during, and after chemoradiotherapy. It leads to nutritional deficiency, weight loss, and prolonged unnatural feeding and also has a major potential risk for aspiration. This has a significant negative impact on the patient's entire quality of life. Because treatment of dysphagia in this setting is rarely effective, prevention is paramount. Several strategies have been developed to reduce dysphagia. These include swallowing exercises, treatment modification techniques such as intensity-modulated radiotherapy, selective delineation of elective nodes, reducing xerostomia by parotid-sparing radiotherapy, and adding of radioprotectors. However, more research is needed to further decrease the incidence of dysphagia and improve quality of life.

  7. Being Ready to Treat Ebola Virus Disease Patients

    PubMed Central

    Brett-Major, David M.; Jacob, Shevin T.; Jacquerioz, Frederique A.; Risi, George F.; Fischer, William A.; Kato, Yasuyuki; Houlihan, Catherine F.; Crozier, Ian; Bosa, Henry Kyobe; Lawler, James V.; Adachi, Takuya; Hurley, Sara K.; Berry, Louise E.; Carlson, John C.; Button, Thomas. C.; McLellan, Susan L.; Shea, Barbara J.; Kuniyoshi, Gary G.; Ferri, Mauricio; Murthy, Srinivas G.; Petrosillo, Nicola; Lamontagne, Francois; Porembka, David T.; Schieffelin, John S.; Rubinson, Lewis; O'Dempsey, Tim; Donovan, Suzanne M.; Bausch, Daniel G.; Fowler, Robert A.; Fletcher, Thomas E.

    2015-01-01

    As the outbreak of Ebola virus disease (EVD) in West Africa continues, clinical preparedness is needed in countries at risk for EVD (e.g., United States) and more fully equipped and supported clinical teams in those countries with epidemic spread of EVD in Africa. Clinical staff must approach the patient with a very deliberate focus on providing effective care while assuring personal safety. To do this, both individual health care providers and health systems must improve EVD care. Although formal guidance toward these goals exists from the World Health Organization, Medecin Sans Frontières, the Centers for Disease Control and Prevention, and other groups, some of the most critical lessons come from personal experience. In this narrative, clinicians deployed by the World Health Organization into a wide range of clinical settings in West Africa distill key, practical considerations for working safely and effectively with patients with EVD. PMID:25510724

  8. Offspring of patients treated for unilateral Wilms' tumor in childhood

    SciTech Connect

    Green, D.M.; Fine, W.E.; Li, F.P.

    1982-01-01

    Twenty-seven women and the wives of nine men who survived unilateral Wilms' tumor in childhood had a total of 59 live born offspring. Among the 33 infants born to women who had received orthovoltage abdominal irradiation, ten weighed less than 2500 g at birth and three died during the perinatal period. In addition, one term infant of normal weight died of complications of a breech delivery. Only one of 26 infants born to the wives of Wilms' tumor patients and unirradiated female patients weighed less than 2500 g at birth and none died. The frequency of congenital malformations and spontaneous abortions in this series was not increased, and no offspring has developed cancer. The findings suggest that the risk of Wilms' tumor is low among progeny of survivors of nonfamilial, unilateral lesions. Damage from abdominal irradiation given to girls with Wilms' tumor may predispose them to the subsequent delivery of low birthweight children.

  9. Epigenetic regulation of HIV, AIDS, and AIDS-related malignancies.

    PubMed

    Verma, Mukesh

    2015-01-01

    Although epigenetics is not a new field, its implications for acquired immunodeficiency syndrome (AIDS) research have not been explored fully. To develop therapeutic and preventive approaches against the human immunodeficiency virus (HIV) and AIDS, it is essential to understand the mechanisms of interaction between the virus and the host, involvement of genetic and epigenetic mechanisms, characterization of viral reservoirs, and factors influencing the latency of the virus. Both methylation of viral genes and histone modifications contribute to initiating and maintaining latency and, depending on the context, triggering viral gene repression or expression. This chapter discusses progress made at the National Institutes of Health (NIH), recommendations from the International AIDS Society Scientific Working Group on HIV Cure, and underlying epigenetic regulation. A number of epigenetic inhibitors have shown potential in treating AIDS-related malignancies. Epigenetic drugs approved by the US Food and Drug Administration and their implications for the eradication of HIV/AIDS and AIDS-related malignancies also are discussed.Past and current progress in developing treatments and understanding the molecular mechanisms of AIDS and HIV infection has greatly improved patient survival. However, increased survival has been coupled with the development of cancer at higher rates than those observed among the HIV/AIDS-negative population. During the early days of the AIDS epidemic, the most frequent AIDS-defining malignancies were Kaposi's sarcoma and non-Hodgkin lymphoma (NHL). Now, with increased survival as the result of widespread use in the developed world of highly active antiretroviral therapy (HAART), non-AIDS defining cancers (i.e., anal, skin, and lung cancers, and Hodgkin disease) are on the increase in HIV-infected populations. The current status of AIDS-related malignancies also is discussed.

  10. [Treating patients on the court-ordered therapy programme].

    PubMed

    Cochez, Florent; Lesueur, Mélanie; Fayet, Marie; Bouchard, Jean-Pierre

    Psychologists and a psychiatrist testify to the clinical condition of people sentenced to socio-judicial supervision with court-ordered therapy. Despite the extension of the indication of the programme, this complex supervision often concerns the perpetrators of intra and/or extra familial sexual abuse. Preventing reoffending through the global treatment of the patient is a major concern both for the doctor-coordinators as well as the doctor and psychologists delivering the therapy.

  11. Quality of life profile and psychometric properties of the EQ-5D-5L in HIV/AIDS patients

    PubMed Central

    2012-01-01

    Objectives We assessed health-related quality of life (HRQOL), its associated factors, and examined measurement properties of the EuroQol - 5 Dimensions - 5 Levels (EQ-5D-5L) in HIV/AIDS patients. Methods A cross-sectional multi-site survey was conducted in 1016 patients (age: 35.4 ± 7.0 years; 63.8% male) in three epicenters of Vietnam. Internal consistency reliability, convergent validity, and discriminative validity of the EQ-5D-5L and a visual analogue scale (VAS) were evaluated. Tobit censored regression models were used to identify predictors of HRQOL in HIV/AIDS patients. Results The mean EQ-5D-5L single index and VAS were 0.65 (95% Confidence Interval (CI) = 0.63; 0.67) and 70.3 (95% CI = 69.2; 71.5). Cronbach’s alpha of five dimensions was 0.85. EQ-5D-5L has a good convergent validity with VAS (0.73). It discriminated patients at different HIV/AIDS stages, duration of ART, and CD4 cell count. Predictors of poorer HRQOL included being female, lower education level, unemployment, alcohol and drug use, CD4<200 cells/mL, and advanced HIV/AIDS stages. Conclusion The EQ-5D-5L has good measurement properties in HIV/AIDS patients and holds potentials for monitoring ART outcomes. Integration of HRQOL measurement using EQ-5D-5L in HIV/AIDS clinical practice could be helpful for economic evaluation of HIV/AIDS interventions. PMID:23116130

  12. Treating patients with peripheral arterial disease and claudication.

    PubMed

    Treat-Jacobson, Diane; Walsh, M Eileen

    2003-03-01

    The vascular nurse plays an important role in the treatment of patients with peripheral arterial disease (PAD), a prevalent atherosclerotic occlusive disease that affects approximately 8 to 12 million people in the United States. Approximately 4 to 5 million individuals with PAD experience claudication, the exercise-induced ischemic pain in the lower extremities that is relieved upon rest. Both PAD and claudication are associated with increased morbidity and mortality, limitations in functional capacity, and a decreased quality of life. Despite its prevalence, PAD is often undiagnosed and, therefore, increases the risk for cardiovascular ischemic events, disease progression, functional disability, amputation, and death. Risk factors for PAD and claudication are similar to those for other atherosclerotic diseases, including age, cigarette smoking, diabetes mellitus, hypertension, dyslipidemia, and hyperhomocysteinemia. Effective treatment to normalize these risk factors can reduce disease progression and the incidence of cardiovascular ischemic events. Claudication symptoms can be improved most effectively through exercise training, which may be used in conjunction with medications specifically indicated to improve these symptoms. Vascular nurses, practicing in a multitude of inpatient and outpatient settings, can assist patients with risk-factor modifications and behavioral changes to help them stop smoking, maintain glycemic control, normalize high blood pressure and lipid levels, and ensure initiation of lifelong antiplatelet therapy and participation in exercise rehabilitation programs, thus, promoting positive outcomes for patients with claudication.

  13. PET studies of parkinsonian patients treated with autologous adrenal implants.

    PubMed

    Guttman, M; Burns, R S; Martin, W R; Peppard, R F; Adam, M J; Ruth, T J; Allen, G; Parker, R A; Tulipan, N B; Calne, D B

    1989-08-01

    Transplantation of autologous adrenal medulla tissue into the striatum has recently been proposed as a treatment for Parkinson's disease. We report the use of positron emission tomography (PET) to evaluate patients who had adrenal implants placed into the right caudate. 6-[18F] fluoro-L-dopa (6-FD) scans were performed to study the integrity and activity of the implant, and the nigrostriatal dopamine system before and six weeks after transplantation surgery. [68Ga] Gallium-ethylenediaminetetraacetate (Ga) scans were also performed to assess the blood brain barrier. The Ga scans performed on two patients showed increased permeability of the blood brain barrier at the surgical site. 6-FD PET scans in five patients did not show a consistent change in striatal uptake following adrenal medullary implantation after six weeks. Further assessment of implant viability with 6-FD PET scans after longer follow up may provide useful information if the blood-brain barrier becomes re-established with the passage of time.

  14. Oral isotretinoin. How can we treat difficult acne patients?

    PubMed

    Leyden, J J

    1997-01-01

    Isotretinoin (Roaccutane/Accutane) therapy (120 mg/kg) normally results in complete clearing of nodulocystic acne followed by prolonged remission, and many patients remain free of disease. Four groups of patients respond poorly or have a high rate of relapse. Preteens and young teenagers show a high rate of relapse and several courses of treatment are usually needed; 14 of 20 under the age of 12 years, 21 of 47 aged 12-14 and 23 of 66 aged 14-16 relapsed within 1 year. Individuals with linear lesions consisting of undermining tracks of follicular epithelium often show only a partial response. These individuals typically have a history of other 'sinus track' disease such as pilonidial sinus and hidradenitis, either themselves or other family members. Hemorrhagic or crusted lesions can be exacerbated by full doses of isotretinoin and patients develop pyrogenic-granuloma-type lesions and even acne-fulminans-like eruptions. Women with adrenal or ovarian syndrome associated with elevated androgens commonly relapse with 6-12 months after isotretinoin therapy.

  15. [The efficacy of treating patients with intraocular hemorrhages with emoxypin].

    PubMed

    Mokhammad, I; Cherkasov, I S

    1990-01-01

    Emoxipin, a home-made preparation approved by the Pharmacological Committee for clinical usage in 1986, is a retinal protector. Its usage is indicated for treatment of chorioretinitis, diabetic retinopathy, thrombosis of retinal vessels as well as to protects the retina from a damaging action of light of high intensity. In order to study therapeutic effectiveness of emoxipin in intraocular hemorrhages of different genesis, the preparation was used subconjunctivally, 0.5 ml of a 1% solution daily for 10-15 days. Emoxipin was used in 29 patients (29 eyes) with intraocular hemorrhages, of them, due to contusion of the eye--in 19, hypertonic disease--in 6, thrombosis of the central retinal vein--in 2, after intraocular operations--in 2 patients. As a result of the treatment, partial or almost total resolution of hemorrhages and a rise of visual acuity of different degree were recorded in all patients. Before treatment, visual acuity was from light perception to 0.04 in 26 eyes, from 0.09 to 0.3 in 3 eyes. After treatment, it rose to 0.1-0.2 in 12 eyes, to 0.3-1.0--in 17 eyes.

  16. Predictive value of cytokines and immune activation biomarkers in AIDS-related non-Hodgkin lymphoma treated with rituximab plus infusional EPOCH (AMC-034 trial)

    PubMed Central

    Epeldegui, Marta; Lee, Jeannette Y.; Martínez, Anna C.; Widney, Daniel P.; Magpantay, Larry I.; Regidor, Deborah; Mitsuyasu, Ronald; Sparano, Joseph A.; Ambinder, Richard F.; Martínez-Maza, Otoniel

    2015-01-01

    Purpose The aims of this study were to determine if pre-treatment plasma levels of cytokines and immune activation-associated molecules changed following treatment for AIDS-NHL with rituximab plus infusional EPOCH, and to determine if pre-treatment levels of these molecules were associated with response to treatment and/or survival. Experimental design We quantified plasma levels of B cell activation-associated molecules (sCD27, sCD30, sCD23) and cytokines (IL-6, IL-10, CXCL13) prior to and after the initiation of treatment in persons with AIDS-NHL (n=69) in the AIDS Malignancies Consortium (AMC) 034 study, which evaluated treatment of AIDS-NHL with EPOCH chemotherapy and rituximab. Results Treatment resulted in decreased plasma levels of some of these molecules (CXCL13, sCD27, sCD30), with decreased levels persisting for one year following the completion of treatment. Lower levels of CXCL13 before treatment were associated with complete responses following lymphoma therapy. Elevated levels of IL-6 pre-treatment were associated with decreased overall survival, while higher IL-10 levels were associated with shorter progression-free survival, in multivariate analyses. Furthermore, patients with CXCL13 or IL-6 levels higher than the median levels for the NHL group, as well as those who had detectable IL-10, had lower overall survival and PFS, in Kaplan Meier analyses. Conclusions These results indicate that CXCL13, IL-6 and IL-10 have significant potential as prognostic biomarkers for AIDS-NHL. PMID:26384320

  17. Long-Term Outcomes of Patients With Spinal Cord Gliomas Treated by Modern Conformal Radiation Techniques

    SciTech Connect

    Kahn, Jenna; Loeffler, Jay Steven; Niemierko, Andrzej

    2011-09-01

    Purpose: This study retrospectively examines the long-term therapeutic outcomes of 32 patients with primary spinal cord gliomas at Massachusetts General Hospital between 1991 and 2005 treated by either photon intensity-modulated radiotherapy or conformal proton radiotherapy. Methods and Materials: Individual patient tumor types included 14 ependymomas, 17 astrocytomas, and one oligodendroglioma. Twenty-two patients were treated with photon beam radiation therapy, and 10 patients were treated with proton beam therapy. The overall survival and time to progression were analyzed. Average radiation dose for patients was 51 Gy in 1.8 median daily fractions over 29 treatments. Results: For all 32 patients, the overall 5-year survival was 65% and the progression-free survival was 61%, respectively. Overall survival was significantly worse for patients more than 55 years of age (p = 0.02). Ependymoma patients had significantly longer survival times than astrocytoma patients (p = 0.05). Patients who had undergone a biopsy developed worse outcomes then those with a resection (p = 0.05). With the caveat of a limited number of patients, the multivariate model seems to suggest improved overall survival for younger patients (<54 years of age), ependymoma histology, and photon vs. proton treatment. Conclusion: For patients with spinal cord gliomas, significant factors associated with patient outcome include tumor pathology, age, extent of surgery, and treatment.

  18. I.v. access options for AIDS patients with cytomegalovirus disease.

    PubMed

    Sargent, J; Nixon, E

    In view of changes over the past 2 years in the intravenous (i.v.) management of patients with AIDS and cytomegalovirus (CMV) disease, a small study was carried out at the Kobler Clinic, an HIV treatment centre in London, to examine optimal i.v. access for CMV induction treatment. Thirty lines were analysed over a period of 4 months: 18 were peripherally inserted central catheters (PICCs) and 12 were midline catheters. Each line was monitored and evaluated for reason for choice of line, insertion data, line survival, patient self-administration, patient comfort scores, infection rate, and other difficulties encountered during treatment induction. The study results indicated noticeable differences between PICC and midline catheter performances, although a change in treatment protocol during the study influenced the choice of line used. There were also marked differences from other studies, carried out predominantly in non-HIV patients, when infection rate, dwell time of lines and thrombus formation were compared. Significant changes in practice have been implemented and further clinical studies/research identified.

  19. Spectrum of Opportunistic Fungal Infections in HIV/AIDS Patients in Tertiary Care Hospital in India

    PubMed Central

    Dhakad, Megh S.; Goyal, Ritu; Dewan, Richa

    2016-01-01

    HIV related opportunistic fungal infections (OFIs) continue to cause morbidity and mortality in HIV infected patients. The objective for this prospective study is to elucidate the prevalence and spectrum of common OFIs in HIV/AIDS patients in north India. Relevant clinical samples were collected from symptomatic HIV positive patients (n = 280) of all age groups and both sexes and subjected to direct microscopy and fungal culture. Identification as well as speciation of the fungal isolates was done as per the standard recommended methods. CD4+T cell counts were determined by flow cytometry using Fluorescent Activated Cell Sorter Count system. 215 fungal isolates were isolated with the isolation rate of 41.1%. Candida species (86.5%) were the commonest followed by Aspergillus (6.5%), Cryptococcus (3.3%), Penicillium (1.9%), and Alternaria and Rhodotorula spp. (0.9% each). Among Candida species, Candida albicans (75.8%) was the most prevalent species followed by C. tropicalis (9.7%), C. krusei (6.4%), C. glabrata (4.3%), C. parapsilosis (2.7%), and C. kefyr (1.1%). Study demonstrates that the oropharyngeal candidiasis is the commonest among different OFIs and would help to increase the awareness of clinicians in diagnosis and early treatment of these infections helping in the proper management of the patients especially in resource limited countries like ours. PMID:27413381

  20. XK469R in Treating Patients With Refractory Hematologic Cancer

    ClinicalTrials.gov

    2013-02-07

    Adult Acute Basophilic Leukemia; Adult Acute Eosinophilic Leukemia; Adult Acute Megakaryoblastic Leukemia (M7); Adult Acute Minimally Differentiated Myeloid Leukemia (M0); Adult Acute Monoblastic Leukemia (M5a); Adult Acute Monocytic Leukemia (M5b); Adult Acute Myeloblastic Leukemia With Maturation (M2); Adult Acute Myeloblastic Leukemia Without Maturation (M1); Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities; Adult Acute Myeloid Leukemia With Inv(16)(p13;q22); Adult Acute Myeloid Leukemia With t(16;16)(p13;q22); Adult Acute Myeloid Leukemia With t(8;21)(q22;q22); Adult Acute Myelomonocytic Leukemia (M4); Adult Erythroleukemia (M6a); Adult Pure Erythroid Leukemia (M6b); Blastic Phase Chronic Myelogenous Leukemia; Chronic Myelomonocytic Leukemia; de Novo Myelodysplastic Syndromes; Previously Treated Myelodysplastic Syndromes; Recurrent Adult Acute Lymphoblastic Leukemia; Recurrent Adult Acute Myeloid Leukemia; Refractory Anemia With Excess Blasts; Refractory Anemia With Excess Blasts in Transformation; Refractory Chronic Lymphocytic Leukemia; Relapsing Chronic Myelogenous Leukemia; Secondary Myelodysplastic Syndromes; Stage III Chronic Lymphocytic Leukemia; Stage IV Chronic Lymphocytic Leukemia; Untreated Adult Acute Myeloid Leukemia

  1. Technetium-99m red blood cell labeling in patients treated with doxorubicin

    SciTech Connect

    Ballinger, J.R.; Gerson, B.; Gulenchyn, K.Y.; Ruddy, T.D.; Davies, R.A.

    1988-03-01

    Radionuclide angiography is useful in monitoring cardiotoxicity of doxorubicin, but in vivo RBC labeling in these patients is believed to be poorer than that in general patients. The left ventricle-to-background activity ratio (R) was not significantly lower in patients treated with doxorubicin (3.24 +/- 1.15, N = 13) than in control patients (3.89 +/- 1.60, N = 14). With both modified in vivo and in vitro labeling, R was significantly improved in patients treated with doxorubicin (4.37 +/- 0.91, N = 8, and 4.37 +/- 1.22, N = 13, respectively). However, with the modified in vivo method, labeling efficiency remained a function of hematocrit, whereas the in vitro method removed this dependency. Both modified in vivo and in vitro labeling result in improved image quality over in vivo labeling in patients treated with doxorubicin, and the choice of method can be based on other factors.

  2. [Treatment with doxycycline and nifuroxazide of Isospora belli infection in AIDS].

    PubMed

    Meyohas, M C; Capella, F; Poirot, J L; Lecomte, I; Binet, D; Eliaszewicz, M; Frottier, J

    1990-06-01

    Isospora belli infection is the most frequent coccidiosis after cryptosporidiosis in AIDS patients. Chronic watery diarrhea is observed. Trimethoprim-sulfamethoxazole is the recommended treatment. Four AIDS patients were intolerant to this drug and were treated with doxycycline and nifuroxazide. Three patients were cured. Two patients died of other infections. The two last patients relapsed and were treated again with long term doxycycline. No relapse occurred during the following twelve months.

  3. Efficacy of amphotericin B in a fat emulsion for the treatment of cryptococcal meningitis in AIDS patients.

    PubMed

    Rubio, Fernando Góngora; Zanon, Jeferson Rodrigo; de Almeida, Margarete Teresa Gottardo; de Góngora, Delzi Vinha Nunes

    2007-04-01

    Several formulae have been developed in an attempt to reduce the toxicity of amphotericin B (AmB), but their high costs preclude widespread use. The aim of this study was to evaluate the efficacy of amphotericin B in a fat emulsion, i.e. Intralipid (AmB-IL), in 37 AIDS patients with cryptococcal meningitis (CM). We retrospectively reviewed data collected in a non-comparative open study between January 1999 and December 2001. The therapeutic cure was defined as complete resolution or improvement of the clinical symptoms or complete absence or improvement of the mycological alterations of the CSF. The outcomes were evaluated at 2 weeks, induction phase (IP), and at the end of treatment or consolidation phase (CP) with the last available CSF. Prior to the diagnosis of CM, 72% of patients had had one or more OI and 67.57% had a concomitant OI. The median CD4-cell count was 32 cells/mm(3), the median leukocyte count in the CSF was 29 cells/mm(3) and the median cumulative dose of AmB-IL was 1,200 mg (300-2,500). The therapeutic cure was 57.14% in the IP and 64.86% in the CP. During IP, 9 patients died (24.32%) and 4 (10.81%) during the CP (p=0.2). Thus, the overall mortality rate was 35.14%. AmB-IL, an inexpensive preparation, might be an alternative to conventional AmB. Some questions remain such as its compatibility, stability and level of toxicity. The benefit is especially important in developing countries, where no drugs other than AmB are available to treat systemic fungal infections.

  4. Religiosity and adherence to antiretroviral therapy among patients attending a public hospital-based HIV/AIDS clinic in Uganda.

    PubMed

    Kisenyi, Rita N; Muliira, Joshua K; Ayebare, Elizabeth

    2013-03-01

    In Uganda, the prevalence of non-adherence to antiretroviral therapy (ART) by HIV/AIDS patients remains high and sometimes this is blamed on patients' religious behavior. A descriptive design was used to examine the relationship between religiosity and ART adherence in a sample of 220 patients attending a HIV/AIDS clinic in a Ugandan public hospital. Participants who self-identified as Pentecostal and Muslim had the highest percentage of members with high religiosity scores and ART adherence. Among Muslim participants (34), 82% reported high religiosity scores and high levels of ART adherence. Of the fifty Pentecostals participants, 96% reported high religiosity scores and 80% reported high levels of ART adherence. Correlation analysis showed a significant relationship between ART adherence and religiosity (r = 0.618, P ≤ 0.01). Therefore, collaboration between religious leaders and HIV/AIDS healthcare providers should be encouraged as one of the strategies for enhancing ART adherence.

  5. The influence of age, smoking, antiretroviral therapy, and esophagitis on the local immunity of the esophagus in patients with AIDS.

    PubMed

    Cavellani, Camila Lourencini; Gomes, Nayara Cândida; de Melo e Silva, Ana Teresa; Silva, Renata Beatriz; Ferraz, Mara Lúcia Fonseca; Faria, Humberto Aparecido; Corrêa, Rosana Rosa Miranda; Teixeira, Vicente de Paula Antunes; Rocha, Laura Penna

    2013-01-01

    Studies have shown immunological and morphological alterations in the esophagus during the course of AIDS. Esophageal postmortem samples of 22 men with AIDS autopsied in a teaching hospital between 1982 and 2009 were collected. We carried out revision of the autopsy reports and medical records, morphometric analysis (Image J and KS-300 Kontron-Zeiss), and immunohistochemical (anti-S100, anti-IgA, anti-IgG, and anti-IgM) analysis of the esophagus. In accordance with most of the parameters evaluated, age and the smoking habit harmed the esophageal local immunity, whereas the use of antiretroviral therapy improved the immune characteristics of this organ. Patients with esophagitis also presented immunological fragility of the esophagus. This leads to the conclusion that alterations in the esophageal epithelium of patients with AIDS are not only caused by direct action of HIV but also the clinical and behavioral characteristics of the patient.

  6. Factors associated with improvement in disability-adjusted life years in patients with HIV/AIDS

    PubMed Central

    Bermudez-Tamayo, Clara; Martin, Jose Jesus Martin; Ruiz-Pérez, Isabel; Lima, Antonio Olry de Labry

    2008-01-01

    Background The epidemic of HIV/AIDS and treatments that have emerged to alleviate, have brought about a shift in the burden of disease from death to quality of life/disability. The aim was to determine which factors are associated with improvements in the level of health of male and female patients with HIV/AIDS in Andalusia, in terms of disability-adjusted life years. Methods Descriptive study based on a sample group of 8800 people on the Andalusian AIDS register between 1983 and 2004. Dependent variables: Life lost due to premature mortality (YLL), years lost due to disability (YLD) and disability-adjusted life years (DALY). Independent variables: vital state, sex, age at the time of diagnosis, age at the time of death, transmission category, province of residence, AIDS-indicator disease and the period of diagnosis. A bivariate analysis was carried out to find out if the health level variables changed in accordance with the independent variables. Using the independent variables which had a statistically significant link with the level of health variables, a multivariate linear regression model, disaggregated by gender, was constructed. Results Amongst the women, we found a model which explained the level of health of 64.9%: a link was found between a higher level of health (lower DALYs) and not intravenous drug use, the province of residence, being diagnosed during the HAART era and older age at the time of diagnosis. Amongst the men, we found a model which explained the level of health of 64.4%: a link was found between a higher level of health (lower DALYs) and intravenous drug use, the province of residence, being diagnosed during the HAART era and older age at the time of diagnosis. Conclusion A higher level of health (lower DALY) amongst both men and women was found to be linked to not be intravenous drug user, the province of residence, being diagnosed during the HAART era and older age at the time of diagnosis. PMID:18939970

  7. Immunological evaluation of rheumatoid arthritis patients treated with itolizumab

    PubMed Central

    Aira, Lazaro E.; Hernández, Patricia; Prada, Dinorah; Chico, Araceli; Gómez, Jorge A.; González, Zuyén; Fuentes, Karla; Viada, Carmen; Mazorra, Zaima

    2016-01-01

    Rheumatoid arthritis is an autoimmune disease characterized by joint inflammation that affects approximately 1% of the general population. Itolizumab, a monoclonal antibody specific for the human CD6 molecule mainly expressed on T lymphocytes, has been shown to inhibit proliferation of T cells and proinflammatory cytokine production in psoriasis patients. We have now assessed the immunological effect of itolizumab in combination with methotrexate in rheumatoid arthritis by analyzing clinical samples taken from 30 patients enrolled in a clinical trial. T and B cell subpopulations were measured at different time points of the study. Plasma cytokine levels and anti-idiotypic antibody response to itolizumab were also evaluated. The combined treatment of itolizumab and methotrexate led to a reduction in the frequency of T cell subpopulations, and plasma levels of proinflammatory cytokines showed a significant decrease up to at least 12 weeks after treatment ended. No anti-idiotypic antibody response was detected. These results support the relevance of the CD6 molecule as a therapeutic target for the treatment of this disease. PMID:26466969

  8. Immunological evaluation of rheumatoid arthritis patients treated with itolizumab.

    PubMed

    Aira, Lazaro E; Hernández, Patricia; Prada, Dinorah; Chico, Araceli; Gómez, Jorge A; González, Zuyén; Fuentes, Karla; Viada, Carmen; Mazorra, Zaima

    2016-01-01

    Rheumatoid arthritis is an autoimmune disease characterized by joint inflammation that affects approximately 1% of the general population. Itolizumab, a monoclonal antibody specific for the human CD6 molecule mainly expressed on T lymphocytes, has been shown to inhibit proliferation of T cells and proinflammatory cytokine production in psoriasis patients. We have now assessed the immunological effect of itolizumab in combination with methotrexate in rheumatoid arthritis by analyzing clinical samples taken from 30 patients enrolled in a clinical trial. T and B cell subpopulations were measured at different time points of the study. Plasma cytokine levels and anti-idiotypic antibody response to itolizumab were also evaluated. The combined treatment of itolizumab and methotrexate led to a reduction in the frequency of T cell subpopulations, and plasma levels of proinflammatory cytokines showed a significant decrease up to at least 12 weeks after treatment ended. No anti-idiotypic antibody response was detected. These results support the relevance of the CD6 molecule as a therapeutic target for the treatment of this disease.

  9. Treating Anterior Cruciate Ligament Tears in Skeletally Immature Patients

    PubMed Central

    Vavken, Patrick; Murray, Martha M

    2011-01-01

    Purpose To systematically review the current evidence for conservative and surgical treatment of anterior cruciate ligament (ACL) tears in skeletally immature patients. Methods A systematic search of PubMed, CINAHL, EMBASE, CCTR, and CDSR was performed for surgical and/or conservative treatment of complete ACL tears in immature individuals. Studies with less than six months of follow-up were excluded. Study quality was assessed and data were collected on clinical outcome, growth disturbance, and secondary joint damage. Results We identified 48 studies meeting the inclusion criteria. Conservative treatment was found to result in poor clinical outcomes and a high incidence of secondary defects, including meniscal and cartilage injury. Surgical treatment had only very weak evidence for growth disturbance, yet strong evidence of good postoperative stability and function. No specific surgical treatment showed clearly superior outcomes, yet the studies using physeal-sparing techniques had no reported growth disturbances at all. Conclusions The current best evidence suggests that surgical stabilization should be considered the preferred treatment in immature patients with complete ACL tears. While physeal-sparing techniques are not associated with a risk of growth disturbance, transphyseal reconstruction is an alternative with a beneficial safety profile and a minimal risk of growth disturbance. Conservative treatment commonly leads to meniscal damage and cartilage destruction and should be considered a last resort. Level of Evidence Level IV, systematic review of Level II, III, and IV studies. PMID:21552340

  10. Computer-aided optimal design of custom scoliosis braces considering clinical and patient evaluations.

    PubMed

    Visser, Daniel; Xue, Deyi; Ronsky, Janet L; Harder, James; Zernicke, Ronald F

    2012-09-01

    Scoliosis causes an abnormal three dimensional curvature of the spine that is often treated by an orthotic device called brace. The objective of this research was to develop a new approach to automatically identify the optimal design of custom-built brace, based on clinical and patient evaluations. In this approach, torso geometry of the scoliosis patient was achieved using a 3-D imaging system that generated a 3-D torso surface model, which was modified using a custom CAD system to design the 3-D brace surface model. Two design parameters, a translational correction factor and a rotational correction factor, were selected to design the brace geometry from the torso geometry. The 3-D digital brace was evaluated by three clinical evaluation measures (imbalance, rib hump and principal axis angle reduction) and one patient evaluation measure (discomfort). A multi-objective optimization method was employed to identify the optimal design parameters considering both clinical and patient evaluations.

  11. MODAFINIL EFFECTS ON COGNITIVE FUNCTION IN HIV+ PATIENTS TREATED FOR FATIGUE: A PLACEBO CONTROLLED STUDY

    PubMed Central

    McElhiney, Martin; Rabkin, Judith; Van Gorp, Wilfred; Rabkin, Richard

    2009-01-01

    Both mild cognitive impairment and fatigue are common among people with HIV/AIDS. This study examined the efficacy of modafinil for HIV+ patients who sought treatment for fatigue in a placebo-controlled double blind 4-week trial. A battery of standard neuropsychological tests was administered at study entry and Week 4, and change in performance was compared for 59 patients receiving modafinil vs. 44 patients receiving placebo. A significant effect on fatigue was observed. In addition, cognitive performance, as measured by a global change score, improved more in the modafinil than placebo group although the effect was not specific to any cognitive domain. PMID:19937504

  12. [Experience in irradiating with helium-neon lasers to treat patients with relapsing aphthous stomatitis].

    PubMed

    Prikuls, V F

    2000-01-01

    Seventy-five patients with relapsing aphthous stomatitis (41 with the fibrinous form, 25 with glandular form, and 9 with necrotic form) were treated using He-Ne laser and a photosensitizer. A good therapeutic effect was attained.

  13. Cases of cryptosporidiosis co-infections in AIDS patients: a correlation between clinical presentation and GP60 subgenotype lineages from aged formalin-fixed stool samples

    PubMed Central

    DEL CHIERICO, F; ONORI, M; DI BELLA, S; BORDI, E; PETROSILLO, N; MENICHELLA, D; CACCIÒ, S M; CALLEA, F; PUTIGNANI, L

    2011-01-01

    Nine cases of cryptosporidiosis co-infections in AIDS patients were clinically categorised into severe (patients 1, 3, 8 and 9), moderate (patients 4 and 5) and mild (patients 2, 6 and 7). Formalin-fixed faecal specimens from these patients were treated to obtain high quality DNA competent for amplification and sequencing of the 60-kDa glycoprotein (GP60) gene. Sequence analysis revealed that one patient was infected with Cryptosporidium hominis whereas the remaining eight patients were infected with C. parvum. Interestingly, the patients showing severe cryptosporidiosis harboured two subtypes within the C. parvum allelic family IIc (IIcA5G3 and IIcA5G3R2), whereas patients with moderate or mild infections showed various subtypes of the C. parvum allelic family IIa (IIaA14G2R1, IIaA15G2R1, IIaA17G3R1 and IIaA18G3R1). DNA extraction and genotyping of Cryptosporidium spp. is a challenging task on formalin-fixed stool samples, whose diagnostic outcome is age-dependent. The method herein reported represents a step forward routine diagnosis and improves epidemiology of HIV-related clinical cases. Due to the need to elucidate genetic richness of Cryptosporidium human isolates, this approach represents a useful tool to correlate individual differences in symptoms to subgenotyping lineages. PMID:21929875

  14. A case of central nervous system nocardiosis in a patient with lupus treated with belimumab

    PubMed Central

    Lai, Richard HC; Kim, Deborah; Constantinescu, Florina

    2016-01-01

    Belimumab was approved by the United States Food and Drug Administration in March 2011 as the first biological agent for treating active systemic lupus erythematosus (SLE). To the best of our knowledge, this is the first case report regarding a patient with SLE treated with belimumab who was diagnosed with central nervous system nocardiosis. PMID:28149666

  15. Fungal Opportunistic Pneumonias in HIV/AIDS Patients: An Indian Tertiary Care Experience

    PubMed Central

    Mehra, Bhanu; Dhakad, Megh Singh; Goyal, Ritu; Bhalla, Preena; Dewan, Richa

    2017-01-01

    Introduction Opportunistic pneumonias are a major cause of mortality and morbidity in Human Immunodeficiency Virus (HIV) reactive patients. Despite the significant role that fungi play in causation of this opportunistic mycoses, very few Indian studies have attempted to investigate the burden and aetiological spectrum of HIV/AIDS-associated fungal pneumonias. Aim To document the prevalence of fungal aetiology in HIV/AIDS-related opportunistic pneumonias in an Indian setting; and to elucidate the various fungal opportunists responsible for the same. Materials and Methods The present study was a prospective, cross-sectional analysis conducted at Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi from October 2008 to September 2011. Expectorated sputa were collected from 71 HIV reactive patients with a clinical diagnosis of pneumonia and subjected to direct microscopic examination employing Gram stain, 10% KOH wet mount and India ink preparation. In addition, direct immunofluorescence of sputum samples was performed for detection of cysts and trophozoites of Pneumocystis carinii. Also, each sputum sample was inoculated in duplicate onto Sabouraud Dextrose Agar (SDA) for culture. A blood sample was drawn from each patient and a battery of serological tests was performed, including Cryptococcal Antigen Latex Agglutination System (CALASTM) for detection of cryptococcal capsular polysaccharide antigen; Platelia™ Aspergillus EIA for detection of Aspergillus galactomannan antigen; SERION ELISA antigen Candida for detection of Candida antigen and Histoplasma DxSelect™ for detecting antibodies to Histoplasma species. Descriptive statistics were employed to depict results as proportions and figures. Further, arithmetic mean and standard deviation were calculated for central tendencies and median for non-normal/skewed distributions. Results A definite fungal aetiology was established in 25 (35.2%) of 71 HIV reactive patients with pneumonic involvement

  16. Reduced Acute Bowel Toxicity in Patients Treated With Intensity-Modulated Radiotherapy for Rectal Cancer

    SciTech Connect

    Samuelian, Jason M.; Callister, Matthew D.; Ashman, Jonathan B.; Young-Fadok, Tonia M.; Borad, Mitesh J.; Gunderson, Leonard L.

    2012-04-01

    Purpose: We have previously shown that intensity-modulated radiotherapy (IMRT) can reduce dose to small bowel, bladder, and bone marrow compared with three-field conventional radiotherapy (CRT) technique in the treatment of rectal cancer. The purpose of this study was to review our experience using IMRT to treat rectal cancer and report patient clinical outcomes. Methods and Materials: A retrospective review was conducted of patients with rectal cancer who were treated at Mayo Clinic Arizona with pelvic radiotherapy (RT). Data regarding patient and tumor characteristics, treatment, acute toxicity according to the Common Terminology Criteria for Adverse Events v 3.0, tumor response, and perioperative morbidity were collected. Results: From 2004 to August 2009, 92 consecutive patients were treated. Sixty-one (66%) patients were treated with CRT, and 31 (34%) patients were treated with IMRT. All but 2 patients received concurrent chemotherapy. There was no significant difference in median dose (50.4 Gy, CRT; 50 Gy, IMRT), preoperative vs. postoperative treatment, type of concurrent chemotherapy, or history of previous pelvic RT between the CRT and IMRT patient groups. Patients who received IMRT had significantly less gastrointestinal (GI) toxicity. Sixty-two percent of patients undergoing CRT experienced {>=}Grade 2 acute GI side effects, compared with 32% among IMRT patients (p = 0.006). The reduction in overall GI toxicity was attributable to fewer symptoms from the lower GI tract. Among CRT patients, {>=}Grade 2 diarrhea and enteritis was experienced among 48% and 30% of patients, respectively, compared with 23% (p = 0.02) and 10% (p = 0.015) among IMRT patients. There was no significant difference in hematologic or genitourinary acute toxicity between groups. In addition, pathologic complete response rates and postoperative morbidity between treatment groups did not differ significantly. Conclusions: In the management of rectal cancer, IMRT is associated with a

  17. Understanding and Managing Erectile Dysfunction in Patients Treated for Cancer

    PubMed Central

    Voznesensky, Maria; Annam, Kiran

    2016-01-01

    Cancer can cause sexual adverse effects by direct and indirect pathways. It can involve sexual organs, indirectly affect body image, or cause fatigue or depression with subsequent effects on libido. Erectile dysfunction (ED), the inability to obtain or maintain an erection firm enough for sexual intercourse, can also result from adverse effects of cancer treatment, such as fatigue, pain, or anxiety about therapy. In addition, depressed feelings about having cancer can affect sexuality, causing a range of signs and symptoms that can lead to ED. Chemotherapy, hormone therapy, surgery, and radiation can all cause sexual adverse effects. Additional factors that play a role include patient age and degree of ED before starting cancer treatment. In this article, we discuss how chemotherapy, hormone therapy, surgery, and radiation affect erectile function as well as possible treatment options for ED. PMID:27072383

  18. Remaining Pain in Early Rheumatoid Arthritis Patients Treated With Methotrexate

    PubMed Central

    Altawil, Reem; Saevarsdottir, Saedis; Wedrén, Sara; Alfredsson, Lars; Klareskog, Lars

    2016-01-01

    Objective To investigate the frequency of remaining pain in early rheumatoid arthritis (RA) after 3 months of treatment with methotrexate as the only disease modifying antirheumatic drug, with a special focus on patients with a good clinical response. Methods The study base was cases reported to a population‐based early RA cohort who had followup data from the Swedish Rheumatology Quality Register (n = 1,241). The Disease Activity Score in 28 joints European League Against Rheumatism (EULAR) response criteria were used to evaluate clinical response to treatment as good, moderate, and no response. The primary end point was remaining pain at the 3‐months followup visit, defined as pain >20 mm on a 100‐mm visual analog scale (VAS). Results Remaining pain in spite of a EULAR good response at followup was associated with higher baseline disability, using the Health Assessment Questionnaire (adjusted odds ratio [OR] 2.2 [95% confidence interval (95% CI) 1.4–3.4] per unit increase), and less baseline inflammation, using the erythrocyte sedimentation rate (adjusted OR 0.81 [95% CI 0.70–0.93] per 10‐mm increase). Similar associations were detected for remaining pain at followup in spite of low inflammatory activity, defined as a C‐reactive protein level <10. Increase in VAS pain during the treatment period was observed in 19% of the whole cohort, with frequencies in the EULAR response groups of 9% (good response), 15% (moderate response), and 45% (no response). Conclusion These results are in line with the hypothesis that a subgroup of early RA patients exhibits pain that is not inflammatory mediated, where alternative treatment strategies to traditional antiinflammatory medications need to be considered. PMID:26784398

  19. Quality of Life in Methadone Maintenance Treated Patients in Iran

    PubMed Central

    Aghayan, Shahrokh; Amiri, Mohammad; Chaman, Reza; Khosravi, Ahmad

    2015-01-01

    Background: Measurement of life quality as an index of health status has a widespread application in health care domain. Objectives: The current study aimed to determine the quality of life of referents to addiction cessation centers of Iran. Patients and Methods: In this cross-sectional study, 988 addicts who had referred to addiction cessation centers in Shahroud were studied through SF-36 questionnaire. The data were analyzed using linear regression in structural equation modeling and STATA 12 statistical software. Results: The mean ± SD age of the participants was 41.2 ± 11.8 years. Most of the referents used smoking followed by eating method of opium abuse. The mean ± SD score of life quality was 67.8 ± 17.2, the mean ± SD score of life quality in physical health dimension was 76.9 ± 26.7, and the mean ± SD score in mental health dimension was 64.5 ± 18.4. Univariate analysis showed a significant relationship between life quality and gender, place of residence, education, occupation, marital status, and income (P ≤ 0.05). However, in multivariate analysis a significant relationship was observed only between gender, socioeconomic status, and quality of life score. Conclusions: Although most studies have reported low and weak quality of life in addicts, the findings of this study shows that the life quality score of addicts is rather good. It seems that the maintenance treatment that addicts receive in addiction cessation centers has been effective in improving the quality of life of the patients. Hence, expanding methadone treatment centers can play a leading role in the improvement of life quality in addicts. PMID:26870708

  20. Intestinal microsporidiosis in a Chilean patient with acquired immunodeficiency syndrome (AIDS).

    PubMed

    Oddó, D; Chuaqui, R; Hoffmann, E; Garcia, M

    1993-03-01

    A 24-year-old male patient with AIDS diagnosed in 1989, and with several episodes of pneumocystosis, was admitted because of a chronic diarrheic syndrome and severe epigastric pain. Endoscopy showed a granular duodenal mucosa. Light microscopy showed a moderate villous atrophy with round-cell inflammatory infiltration of the chorion. Giemsa, Ziehl-Neelsen, and Gram stains showed microsporidial spores measuring between 1.5 and 2 microns in the supranuclear cytoplasm of some enterocytes. Electron microscopy showed sporoblasts and spores consistent with Enterocytozoon bieneusi, with an apparently non-tubular, rather electron-dense polar filament showing up to 7 coils and also a microtubular internal structure with annular disposition, a finding which has not been adequately emphasized in the pertinent literature, probably representing a contractile property of the polar filament, rather than a mere duct for the parasitic sporoplasm to be inoculated.

  1. Rapid susceptibility testing of Mycobacterium avium complex and Mycobacterium tuberculosis isolated from AIDS patients

    NASA Technical Reports Server (NTRS)

    Dhople, Arvind M.

    1994-01-01

    In ominous projections issued by both U.S. Public Health Service and the World Health Organization, the epidemic of HIV infection will continue to rise more rapidly worldwide than predicted earlier. The AIDS patients are susceptible to diseases called opportunistic infections of which tuberculosis and Mycobacterium avium complex (MAC) infection are most common. This has created an urgent need to uncover new drugs for the treatment of these infections. In the seventies, NASA scientists at Goddard Space Flight Center, Greenbelt, MD, had adopted a biochemical indicator, adenosine triphosphate (ATP), to detect presence of life in extraterrestrial space. We proposed to develop ATP assay technique to determine sensitivity of antibacterial compounds against MAC and M. tuberculosis.

  2. Immunological response to hepatitis B vaccination in patients with AIDS and virological response to highly active antiretroviral therapy.

    PubMed

    Paitoonpong, Leilani; Suankratay, Chusana

    2008-01-01

    Previous studies showed that an immunological response to hepatitis B virus (HBV) vaccination in patients with AIDS was lower than in the normal population. However, those with virological response to highly active antiretroviral therapy (HAART) may have a normal immunological response to HBV vaccination. In our study, patients with AIDS who had a virological response to HAART and no immunity to HBV received 3 doses of HBV vaccine (20 microg of Engerix-B(R)) on d 0, 30, and 180. Anti-HBs level was measured 1 month after complete vaccination. Of 28 patients, overall response rate to vaccination was 71.4%. The responder group had a significantly higher CD4 count at 1 month after complete vaccination than the non-responder group (466.95+/-146.94 and 335+/-112.62 cells/microl, p =0.035). The patients receiving efavirenz-containing HAART had better response than those without efavirenz-containing HAART (p =0.030). The responder group had received a longer duration of HAART. In conclusion , to our knowledge, ours is the first prospective study to determine the immunological response to HBV vaccination in all patients with AIDS who had maintained the virological response after receiving HAART throughout the study period. Patients with AIDS and virological response to HAART have a good immunological response to HBV vaccination.

  3. Syncope in a patient being treated for hepatic and intestinal amoebiasis

    PubMed Central

    Yelve, Kavita; Phatak, Sanat; Patil, Meenakshi Amit; Pazare, Amar R

    2012-01-01

    A 63-year-old man presented to our hospital with amoebic liver abscess and was treated successfully for the same. During the course of his treatment, he developed syncopal attacks and was found to have Torsades de Pointes on electrocardiogram. The patient was treated with intravenous magnesium and direct current cardioversion. Hypokalaemia, chloroquine and sepsis were suspected to have precipitated the arrhythmia. The patient remained arrhythmia-free following the correction of these factors. PMID:23203174

  4. Evolut R Implantation to Treat Severe Pure Aortic Regurgitation in a Patient With Mitral Bioprosthesis.

    PubMed

    Bruschi, Giuseppe; Colombo, Paola; Nava, Stefano; Musca, Francesco; Merlanti, Bruno; Belli, Oriana; Soriano, Francesco; Botta, Luca; De Caria, Danile; Giannattasio, Cristina; Russo, Claudio F

    2016-12-01

    Transcatheter aortic valves have been designed to treat high-risk surgical candidates affected by severe aortic stenosis, but little is known about the use of transcatheter valves in patients with severe pure aortic regurgitation. We describe the implantation of Medtronic CoreValve Evolut R (Medtronic, Minneapolis, MN) to treat an 82-year-old patient affected by severe pure aortic regurgitation who underwent prior mitral valve replacement with a biological valve protruding into the left ventricular outflow tract.

  5. A clinical contrast: physical therapists with low back pain treating patients with low back pain.

    PubMed

    Louw, Adriaan; Puentedura, Emilio J; Zimney, Kory

    2015-01-01

    Patients with low back pain (LBP) often display faulty beliefs and cognitions regarding their pain experience. Pain neuroscience education (PNE) aims to alter the pain experience by targeting these faulty beliefs and cognitions. One PNE strategy aims specifically to reframe commonly held beliefs about tissues by patients with LBP as the single source of pain. In line with this reasoning, it is hypothesized that physical therapists (PT) treating patients with LBP may indeed experience similar, if not worse, pain experiences while treating a patient with LBP. To date, this assumption has never been studied. A PT LBP questionnaire was developed, validated and distributed to a convenience sample of attendees of an international PT conference. One-hundred and ten PTs completed the questionnaire for a 71% response rate. Ninety percent of the PTs reported having experienced LBP, with 27% at the conference experiencing LBP at the time. Of the PTs that have experienced LBP 75% reported not having received any imaging; 81% no formal diagnoses, 58% no treatment and 86% not having missed work due to LBP. Eighty-six percent of therapists reported having experienced LBP while treating a patient with LBP, with 50% convinced their LBP was higher than the LBP experienced by the patient they were treating. The results from this study indicate PTs often treat patients with LBP while suffering LBP. It is suggested that this knowledge may potentially help patients with LBP reconceptualize their LBP experience leading to expedited recovery.

  6. Clarithromycin-ciprofloxacin-amikacin for therapy of Mycobacterium avium-Mycobacterium intracellulare bacteremia in patients with AIDS.

    PubMed Central

    de Lalla, F; Maserati, R; Scarpellini, P; Marone, P; Nicolin, R; Caccamo, F; Rigoli, R

    1992-01-01

    A combination of clarithromycin, ciprofloxacin, and amikacin for the treatment of Mycobacterium avium-Mycobacterium intracellulare bacteremia was evaluated in 12 AIDS patients. Mycobacteremia cleared in all patients by 2 to 8 weeks of treatment, and symptoms resolved. Four patients died; all had negative blood cultures until death, and disseminated M. avium-M. intracellulare complex infection was not considered the primary cause of death. PMID:1387303

  7. Usability testing of ANSWER: a web-based methotrexate decision aid for patients with rheumatoid arthritis

    PubMed Central

    2013-01-01

    Background Decision aids are evidence-based tools designed to inform people of the potential benefit and harm of treatment options, clarify their preferences and provide a shared decision-making structure for discussion at a clinic visit. For patients with rheumatoid arthritis (RA) who are considering methotrexate, we have developed a web-based patient decision aid called the ANSWER (Animated, Self-serve, Web-based Research Tool). This study aimed to: 1) assess the usability of the ANSWER prototype; 2) identify strengths and limitations of the ANSWER from the patient’s perspective. Methods The ANSWER prototype consisted of: 1) six animated patient stories and narrated information on the evidence of methotrexate for RA; 2) interactive questionnaires to clarify patients’ treatment preferences. Eligible participants for the usability test were patients with RA who had been prescribed methotrexate. They were asked to verbalize their thoughts (i.e., think aloud) while using the ANSWER, and to complete the System Usability Scale (SUS) to assess overall usability (range = 0-100; higher = more user friendly). Participants were audiotaped and observed, and field notes were taken. The testing continued until no new modifiable issues were found. We used descriptive statistics to summarize participant characteristics and the SUS scores. Content analysis was used to identified usability issues and navigation problems. Results 15 patients participated in the usability testing. The majority were aged 50 or over and were university/college graduates (n = 8, 53.4%). On average they took 56 minutes (SD = 34.8) to complete the tool. The mean SUS score was 81.2 (SD = 13.5). Content analysis of audiotapes and field notes revealed four categories of modifiable usability issues: 1) information delivery (i.e., clarity of the information and presentation style); 2) navigation control (i.e., difficulties in recognizing and using the navigation control buttons); 3

  8. The experiences of Batswana families regarding hospice care of AIDS patients in the Bophirima district, North West province, South Africa.

    PubMed

    Makhele, M F; Mulaudzi, F M

    2012-01-01

    The HIV/AIDS pandemic put significant strain on healthcare services in the country. Hospitals were no longer coping with the escalating number of AIDS patients. This resulted in the early discharge of patients, with some patients, too ill to be nursed at home, being sent to hospices for continued care. The Batswana had mixed feelings about hospice care, because their beliefs on patient care are based on the ubuntu philosophy, which emphasises the principle of caring for one another. The purpose of this study was to explore and describe the experiences of Batswana families regarding hospice care for patients in the Thlabane township in the province of the North West as well as to make recommendations to policy-makers to ensure that hospices are accepted by community members and utilised effectively. A qualitative, explorative, descriptive research design was applied. Purposive sampling was applied to select study participants with whom in-depth unstructured interviews were conducted. A qualitative data analysis was done by categorising, ordering, and summarising the data, and describing the findings. The findings indicated that families of patients in hospice care experienced such care as foreign to their culture. These families also experienced stigmatisation, firstly owing to the stigma associated with AIDS and secondly because they opted for hospice care. However, they also observed the high quality of care provided by the hospice and understood its benefits for AIDS patients. The study concluded that hospice care relieved families of terminally ill AIDS patients of the burden of care and enabled them to keep on working and earning a living. Recommendations to policy-makers included enhancing hospice care and ensuring the provisioning of culturally safe hospice care.

  9. Characteristics of Patients with Hearing Aids according to the Degree and Pattern of Hearing Loss

    PubMed Central

    Byun, Young Seok; Kim, Sung Su; Park, Sang Hyun; Park, Eun Bin; Kim, Ho Joong; Kim, Sang Hoon

    2016-01-01

    Background and Objectives This study was designed to assess the characteristics of patients according to the degree and audiogram shape of hearing loss and the association of these characteristics with hearing aids (HA) choice, return rate, and cause of return. Subjects and Methods This study included 460 individuals who received HAs from 2011 to 2015. The relationships between type of HA and age, primary and accompanying symptoms, HA choice and return and cause of return were evaluated according to the degree and pattern of hearing loss. Results HA type did not differ significantly according to the degree and pattern of hearing loss. Intensity of hearing loss was greater in male than in female (p<0.05). Open and completely-in-canal types of HA decreased with age (p<0.05). As degree of hearing loss intensified, behind-the-ear and in-the-ear types increased and Open type decreased (p<0.05). The HA return rate was 9.7%, but was not associated with degree or pattern of hearing loss. The main causes of HA return were costs, psychological fears and adaptive failure. Conclusions Choice of HA is affected by age, sex, and degree and pattern of hearing loss. HA for hearing rehabilitation in patients with hearing loss can be personalized according to each patient's characteristics and tendencies. PMID:27942600

  10. Pilot test of a patient decision aid about liver transplant organ quality.

    PubMed

    Volk, Michael L; Roney, Meghan; Fagerlin, Angela

    2014-07-01

    Prior studies have shown that patients are reluctant to accept donor-specific risks, and transplant professionals lack an effective and time-efficient means of obtaining informed consent. We designed and pilot-tested a Web-based patient decision aid (DA) on organ quality. The DA was administered to 53 liver transplant candidates (median Model for End-Stage Liver Disease score = 14, range = 7-26), and they took a mean of 15 minutes to complete it. Questions about knowledge and attitudes were asked before and after the DA. Subjects' knowledge improved, with 53% and 60% correctly answering questions about hepatitis B virus and human immunodeficiency virus transmission before the DA and 94% and 100%, respectively, correctly answering them afterward (P < 0.001). The accuracy of mortality prediction also improved from a mean 3-month mortality estimate of 22% before the DA to 12% afterward (P < 0.001). After the DA, subjects felt that it was more likely that they might be offered a less-than-perfect liver (P = 0.001), and they were more likely to consider accepting such a liver (P < 0.001). In conclusion, implementing a Web-based patient DA is feasible and improves knowledge among liver transplant candidates. The use of this tool may decrease candidates' reluctance to accept extended criteria organs.

  11. Total Body Photography as an Aid to Skin Self-examination: A Patient's Perspective.

    PubMed

    Secker, Lisanne J; Bergman, Wilma; Kukutsch, Nicole A

    2016-02-01

    Skin self-examination can help patients who are at high risk for developing melanoma to become more involved in their own surveillance and treatment. This study examined the use of total body photography as an aid to skin self-examination from the patients' perspective. A total of 179 individuals at high risk for developing melanoma who had undergone total body photography (60.5% response rate) completed a self-reported questionnaire assessing the frequency of skin self-examination, perceived usefulness of total body photography, and a variety of potential demographic, clinical and psychological factors. Only approximately half of the participants indicated skin self-examination as useful and 78.9% preferred clinical skin examination by a specialist. Finding total body photography useful was associated with having received instructions on how to perform skin self-examination, the use of a (hand)mirror, and confidence to detect changing moles. These findings allow us to develop strategies to further improve patients' self-screening behaviours.

  12. Progressive outer retinal necrosis (PORN) in AIDS patients: a different appearance of varicella-zoster retinitis.

    PubMed

    Pavesio, C E; Mitchell, S M; Barton, K; Schwartz, S D; Towler, H M; Lightman, S

    1995-01-01

    Retinal infections caused by the varicella-zoster virus (VZV) have been reported in immunocompetent and immunocompromised individuals. Two cases of a VZV-related retinitis are described with the characteristic features of the recently described progressive outer retinal necrosis (PORN) syndrome. Both patients suffered from the acquired immunodeficiency syndrome (AIDS) with greatly reduced peripheral blood CD4+ T lymphocyte counts, and presented with macular retinitis without vitritis. The disease was bilateral in one case and unilateral in the other. The clinical course was rapidly progressive with widespread retinal involvement and the development of rhegmatogenous retinal detachment with complete loss of vision in the affected eyes despite intensive intravenous antiviral therapy. VZV DNA was identified in vitreous biopsies, by molecular techniques based on the polymerase chain reaction (PCR), in both patients. At present, the use of very high-dose intravenous acyclovir may be the best therapeutic option in these patients for whom the visual prognosis is poor. Intravitreal antiviral drugs could also contribute to the management of these cases.

  13. [EMOTIONAL MANAGEMENT AND CRITICAL THINKING IN THE AID RELATIONSHIP OF THE HOLISTIC CARE OF PALLIATIVE PATIENTS].

    PubMed

    De Blas Gómez, Irene; Rodríguez García, Marta

    2015-05-01

    To care for palliative patients is essential that healthcare professionals develop emotional competencies. This means acquiring the habit of self reflection and be emphatic with other people, in order to be able to identify the personal emotions of patients, family and team. Reflection involves a continuing effort to reason about aspects of professional practice, especially on issues as complex as suffering and death. Both reflective reasoning and emotional management are vital in an Aid Relationship. For nursing healthcare professionals, to care the emotional aspects means becoming aware of their own and others feelings, and get to understand and accept to handle them properly. Nursing actions involves many qualities of social competence, such as empathy, understanding, communication skills, honesty, flexibility and adaptability to the individual needs of people cared. In the context of palliative care patients and their families all these aspects are fundamental and are part of the same philosophy. Emotional education still remains a challenge in our profession both in the initial and continuing training.

  14. [Digestive manifestations of the acquired immunodeficiency syndrome (AIDS): study in 26 patients].

    PubMed

    René, E; Marche, C; Régnier, B; Saimot, A G; Vittecoq, B; Matheron, S; Le Port, C; Bricaire, F; Bure, A; Brun-Vezinet, C

    1985-04-01

    We studied the gastrointestinal manifestations in 26 cases of AIDS. The patients belonged to two different epidemiological groups: the first group included thirteen french homosexual men, the second group included 6 Haitians, 6 Africans and a Pakistanian, none of them admit homosexual activity. The clinical manifestations were: chronic watery diarrhea in 17 cases, bloody diarrhea in 2 cases; loss of weight in the 26 cases; dysphagia in five cases; jaundice in one patient (due to Kaposi sarcoma of the ampulla of Vater). The digestive lesions found, alone or associated, were necrotizing enteritis (2), ulcerative colitis (1), pseudomembranous colitis (1), Candida esophagitis (10), erythematous duodenitis (6), proctitis (4), Kaposi sarcoma (3), diffuse (2) or localized (1). Thirteen patients out of the 26 presented opportunistic digestive infections due to one or several germs. These were 10 cases of esophageal infection (due to Candida albicans) and 8 cases of enterocolonic infection due to Cytomegalovirus (3 cases), Cryptosporidium (3 cases), Mycobacterium avium intracellulare (1 case), Cryptococcus neoformans (1 case). The other digestive infections cases were due to non-opportunistic pathogens: Entamoeba histolytica (3 cases); Giardia lamblia (3 cases); Strongyloides stercoralis (2 cases); Salmonella typhi (2 cases); Shigella (1 case); Herpes simplex virus (1 case). No difference was noticed between the homosexual and the heterosexual groups with respect to the nature and the frequency of the digestive infections.

  15. Ocular Manifestations in Patients with HIV Infection/AIDS who were Referred from the ART Centre, Hassan, Karnataka, India

    PubMed Central

    Acharya, Pavana Krishnaraj; Venugopal, Kavitha Chikkanayakanahalli; Karimsab, Dada Peer; Balasubramanya, S

    2012-01-01

    Background Ocular involvement in HIV infection/AIDS is very common and it includes various clinical presentations which may be asymptomatic or atypical or they may be the initial manifestations of the underlying disease. The severity of these lesions increases as the immune competency decreases, leading to visual impairment or blindness. Objective The purpose of this study was to determine the prevalence and the types of HIV associated ocular conditions and their effect on the vision in patients with HIV/AIDS. Methods This cross sectional study was based on the patients with HIV infection/AIDS, who were referred to the Ophthalmic OPD, District hospital, Hassan. These patients were referred from the District ART Centre for a complete ophthalmic evaluation, irrespective of their immune status and the presence or absence of symptoms. All the patients underwent a complete ophthalmic examination, which included both anterior and posterior segment evaluation and colour vision assessment. Results Out of the 553 patients, 66% belonged to the age group of 21-40 years. 87% of the patients had a BCVA of >6/18, whereas 4.7% had very poor vision. 37.6% of the patients had ocular manifestations. Anterior segment, posterior segment and neuro-ophthalmic manifestations were seen in 7%, 9.94% and 5.79% of the patients respectively. The most common anterior segment manifestation was recurrent lid infections, while HIV microangiopathy was the most common posterior segment manifestation. The other unusual findings included an abnormal colour vision in 6.3% of the patients and bilateral lid retraction in 8.5% of the patients. Conclusion Since ocular manifestations are very common and as they can occur at any time during the course of HIV infection, an awareness on various patterns of the ocular disease and the screening of all the patients with HIV infection/AIDS is a must. PMID:23373045

  16. Electrophysiological correlates of information processing in breast-cancer patients treated with adjuvant chemotherapy.

    PubMed

    Kreukels, Baudewijntje P C; Schagen, Sanne B; Ridderinkhof, K Richard; Boogerd, Willem; Hamburger, Hans L; van Dam, Frits S A M

    2005-11-01

    Cognitive deficits are found in a number of breast-cancer patients who have undergone adjuvant (Cyclophosphamide, Methotrexate, and 5-Fluorouracil (CMF)) chemotherapy, but the underlying mechanisms are still unclear. The objective of this study is to investigate information processing in these patients with concurrent registration of brain activity. Twenty-six breast-cancer patients treated with adjuvant CMF chemotherapy and a control group of 23 stage I breast-cancer patients not treated with chemotherapy were examined. Mean time since treatment for the CMF patients was 5.1 years after the last CMF course, and for the control patients 3.6 years after termination of radiotherapy. An information processing task was administered with concurrent EEG registration. Reaction times and the amplitudes and latencies of an Event Related Potential component (P3) in different task conditions related to input, central, and output processing of information were studied. Significant differences in latency and amplitude of the P3 component were found between the treatment groups with an earlier and reduced P3 in the chemotherapy group. Patients treated with chemotherapy had longer reaction times (although not significantly different) than the control group on all task conditions. Our data provide further evidence for long-term neurocognitive problems in breast-cancer patients treated with adjuvant (CMF) chemotherapy and offer new information regarding abnormalities in brain functioning in these patients.

  17. Increased risk of solid renal tumors in lithium-treated patients.

    PubMed

    Zaidan, Mohamad; Stucker, Fabien; Stengel, Bénédicte; Vasiliu, Viorel; Hummel, Aurélie; Landais, Paul; Boffa, Jean-Jacques; Ronco, Pierre; Grünfeld, Jean-Pierre; Servais, Aude

    2014-07-01

    Cystic kidney diseases and toxic interstitial nephritis may be complicated by renal tumors. Long-term lithium intake is associated with tubulointerstitial nephritis and renal cysts but to date such an association with tumors has not been determined. We evaluated this in a retrospective study to determine whether lithium-treated patients were at higher risk of renal tumors compared with lithium-free patients with chronic kidney disease (CKD), and to the general population. Over a 16-year period, 14 of 170 lithium-treated patients had renal tumors, including seven malignant and seven benign tumors. The mean duration of lithium exposure at diagnosis was 21.4 years. The renal cancers included three clear-cell and two papillary renal cell carcinomas, one hybrid tumor with chromophobe and oncocytoma characteristics, and one clear-cell carcinoma with leiomyomatous stroma. The benign tumors included four oncocytomas, one mixed epithelial and stromal tumor, and two angiomyolipomas. The percentage of renal tumors, particularly cancers and oncocytomas, was significantly higher in lithium-treated patients compared with 340 gender-, age-, and estimated glomerular filtration rate (eGFR)-matched lithium-free patients. Additionally, the Standardized Incidence Ratio of renal cancer was significantly higher in lithium-treated patients compared with the general population: 7.51 (95% confidence interval (CI) (1.51-21.95)) and 13.69 (95% CI (3.68-35.06)) in men and women, respectively. Thus, there is an increased risk of renal tumors in lithium-treated patients.

  18. The Relation of Patient Dependence to Home Health Aide Use in Alzheimer’s Disease

    PubMed Central

    Scherer, Rachel K.; Scarmeas, Nikolaos; Brandt, Jason; Blacker, Deborah; Albert, Marilyn S.; Stern, Yaakov

    2009-01-01

    Background Although there has been much research devoted to understanding the predictors of nursing home placement (NHP) in Alzheimer’s disease (AD) patients, there is currently a lack of research concerning the predictors of home health care. The objective of this study was to examine whether the Dependence Scale can predict home health aide (HHA) use. Methods The sample is drawn from the Predictors Study, a large, multicenter cohort of patients with probable AD, prospectively followed annually for up to 7 years in three university-based AD centers in the United States. Markov analyses (n = 75) were used to calculate annual transition probabilities for the “new onset” of HHA use (instances where an HHA was absent at the previous visit, but present at the next visit) as a function of HHA presence at the preceding year’s visit and dependence level at that preceding year’s visit. Results The dependence level at the previous year’s visit was a significant predictor of HHA use at the next year’s visit. Three specific items of the Dependence Scale (needing household chores done for oneself, needing to be watched or kept company when awake, and needing to be escorted when outside) were significant predictors of the presence of an HHA. Conclusion The Dependence Scale is a valuable tool for predicting HHA use in AD patients. Obtaining a better understanding of home health care in AD patients may help delay NHP and have a positive impact on the health and well-being of both the caregiver and the patient. PMID:18840808

  19. Osteonecrosis of the jaw in patients treated with denosumab for metastatic tumors to the bone: A series of thirteen patients.

    PubMed

    Owosho, Adepitan A; Blanchard, Ariel; Levi, Lauren; Kadempour, Arvin; Rosenberg, Haley; Yom, SaeHee K; Farooki, Azeez; Fornier, Monica; Huryn, Joseph M; Estilo, Cherry L

    2016-03-01

    This case series describes the course of osteonecrosis of the jaw (ONJ) in thirteen patients with metastatic bone tumors treated solely with denosumab. Patients on denosumab may be more prone to developing ONJ even without a risk/precipitating factor and they may develop ONJ early in their denosumab therapy. The outcomes of ONJ in ten patients following a period of denosumab discontinuation after the onset of ONJ were: 3 had complete resolution of symptoms, 4 patients' ONJ progressed, 2 patients' ONJ was unchanged and in 1 patient there was partial ONJ resolution. The role of drug discontinuation prior to an invasive dental procedure or after the onset of ONJ still remains debatable.

  20. [Burkitt's lymphoma of the caecum in a patient with AIDS: clinical case and review of the literature].

    PubMed

    Siani, L M; Siani, A; Ricci, V; D'Elia, M; Masoni, T; Uggeri, G

    2009-04-01

    Overall, lymphomas of the gastrointestinal tract are rare, although they are the most frequent extranodal location. The incidence of primary colic lymphoma, above all in the non-Hodgkin variant, is clearly higher in the HIV positive population, especially in subjects with AIDS. The authors present the case of a 51-year-old patient with AIDS undergoing antiviral therapy; he was suffering from abdominal pain and presented a palpable mass in the right iliac fossa; diagnosis was caecal non-Hodgkin lymphoma (NHL); radical right hemicolectomy was carried out with definitive histological diagnosis of Burkitt-type small cell NHL. The NHL of the colon represents no more than 1.2% of all malignant cancers of this part of the intestinal tract. Nevertheless such cases are comparatively frequent in patients with HIV virus, especially in the active phase and clinically proven to be due to immunodeficient syndrome. Of cardinal importance is the differential diagnosis between primary and secondary forms because of the different treatment and prognosis. Frequently such forms are observed in patients with AIDS, at advanced stages and with differentiated and hence more aggressive histotypes, also because they are present in organisms weakened by the underlying disease and by immunodeficiency. Primary NHLs of the colon are relatively frequent and aggressive in patients with AIDS; early diagnosis and treatment are therefore of fundamental importance to improve the oncological outcome for these patients.

  1. Adjunctive effects of aripiprazole on metabolic profiles: comparison of patients treated with olanzapine to patients treated with other atypical antipsychotic drugs.

    PubMed

    Wang, Liang-Jen; Ree, Shao-Chun; Huang, Yu-Shu; Hsiao, Cheng-Cheng; Chen, Chih-Ken

    2013-01-10

    Metabolic abnormalities are serious adverse effects of atypical antipsychotic treatment. This study aims to determine the effects of adjunctive aripiprazole on metabolic profiles among patients receiving treatment with atypical antipsychotics, and to examine whether these effects are different from that of pre-existing atypical antipsychotics. In the 8-week open-label trial, aripiprazole was added to patients who were receiving treatment with atypical antipsychotics and had experienced weight gain or dyslipidemia. The dosage of pre-existing atypical antipsychotics was fixed, while the dosage of aripiprazole ranged from 5 to 20 mg/day during the study period. Metabolic profiles, including body weight, body mass index (BMI), plasma levels of fasting glucose, triglycerides, total cholesterol, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, and adiponectin, were measured at baseline and week 8. As a result, 43 subjects (16 males and 27 females, mean age: 37.8±10.8 years) completed the study. The pre-existing antipsychotics were olanzapine (n=12), risperidone (n=19), quetiapine (n=6) and amisulpiride (n=6). The mean dosage of adjunctive aripiprazole was 9.9±3.2 mg/day. After the aripiprazole-augmented regimen for 8 weeks, patients treated with olanzapine had significant decreases in body weight, BMI and triglyceride levels, and had significant increases in adiponectin levels. For patients treated with other atypical antipsychotics, none of the metabolic parameters significantly changed after administering aripiprazole. In conclusion, aripiprazole-augmented treatment might be beneficial for the metabolic regulation of patients being treated with a stable dose of olanzapine, but not for those treated with other atypical antipsychotics. A long-term, randomized, double-blind controlled design is suggested to confirm these findings.

  2. Prosthetic rehabilitation with an implant-supported fixed prosthesis using computer-aided design and computer-aided manufacturing dental technology for a patient with a mandibulectomy: A clinical report.

    PubMed

    Yoon, Hyung-In; Han, Jung-Suk

    2016-02-01

    The fabrication of dental prostheses with computer-aided design and computer-aided manufacturing shows acceptable marginal fits and favorable treatment outcomes. This clinical report describes the management of a patient who had undergone a mandibulectomy and received an implant-supported fixed prosthesis by using additive manufacturing for the framework and subtractive manufacturing for the monolithic zirconia restorations.

  3. Effective doses to family members of patients treated with radioiodine-131

    NASA Astrophysics Data System (ADS)

    Zdraveska Kocovska, M.; Vaskova, O.; Majstorov, V.; Kuzmanovska, S.; Pop Gjorceva, D.; Spasic Jokic, V.

    2011-09-01

    The purpose of this study was to evaluate the effective dose to family members of thyroid cancer and hyperthyroid patients treated with radioiodine-131, and also to compare the results with dose constraints proposed by the International Commission of Radiological Protection (ICRP) and the Basic Safety Standards (BSS) of the International Atomic Energy Agency (IAEA). For the estimation of the effective doses, sixty family members of sixty patients, treated with radioiodine-131, and thermoluminiscent dosimeters (Model TLD 100) were used. Thyroid cancer patients were hospitalized for three days, while hyperthyroid patients were treated on out-patient basis. The family members wore TLD in front of the torso for seven days. The radiation doses to family members of thyroid cancer patients were well below the recommended dose constraint of 1 mSv. The mean value of effective dose was 0.21 mSv (min 0.02 - max 0.51 mSv). Effective doses, higher than 1 mSv, were detected for 11 family members of hyperthyroid patients. The mean value of effective dose of family members of hyperthyroid patients was 0.87 mSv (min 0.12 - max 6.79). The estimated effective doses to family members of hyperthyroid patients were higher than the effective doses to family members of thyroid carcinoma patients. These findings may be considered when establishing new national guidelines concerning radiation protection and release of patients after a treatment with radioiodine therapy.

  4. Structural modification of serum vitamin D3-binding protein and immunosuppression in AIDS patients.

    PubMed

    Yamamoto, N; Naraparaju, V R; Srinivasula, S M

    1995-11-01

    A serum glycoprotein, vitamin D3-binding protein (Gc protein), can be converted by beta-galactosidase of stimulated B lymphocytes and sialidase of T lymphocytes to a potent macrophage-activating factor (MAF), a protein with N-acetylgalactosamine as the remaining sugar moiety. Thus, Gc protein is a precursor for MAF. Treatment of purified Gc protein with immobilized beta-galactosidase and sialidase generates an extremely high-titered MAF (GcMAF). When peripheral blood monocytes/macrophages of 46 HIV-infected patients were treated with GcMAF (100 pg/ml), the monocytes/macrophages of all patients were efficiently activated. However, the MAF precursor activity of plasma Gc protein was low in 16 (35%) of of these patients. Loss of the MAF precursor activity appeared to be due to deglycosylation of plasma Gc protein by alpha-N-acetylgalactosaminidase found in the patient blood stream. Levels of plasma alpha-N-acetylgalactosaminidase activity in individual patients had an inverse correlation with the MAF precursor activity of their plasma Gc protein. Thus, precursor activity of Gc protein and alpha-N-acetylgalactosaminidase activity in patient blood can serve as diagnostic and prognostic indices.

  5. Assessing and Interpreting Personality Change and Continuity in Patients Treated for Major Depression

    ERIC Educational Resources Information Center

    De Fruyt, Filip; Van Leeuwen, Karla; Bagby, R. Michael; Rolland, Jean-Pierre; Rouillon, Frederic

    2006-01-01

    Structural, mean- and individual-level, differential, and positive personality continuity were examined in 599 patients treated for major depression assigned to 1 of 6 forms of a 6-month pharmacy-psychotherapy program. Covariation among traits from the Five Factor model remained invariant across treatment, and patients described themselves as…

  6. Lymphocyte subsets as biomarkers of therapeutic response in Fingolimod treated Relapsing Multiple Sclerosis patients.

    PubMed

    Paolicelli, D; Manni, A; D'Onghia, M; Direnzo, V; Iaffaldano, P; Zoccolella, S; Di Lecce, V; Tortorella, C; Specchia, G; Trojano, M

    2017-02-15

    We investigated, lymphocyte count (LC) and lymphocyte subpopulations (LS) in a real life setting of Fingolimod (FTY) treated Relapsing MS (RMS) patients. Peripheral blood counts with LS, relapses and MRI scans were recorded in a cohort of 119 FTY patients, during one year of treatment. Simple and multivariate logistic regression models, were performed. ROC analysis identified cut-off values of LS predicting a higher risk of relapses and of Gd+ lesions. We demonstrated a FTY-induced re-modulation of the immune system, suggesting that LS in RMS FTY treated patients can predict the clinical response to the drug.

  7. Thrombokinetics in patients with rheumatoid arthritis treated with D-penicillamine.

    PubMed Central

    Thomas, D; Gallus, A S; Brooks, P M; Tampi, R; Geddes, R; Hill, W

    1984-01-01

    The mechanism of D-penicillamine induced thrombocytopenia in rheumatoid arthritis was investigated by measuring platelet life-span and platelet production rate in 2 groups of rheumatoid arthritis patients treated with 250-750 mg/day D-penicillamine, 14 with a normal platelet count and 9 with thrombocytopenia (platelet count 50-130 X 10(9)/1). Age matched control patients not treated with D-penicillamine included 14 with rheumatoid arthritis and 9 with osteoarthritis. The platelet life-span was normal, but platelet production rate was significantly reduced in the thrombocytopenic patients, suggesting that D-penicillamine causes thrombocytopenia through bone marrow suppression. PMID:6742902

  8. In vitro growth of the microsporidian Septata intestinalis from an AIDS patient with disseminated illness.

    PubMed Central

    Doultree, J C; Maerz, A L; Ryan, N J; Baird, R W; Wright, E; Crowe, S M; Marshall, J A

    1995-01-01

    A new species of microsporidian, Septata intestinalis, was recently recognized as an opportunistic pathogen of AIDS patients. In this study, it was cultured from the nasopharyngeal aspirate of a human immunodeficiency virus type 1-infected patient with disseminated microsporidiosis. In human embryonic lung cells exposed to S. intestinalis, a cytopathic effect appeared within 28 days as foci of rounded up cells. Thin-section electron microscopy showed a variety of developmental stages of the microsporidium within parasitophorous vacuoles. In monocyte-derived macrophages, evidence of infection and development of the parasite was demonstrated by light and electron microscopy. In both infected human embryonic lung cells and monocyte-derived macrophages, a network of septa separated individual spores. Partial sequencing of the RNA small-subunit gene (16S rDNA gene) confirmed the identity of this parasite as S. intestinalis. This is the first report of the isolation of S. intestinalis in vitro and provides evidence that the parasite can be disseminated by macrophages. PMID:7714208

  9. Comparison of the success of root canal therapy in HIV/AIDS patients and non-infected controls.

    PubMed

    Alley, Bradley S; Buchanan, Trenton H; Eleazer, Paul D

    2008-01-01

    This study compared the rate of successful endodontic treatments between two cohorts of patients with similar teeth, one group with HIV/AIDS and one without. A retrospective chart review was performed on two cohorts, with 50 teeth in each cohort. There was no statistically significant difference in endodontic success between the two groups. The failure groups were small, with no significant trends.

  10. Coping Strategies of Patients with Haemophilia as a Risk Group for AIDS (Acquired Immune Deficiency Syndrome). Brief Research Report.

    ERIC Educational Resources Information Center

    Naji, Simon; And Others

    1986-01-01

    Plans are described for a 2-year project whose major focus is the identification of ways in which patients with hemophilia and their families assimilate, interpret, and act on information about Acquired Immune Deficiency Syndrome (AIDS). Findings will be related to perceived risk, anxiety levels, and the development of coping strategies.…

  11. A systematic review of cohort studies of the quality of life in HIV/AIDS patients after antiretroviral therapy.

    PubMed

    Jin, Yantao; Liu, Zhibin; Wang, Xin; Liu, Huixin; Ding, Guowei; Su, Yingying; Zhu, Lin; Wang, Ning

    2014-10-01

    The aim of this paper was to review cohort studies that analyze changes in the quality of life of people living with HIV/AIDS. We searched the PubMed and EmBase databases from inception to December 2012 for primary cohort studies of the quality of life of people living with HIV/AIDS after combination antiretroviral therapy (cART). Two independent reviewers screened and selected published studies of quality of life that had been followed up for more than 12 weeks after the beginning of cART. Data from the papers were analyzed to identify common characteristics of the effects of cART on the quality of life of HIV/AIDS patients. Eight cohort studies were found: only four were assessed as high quality and four were assessed as moderate quality. None of the studies described patient selection. Six studies followed the patients for one year or more, and the other studies for less than 6 months. Seven studies reported quality of life had been improved after initiation of cART, and one study reported no change. Previous research suggested that cART improved the quality of life of AIDS patients for a limited time, so further research for longer periods is needed to confirm this outcome.

  12. Markedly elevated serum lactate dehydrogenase levels are a clue to the diagnosis of disseminated histoplasmosis in patients with AIDS.

    PubMed

    Corcoran, G R; Al-Abdely, H; Flanders, C D; Geimer, J; Patterson, T F

    1997-05-01

    Disseminated histoplasmosis is a common late manifestation of AIDS, but the diagnosis may be unsuspected in some patients because the clinical presentation of histoplasmosis may mimic other opportunistic infections. High serum lactate dehydrogenase (LDH) levels have been associated with disseminated histoplasmosis. We therefore evaluated whether markedly increased LDH levels were useful for making a diagnosis of disseminated histoplasmosis by comparing admission LDH levels for 15 patients with culture-proven disseminated histoplasmosis with those for 30 patients with advanced AIDS who were admitted to the hospital for evaluation of pulmonary infiltrates and fever. The mean admission LDH level in patients with disseminated histoplasmosis was 1,356 IU/L (range, 145-5,410 IU) whereas it was 332 (range, 77-832 IU) in the patients with other pulmonary processes. Admission LDH levels were >600 IU in 11 (73%) of the 15 patients with disseminated histoplasmosis vs. 3 (10%) of controls (P < .001). We conclude that markedly elevated admission LDH levels may be a clinical clue to the diagnosis of disseminated histoplasmosis in patients with AIDS.

  13. Using decision aids in community-based primary care: A theory-driven evaluation with ethnically diverse patients

    PubMed Central

    Frosch, Dominick L.; Légaré, France; Mangione, Carol M.

    2010-01-01

    Objective To assess the effects of informational brochures and video decision aids about cancer screening on patient intention to engage in shared decision making and its predictors in a racially diverse sample. Methods Participants were recruited from 13 community-based primary care practices serving racially and ethnically diverse patients in predominately economically disadvantaged neighborhoods. Participants completed theory-based measures assessing attitudes, perceived social norms, self-efficacy and intentions for working with their physician to make a cancer screening decision after reviewing a brochure or video decision aid, but before seeing the physician. A post-questionnaire assessed screening decisions and participant knowledge. Results Participants who reviewed a video decision aid had higher knowledge and were more likely to want to be the primary decision-maker. They reported lower perceived social norms, self-efficacy and intentions to work with their physicians than participants who reviewed a brochure. Participants who decided against cancer screening reported lower intentions to work with their physician in making a decision and were less likely to report having spoken with their physician about screening. Conclusion Participants who opted against cancer screening after reviewing a brochure or decision aid were less likely to discuss their decision with their physician. The tendency toward autonomous decision-making was stronger among participants who reviewed a video decision aid. PMID:18771875

  14. Association between obstructive sleep apnea severity and glucose control in patients with untreated versus treated diabetes.

    PubMed

    Priou, Pascaline; Le Vaillant, Marc; Meslier, Nicole; Chollet, Sylvaine; Pigeanne, Thierry; Masson, Philippe; Bizieux-Thaminy, Acya; Humeau, Marie-Pierre; Goupil, François; Ducluzeau, Pierre-Henri; Gagnadoux, Frédéric

    2015-08-01

    The purpose of this study was to determine whether the association between obstructive sleep apnea severity and glucose control differs between patients with newly diagnosed and untreated type 2 diabetes, and patients with known and treated type 2 diabetes. This multicentre cross-sectional study included 762 patients investigated by sleep recording for suspected obstructive sleep apnea, 497 of whom were previously diagnosed and treated for type 2 diabetes (treated diabetic patients), while 265 had no medical history of diabetes but had fasting blood glucose ≥126 mg dL(-1) and/or glycated haemoglobin (HbA1c ) ≥6.5% consistent with newly diagnosed type 2 diabetes (untreated diabetic patients). Multivariate regression analyses were performed to evaluate the independent association between HbA1c and obstructive sleep apnea severity in treated and untreated patients with diabetes. In untreated diabetic patients, HbA1c was positively associated with apnea-hypopnea index (P = 0.0007) and 3% oxygen desaturation index (P = 0.0016) after adjustment for age, gender, body mass index, alcohol habits, metabolic dyslipidaemia, hypertension, statin use and study site. The adjusted mean value of HbA1c increased from 6.68% in the lowest quartile of the apnea-hypopnea index (<17) to 7.20% in the highest quartile of the apnea-hypopnea index (>61; P = 0.033 for linear trend). In treated patients with diabetes, HbA1c was associated with non-sleep variables, including age, metabolic dyslipidaemia and insulin use, but not with obstructive sleep apnea severity. Obstructive sleep apnea may adversely affect glucose control in patients with newly diagnosed and untreated type 2 diabetes, but may have a limited impact in patients with overt type 2 diabetes receiving anti-diabetic medications.

  15. Cryptococcal pleuritis containing a high level of adenosine deaminase in a patient with AIDS: a case report.

    PubMed

    Yoshino, Yusuke; Kitazawa, Takatoshi; Tatsuno, Keita; Ota, Yasuo; Koike, Kazuhiko

    2010-01-01

    Cryptococcal infection is the 4th most common opportunistic infection in patients with acquired immune deficiency syndrome (AIDS). Although pleural effusion alone is an unusual presentation, we present a case of cryptococcal pleuritis in an AIDS patient which was initially difficult to discriminate from tuberculous pleuritis because of the high level of pleural adenosine deaminase (ADA). Cryptococcus neoformans was detected in the culture of the pleural effusion after the initiation of antituberculous treatment. High levels of ADA in the pleural fluid can be observed in patients with cryptococcal pleuritis, and longer incubation of pleural fluid should be performed in all patients who present with pleuritis associated with a high ADA level as the only significant finding.

  16. Robot-aided therapy on the upper limb of subacute and chronic stroke patients: a biomechanical approach.

    PubMed

    Mazzoleni, S; Filippi, M; Carrozza, M C; Posteraro, F; Puzzolante, L; Falchi, E

    2011-01-01

    The goal of this study is to propose a methodology for evaluating recovery mechanisms in subacute and chronic post-stroke patients after a robot-aided upper-limb therapy, using a set of biomechanical parameters. Fifty-six post-stroke subjects, thirteen subacute and forty-three chronic patients participated in the study. A 2 dof robotic system, implementing an "assist-as-needed" control strategy, was used. Biomechanical parameters related (i) to the speed measured at the robot's end-effector and (ii) to the movement's smoothness were computed. Outcome clinical measures show a decrease in motor impairment after the treatment both in chronic and subacute patients. All the biomechanical parameters show an improvement between admission and discharge. Our results show that the robot-aided training can contribute to reduce the motor impairment in both subacute and chronic patients and identify neurophysiological mechanisms underlying the different stages of motor recovery.

  17. Early bactericidal activity of rifabutin versus that of placebo in treatment of disseminated Mycobacterium avium complex bacteremia in AIDS patients.

    PubMed Central

    Dautzenberg, B; Castellani, P; Pellegrin, J L; Vittecoq, D; Truffot-Pernot, C; Pirotta, N; Sassella, D

    1996-01-01

    Rifabutin, 600 mg/day, was compared with a placebo in the early treatment of culture-proven Mycobacterium avium bacteremia in patients with AIDS. Following 14 days' treatment, bacteriological success, defined as a negative culture or a reduction in the number of CFU of M. avium organisms per milliliter of blood by a factor of > or = 0.5 log from the baseline, was observed in 7 of 10 (70%) evaluable rifabutin patients and in 1 of 13 (8%) evaluable placebo patients (P = 0.002). Rifabutin is active against M. avium as a single agent and can make a significant contribution to combination regimens for the treatment of disseminated M. avium infection in AIDS patients. PMID:8807071

  18. Sideroblastic anemia as a preleukemic event in patients treated for Hodgkin's disease

    SciTech Connect

    Kitahara, M.; Cosgriff, T.M.; Eyre, H.J.

    1980-05-01

    Sideroblastic anemia after treatment for Hodgkin's disease was seen in two patients 3 years after completion of radiation therapy and chemotherapy. This was followed in both by the development of myelomonoblastic leukemia. No evidence of recurrent Hodgkin's disease was present in either patient. Our observation suggests that development of sideroblastic anemia in patients previously treated for Hodgkin's disease is probably secondary to the treatment and is a preleukemic event.

  19. Co-financing for viral load monitoring during the course of antiretroviral therapy among patients with HIV/AIDS in Vietnam: A contingent valuation survey

    PubMed Central

    Tran, Bach Xuan; Phan, Huong Thi Thu; Le, Huong Thi; Nguyen, Hinh Duc; Tran, Tho Dinh; Do, Cuong Duy; Nguyen, Cuong Manh; Thuc, Vu Thi Minh; Latkin, Carl; Zhang, Melvyn W. B.; Ho, Roger C. M.

    2017-01-01

    Background Viral load testing is considered the gold standard for monitoring HIV treatment; however, given its high cost, some patients cannot afford viral load testing if this testing is not subsidized. Since foreign aid for HIV/AIDS in Vietnam is rapidly decreasing, we sought to assess willingness to pay (WTP) for viral load and CD4 cell count tests among HIV-positive patients, and identified factors that might inform future co-payment schemes. Methods A multi-site cross-sectional survey was conducted with 1133 HIV-positive patients on antiretroviral therapy (ART) in Hanoi and Nam Dinh. Patients’ health insurance coverage, quality of life, and history of illicit drug use were assessed. A contingent valuation approach was employed to measure patients’ WTP for CD4 cell count and viral load testing. Results HIV-positive patients receiving ART at provincial sites reported more difficulty obtaining health insurance (HI) and had the overall the poorest quality of life. Most patients (90.9%) were willing to pay for CD4 cell count testing; here, the mean WTP was valued at US$8.2 (95%CI = 7.6–8.8 US$) per test. Most patients (87.3%) were also willing to pay for viral load testing; here, mean WTP was valued at US$18.6 (95%CI = 16.3–20.9 US$) per test. High income, high education level, and hospitalization were positively associated with WTP, while co-morbidity with psychiatric symptoms and trouble paying for health insurance were both negatively related to WTP. Conclusions These findings raise concerns that HIV-positive patients in Vietnam might have low WTP for CD4 cell count and viral load testing. This means that without foreign financial subsidies, many of these patients would likely go without these important tests. Treating psychiatric co-morbidities, promoting healthcare services utilization, and removing barriers to accessing health insurance may increase WTP for monitoring of HIV/AIDS treatment among HIV+-positive Vietnamese patients. PMID:28199405

  20. Viral Outcome in Patients with Occult HBV Infection or HCV-Ab Positivity Treated for Lymphoma.

    PubMed

    Guarino, Maria; Picardi, Marco; Vitello, Anna; Pugliese, Novella; Rea, Matilde; Cossiga, Valentina; Pane, Fabrizio; Caporaso, Nicola; Morisco, Filomena

    2017-01-01

    HBV and HCV reactivation has been widely reported in patients undergoing immunosuppressive therapy for oncohaematological diseases. We aimed to evaluate the HBV and HCV reactivation events in patients with non-Hodgkin lymphoma (NHL) or Hodgkin lymphoma (HL) underwent cytotoxic chemotherapy containing or not rituximab. This is a retrospective observational study, including all patients with NHL and HL attending an Italian tertiary referral hospital, the University of Naples "Federico II". A total of 322 patients were enrolled. We evaluated serum HBV and HCV markers. A total of 47 (38%) patients with occult HBV infection were enrolled. Seven/47 were treated with therapeutic cytotoxic schedule containing rituximab. Of them, 6/7 received prophylaxis with lamivudine. HBV reactivation was observed in two patients treated with rituximab. A reactivation was observed in the only patient (HBcAb+/HBsAb+) not receiving lamivudine prophylaxis, and the other one was observed in 1 patient with isolated HBcAb positivity during lamivudine prophylaxis. Moreover, 8 patients with HCV-Ab positivity were enrolled. No viral reactivation was observed in these patients. In conclusion, patients with occult HBV infection receiving chemotherapy containing rituximab for lymphoma without antiviral prophylaxis are at risk of viral reactivation. On the contrary, there is no risk of reactivation in patients undergoing rituximab-free schedule. Our findings suggest that there is also very low risk of HCV reactivation. This preliminary report underlines the concept that HBV reactivationis strongly related to the type of immunosuppressive therapy administered and that antiviral prophylaxis needs to be tailored.

  1. Muscle mitochondrial metabolism and calcium signaling impairment in patients treated with statins

    SciTech Connect

    Sirvent, P.; Fabre, O.; Bordenave, S.; Hillaire-Buys, D.; Raynaud De Mauverger, E.; Lacampagne, A.; Mercier, J.

    2012-03-01

    The most common and problematic side effect of statins is myopathy. To date, the patho-physiological mechanisms of statin myotoxicity are still not clearly understood. In previous studies, we showed that acute application in vitro of simvastatin caused impairment of mitochondrial function and dysfunction of calcium homeostasis in human and rat healthy muscle samples. We thus evaluated in the present study, mitochondrial function and calcium signaling in muscles of patients treated with statins, who present or not muscle symptoms, by oxygraphy and recording of calcium sparks, respectively. Patients treated with statins showed impairment of mitochondrial respiration that involved mainly the complex I of the respiratory chain and altered frequency and amplitude of calcium sparks. The muscle problems observed in statin-treated patients appear thus to be related to impairment of mitochondrial function and muscle calcium homeostasis, confirming the results we previously reported in vitro. -- Highlights: ► The most common and problematic side effect of statins is myopathy. ► Patients treated with statins showed impairment of mitochondrial respiration. ► Statins-treated patients showed altered frequency and amplitude of calcium sparks.

  2. High incidence of co-infection with Malaria and Typhoid in febrile HIV infected and AIDS patients in Ekpoma, Edo State, Nigeria

    PubMed Central

    Agwu, E.; Ihongbe, J.C.; Okogun, G.R.A.; Inyang, N.J.

    2009-01-01

    This survey was designed to determine the prevalence of Plasmodium falciparum and Salmonella Typhi among febrile HIV/AIDS patients in Ekpoma. Malaria and typhoid risk factors in Ekpoma included occupation, poor health facilities and poor sanitation. Malaria and typhoid are highly prevalent among Ekpoma HIV/AIDS patients. PMID:24031367

  3. MGMT inactivation and clinical response in newly diagnosed GBM patients treated with Gliadel.

    PubMed

    Grossman, Rachel; Burger, Peter; Soudry, Ethan; Tyler, Betty; Chaichana, Kaisorn L; Weingart, Jon; Olivi, Alessandro; Gallia, Gary L; Sidransky, David; Quiñones-Hinojosa, Alfredo; Ye, Xiaobu; Brem, Henry

    2015-12-01

    We examined the relationship between the O(6)-methylguanine-methyltransferase (MGMT) methylation status and clinical outcomes in newly diagnosed glioblastoma multiforme (GBM) patients who were treated with Gliadel wafers (Eisai, Tokyo, Japan). MGMT promoter methylation has been associated with increased survival among patients with GBM who are treated with various alkylating agents. MGMT promoter methylation, in DNA from 122 of 160 newly diagnosed GBM patients treated with Gliadel, was determined by a quantitative methylation-specific polymerase chain reaction, and was correlated with overall survival (OS) and recurrence-free survival (RFS). The MGMT promoter was methylated in 40 (32.7%) of 122 patients. The median OS was 13.5 months (95% confidence interval [CI] 11.0-14.5) and RFS was 9.4 months (95% CI 7.8-10.2). After adjusting for age, Karnofsky performance score, extent of resection, temozolomide (TMZ) and radiation therapy (RT), the newly diagnosed GBM patients with MGMT methylation had a 15% reduced mortality risk, compared to patients with unmethylated MGMT (hazard ratio 0.85; 95% CI 0.56-1.31; p=0.46). The patients aged over 70 years with MGMT methylation had a significantly longer median OS of 13.5 months, compared to 7.6 months in patients with unmethylated MGMT (p=0.027). A significant difference was also found in older patients, with a median RFS of 13.1 versus 7.6 months for methylated and unmethylated MGMT groups, respectively (p=0.01). Methylation of the MGMT promoter in newly diagnosed GBM patients treated with Gliadel, RT and TMZ, was associated with significantly improved OS compared to the unmethylated population. In elderly patients, methylation of the MGMT promoter was associated with significantly better OS and RFS.

  4. [Update on the morbidity of psychiatric disorders in patients with AIDS: results of a clinical follow-up].

    PubMed

    Crespo, M D; Ochoa, E; Vicente, N; Pérez de los Cobos, J; Morales, P

    1990-01-01

    A follow-up study after one or two years of treatment was carried out on 107 AIDS patients who were seen by the Consultation-Liaison Psychiatry Unit of the Ramon y Cajal Hospital. The sample was reduced to 52 patients (49%) mainly due to the lack of check-ups in 43% and to the death of 8% of the cases. 36% of patients suffered from Delirium or Dementia and these had the greater mortality rate. Grade IV patients and those with a diagnosis of Adjustment Disorders came to the check-ups most frequently.

  5. [General practitioners' commitment to treating excessive alcohol consumption: A question of role security in treating affected patients?].

    PubMed

    Fankhänel, Thomas; Rascher, Anja; Thiel, Carolin; Schulz, Katrin; Klement, Andreas

    2016-01-01

    Only a few general practitioners (GPs) are committed to screen their patients for alcohol consumption and, in case of excessive alcohol consumption conduct by a brief intervention according to WHO recommendations. Apart from inadequate compensation and work load, another barrier identified by the GPs was their uncertainty about how to deal with affected patients. Most German universities presently spend no more than 90minutes lecture time on addiction medicine teaching. Our research aims to investigate the question whether medical studies and advanced medical education increases the role security of medical students and physicians and their commitment to implementing alcohol screening and brief intervention. Moreover, we will explore whether lack of therapeutic commitment can be related to lack of role security. Questionnaires were administered to pre-clinical and clinical medical students as well as senior house officers. Role security and therapeutic commitment of students and senior house officers were assessed using the Alcohol and Alcohol Problems Questionnaire (SAAPPQ) subscales "Role Security" and "Therapeutic Commitment". Analysis was based on 367 questionnaires. As expected, senior house officers reported more Role Security than clinical medical students who showed a higher level of Role Security than pre-clinical medical students. No differences could be found for Therapeutic Commitment. An association between Role Security and Therapeutic Commitment was only revealed for clinical medical students. Medical studies and advanced medical education can increase students' and senior house officers' Role Security to treat patients with excessive alcohol consumption, but not Therapeutic Commitment. Moreover, no association between Role Security and Therapeutic Commitment could be found for senior house officers. Hence, it may be assumed that educational activities aiming to increase Role Security do not promote the development of motivational aspects such as

  6. Papillary Thyroid Carcinoma Treated with Radiofrequency Ablation in a Patient with Hypertrophic Cardiomyopathy: A Case Report

    PubMed Central

    Sun, Jianyi; Liu, Xiaosun; Zhang, Qing; Hong, Yanyun; Song, Bin; Teng, Xiaodong

    2016-01-01

    Standard therapy has not been established for thyroid cancer when a thyroidectomy is contraindicated due to systemic disease. Herein, we reported a patient who had hypertrophic cardiomyopathy and papillary thyroid carcinoma treated by radiofrequency ablation because of inability to tolerate a thyroidectomy. Radiofrequency ablation can be used to treat thyroid cancer when surgery is not feasible, although the long-term outcome needs further observation. PMID:27390548

  7. Repair of radiographic hip joint in juvenile rheumatoid arthritis patients treated with etanercept plus methotrexate.

    PubMed

    Remy, Anouck; Combe, Bernard

    2014-10-01

    For patients suffering from rheumatoid arthritis (RA), structural damage, i.e. bone erosion and joint space narrowing, is a major factor leading to functional disability. Negative radiographic progression has been shown in joints, especially in RA patients treated with tumor necrosis factor alpha (TNFα) inhibitors in combination with methotrexate. Bone erosion repair in small joints have been observed but only one study selected large weight-bearing joints. We reported 2 cases of patients with severe seropositive juvenile RA who shown improvement of joint space narrowing and subchondral erosion in hip joint when treated with etanercept in combination with methotrexate for at least 1year. Two Japanese cases were also published but with different TNF inhibitors. The mechanisms of bone erosion or joint space narrowing repair are unclear. One study investigated whether bone erosions in rheumatoid arthritis patients show evidence of repair in metacarpophalangeal joints when treated with TNF inhibitors and MTX. These results suggested that repair in RA emerged from the bone marrow and the endosteal lining rather than the periosteal compartment. No study investigated joint space narrowing repair in hip joint in rheumatoid arthritis patients. Larger studies needed to confirm joint space narrowing improvement in hip joint in patients treated with TNF inhibitors and to explain the mechanisms of repair.

  8. [Prevention of medication errors in healthcare transition of patients treated with apomorphine].

    PubMed

    Ucha Sanmartin, M; Martín Vila, A; López Vidal, C; Caaamaño Barreiro, M; Piñeiro Corrales, G

    2014-05-01

    The transition of patients between different levels of care process is a particular risk in the production of medication errors. The aim of this paper is to analyze the role of the pharmacist in preventing errors transition care to ensure a safe and cross pharmacotherapy of patients.Transversal, observational and descriptive study in a University Hospital that has a pharmacy service that integrates specialized inpatient care and health centers. Transition of care a patient treated with Apormorfina was analyzed to determine the keypoints of action of the pharmacist. Demographics, disease and medication history, and care transition episodes were collected through the pharmacy program and electronics history.The pharmacist did tasks adapting, reconciliation, management and reporting of medication to the health care team to prevent medication errors in care transition of patients treated with drugs requiring special handling .In conclusion, this work represents perfectly the key role of the pharmacist as coordinator of safe and transverse pharmacotherapy of patients.

  9. EPIDEMIOLOGICAL PROFILE OF PATIENTS WITH PROXIMAL HUMERUS FRACTURE TREATED AT HOSPITAL SÃO PAULO, BRAZIL

    PubMed Central

    de Oliveira, Ana Paula Cortes; Mestieri, Mariana Christovam; Pontin, José Carlos Baldocchi

    2015-01-01

    ABSTRACT Objective: To analyze the epidemiological aspects of proximal humerus fractures and describe the profile of patients with proximal humerus fractures hospitalized and treated at Hospital São Paulo, between 2008 and 2013. Methods: Hospital records were retrospectively analyzed for surgically treated patients diagnosed with proximal humerus fracture. Age, gender, injury mechanism, length of hospital stay, performed treatment and associated diseases were considered. Results: From all patients studied, 52 were female at their sixth decade of life. As for the injury mechanism, fall from height was the main cause for women (88.46%) and for man it was motorcycle accidents (31.42%). Fixation with locked plate was the most frequently used treatment. Conclusion: Most patients were female in their fifth decade of life, injured mainly by fall from height. Fixation with locked plate was the most frequently used treatment and the patients were admitted for 7 days, on average. Level of Evidence II, Retrospective Study. PMID:26981037

  10. Incidence of Second Malignancies Among Patients Treated With Proton Versus Photon Radiation

    SciTech Connect

    Chung, Christine S.; Yock, Torunn I.; Nelson, Kerrie; Xu, Yang; Keating, Nancy L.; Tarbell, Nancy J.

    2013-09-01

    Purpose: Proton radiation, when compared with photon radiation, allows delivery of increased radiation dose to the tumor while decreasing dose to adjacent critical structures. Given the recent expansion of proton facilities in the United States, the long-term sequelae of proton therapy should be carefully assessed. The objective of this study was to compare the incidence of second cancers in patients treated with proton radiation with a population-based cohort of matched patients treated with photon radiation. Methods and Materials: We performed a retrospective cohort study of 558 patients treated with proton radiation from 1973 to 2001 at the Harvard Cyclotron in Cambridge, MA and 558 matched patients treated with photon therapy in the Surveillance, Epidemiology, and End Results (SEER) Program cancer registry. Patients were matched by age at radiation treatment, sex, year of treatment, cancer histology, and site. The main outcome measure was the incidence of second malignancies after radiation. Results: We matched 558 proton patients with 558 photon patients from the Surveillance, Epidemiology, and End Results registry. The median duration of follow-up was 6.7 years (interquartile range, 7.4) and 6.0 years (interquartile range, 9.3) in the proton and photon cohorts, respectively. The median age at treatment was 59 years in each cohort. Second malignancies occurred in 29 proton patients (5.2%) and 42 photon patients (7.5%). After we adjusted for sex, age at treatment, primary site, and year of diagnosis, proton therapy was not associated with an increased risk of second malignancy (adjusted hazard ratio, 0.52 [95% confidence interval, 0.32-0.85]; P=.009). Conclusions: The use of proton radiation therapy was not associated with a significantly increased risk of secondary malignancies compared with photon therapy. Longer follow-up of these patients is needed to determine if there is a significant decrease in second malignancies. Given the limitations of the study

  11. [Epidemiological and clinical characteristics of HIV/AIDS patients followed-up in Cappadocia region: 18 years experience].

    PubMed

    Alp, Emine; Bozkurt, Ilkay; Doğanay, Mehmet

    2011-01-01

    HIV/AIDS is still an important health problem worldwide and the number of people living with HIV worldwide continued to grow in the last years. The first HIV/AIDS cases had been reported in 1985 from Turkey and with an increasing trend during the following years, the number of cases reached to 3898 with 528 new cases in 2009. The aim of this retrospective study was to share the 18 years experience with the patients who were followed-up in Erciyes University Hospital Infectious Diseases Clinics in Cappadocia region. The records of 55 (81%) HIV/AIDS patients out of 68 who were admitted to our clinic between 1992- 2009 have been attained and the demographic and clinical characteristics, administered therapy regimens and adverse effects of antiretroviral therapy of those cases have been evaluated. Forty-three (78%) of the patients were male and 12 (22%) were female of which 11 (92%) of their spouses had HIV/AIDS. The median age of the patients was 45 and 20 (36%) of them were over 54 years old. Fifty (91%) of patients lived in Cappadocia region, and 24 (44%) had lived in foreign countries. Fifty (91%) patients had risky heterosexual contact as a risk factor. Of these patients, 47 (85%) were in full-blown AIDS stage at admission. Twenty-seven (49%) of the patients diagnosed occasionally during routine anti-HIV testing, did not have any symptoms. Fever, weakness and weight loss were the most frequently detected symptoms in the rest of the patients. Ten (18%) patients had underlying diseases such as hypertension, chronic hepatitis B or C, coronary artery disease, diabetes mellitus and chronic renal disfunction. Opportunistic infections were determined in 25 (45.5%) patients and 20 (40%) of these infections were determined at admission. The most frequent opportunistic infection was oral candidiasis, followed by Pneumocystis (carinii) jiroveci pneumonia and tuberculosis. Malignancy was diagnosed in three patients; two had Kaposi's sarcoma and one had multiorgan

  12. Balancing the Duty to Treat Patients with Ebola Virus Disease with the Risks to Dialysis Personnel

    PubMed Central

    2015-01-01

    In 2014, the author was invited to present at the American Society for Nephrology’s annual conference in Philadelphia on the ethics of treating patients with Ebola virus disease. The argument was made that the status of health care workers, including nephrologists, was the dominant ethical standard that generated both the duty to treat and the conflicts between this commitment and other ethical commitments that arise in public health emergencies. Conflicts between duty to treat and personal safety, duty to community, and duty to colleagues were illustrated, and suggestions for designing ethics into medical practice were given. This article is a summary of that presentation. PMID:26251324

  13. [Transcultural adaptation of the HIV/AIDS-Target Quality of Life for HIV/AIDS for the evaluation of patients' quality of life].

    PubMed

    Moser, Ana Maria Martins; Traebert, Jefferson

    2011-01-01

    The objectives of this study were to carry out cross-cultural adaptation of the HIV/AIDS-Target Quality of Life Instrument for Portuguese and to observe its psychometric properties. Translations, translations synthesis, back translation, analysis by a committee of specialists, pre-final version test, studies of validity and reliability of the final version were carried out. Psychometric properties were evaluated by the administration of the Brazilian version in 50 consecutive HIV positive patients, from the DST/HIV/AIDS municipal ambulatory of São Miguel do Oeste, Santa Catarina State. The internal consistency was observed by a-Cronbach. The reliability was estimated using the intraclass correlation coefficient and Bland-Altmann diagram. The validity was observed comparing the scores of the questionnaire with the WHOQOL-HIV-Brief through the Spearman rank correlation coefficient. The results pointed out to a-Cronbach of 0.893. The correlations obtained were 0.934 for inter-interviewer and 0.977 for intra-interviewer. The correlation with WHOQOL-HIV-Bref was 0.824. It was concluded that the cross-cultural adaptation process was successful and the adapted questionnaire demonstrated good psychometric properties.

  14. Proposal for Development of EBM-CDSS (Evidence-based Clinical Decision Support System) to Aid Prognostication in Terminally Ill Patients

    DTIC Science & Technology

    2014-10-01

    TITLE: Proposal for Development of EBM-CDSS (Evidence-based Clinical Decision Support System) to Aid Prognostication in Terminally Ill Patients...SUBTITLE Proposal for development of EBM-CDSS (Evidence-based Clinical Decision Support System) to aid prognostication in terminally ill patients 5a...to improve prognostication of the life expectancy of terminally ill patients to improve referral of patients to hospice. In addition, the EBM-CDSS

  15. Determination of Spatial Distribution of Children Treated in Children Oncology Clinic with the Aid of Geographic Information Systems.

    PubMed

    Topan, Aysel; Bayram, Dilek; Özendi, Mustafa; Cam, Ali; Öztürk, Özlem; Ayyıldız, Tülay Kuzlu; Kulakçı, Hülya; Veren, Funda

    2016-10-01

    The main objective of this research is to examine child cancer cases in Zonguldak/Turkey descriptively in epidemiological aspect with the help of GIS. Universe of the study is composed of 60 children between 1 and 19 years old who were treated in Children Oncology Clinic with a diagnosis of cancer. Whole universe was reached without selecting a sample in the study. Data were collected by using a form prepared by obtaining expert advice and they were applied to children and their parents at study dates. Results were expressed as percentages. Chi-Square test was used in intergroup comparisons, results were assessed within 95 % confidence interval and p < 0.05 was considered as statistically significant. Variables that were used in the study were assessed, recorded in prepared data collection form and distribution maps were produced. When disease diagnosis of the children participated in the study were evaluated, the most observed three types are ALL with 33.3 % (n = 20), Medullablastoma with 13.3 % (n = 8) and Hodgkin-nonHodgkin Lymphoma with 11.7 % (n = 7). Kdz. Eregli with 31.7 % (n = 19), Center with 31.7 % (n = 19), and Caycuma with 18.3 % (n = 11) are the first-three counties where the cases were mostly observed. Statistically significant difference was found (p = 0.016) comparing disease diagnosis with living place, and distribution maps of the number of cancer cases were produced.

  16. [Diagnostic and treatment difficulties in patients with HIV and AIDS infections; the importance of interdisciplinary collaboration].

    PubMed

    Apostol, S; Colţan, G; Balş, M

    2000-01-01

    At present, the immunodeficiency syndrome has became pandemic. In these conditions, every doctor, no matter his profile, will have to carry out patients with AIDS. This multisystemic disease goes beyond the limits of a single medical discipline, presenting a lot of clinical manifestations. In ophthalmology, the infection with immunodeficiency virus has a lot of clinical aspects. In the beginning stages, the ocular manifestations are nonspecific, often being the prime symptoms of the general infection. In time, the disease is advancing and the opportunistic infections are becoming very frequent. In the latest stages of the diseases, one can see ocular complications, recurrences of the retinitis and also accidents caused or related with therapy. We have formulated an algorithm of diagnosis, together with some elements of etiology, extremely important for the ocular determinations of the systemic disease. We have presented some general idea about the points, the aim and the principles of the antiretroviral treatment and about the monitoring activity of the disease. We have also presented an algorithm for the initiation of the treatment. As a conclusion, we notice the significance of a close cooperation between doctors, for the diagnostic and also for the therapeutical activity.

  17. Rapid susceptibility testing of mycobacterium avium complex and mycobacterium tuberculosis isolated from AIDS patients

    NASA Technical Reports Server (NTRS)

    Dhople, Arvind M.

    1993-01-01

    In ominous projections issued by both U.S. Public Health Service and the World Health Organization, the epidemic of the Human Immunodeficiency Virus (HIV) infection will continue to rise more rapidly worldwide than predicted earlier. The Acquired Immunodeficiency Syndrome (AIDS) patients are susceptible to diseases called opportunistic infections of which tuberculosis and M. avium Complex (MAC) infection are most common. This has created an urgent need to uncover new drugs for the treatment of these infections. In the seventies, NASA scientists at Goddard Space Flight Center, Greenbelt, Maryland, had adopted a biochemical indicator, adenosine triphosphate (ATP), to detect presence of life in extraterrestrial space. Therefore, we proposed to develop ATP assay technique to determine sensitivity of antibacterial compounds against MAC and M. tuberculosis. The work was initiated in June 1992. In the last report, we described our efforts in developing ATP assay method using MAC. Studies were continued further, and during the period of this report, we established the relationship between colony forming units and ATP levels of these organisms during the growth cycle. Also, we evaluated the effects of standard antimycobacterial drugs using ATP assay technique and compared the results with those obtained with conventional tube dilution proportional method.

  18. Implementing emergency manuals: can cognitive aids help translate best practices for patient care during acute events?

    PubMed

    Goldhaber-Fiebert, Sara N; Howard, Steven K

    2013-11-01

    In this article, we address whether emergency manuals are an effective means of helping anesthesiologists and perioperative teams apply known best practices for critical events. We review the relevant history of such cognitive aids in health care, as well as examples from other high stakes industries, and describe why emergency manuals have a role in improving patient care during certain events. We propose 4 vital elements: create, familiarize, use, and integrate, necessary for the widespread, successful development, and implementation of medical emergency manuals, using the specific example of the perioperative setting. The details of each element are presented, drawing from the medical literature as well as from our combined experience of more than 30 years of observing teams of anesthesiologists managing simulated and real critical events. We emphasize the importance of training clinicians in the use of emergency manuals for education on content, format, and location. Finally, we discuss cultural readiness for change, present a system example of successful integration, and highlight the importance of further research on the implementation of emergency manuals.

  19. Outcomes of Breast Cancer Patients With Triple Negative Receptor Status Treated With Accelerated Partial Breast Irradiation

    SciTech Connect

    Wilkinson, J. Ben; Reid, Robert E.; Shaitelman, Simona F.; Chen, Peter Y.; Mitchell, Christine K.; Wallace, Michelle F.; Marvin, Kimberly S.; Grills, Inga S.; Margolis, Jeffrey M.; Vicini, Frank A.

    2011-11-01

    Purpose: Triple negative receptor status (TNRS) of patients undergoing breast-conserving therapy treated with whole-breast irradiation has been associated with increased distant metastasis and decreased disease-free and overall survival. This paper reports the outcomes of TNRS patients treated with accelerated partial breast irradiation (APBI). Methods and Materials: We studied 455 patients who received APBI at our institution, using interstitial, intracavitary, and three-dimensional conformal radiation therapy. TNRS was assigned if a patient tested negative for all three (ER [estrogen receptor], PR [progesterone receptor], and HER2/neu) receptors. Of 202 patients with all receptor results available, 20 patients were designated TNRS, and 182 patients had at least one receptor positive (RP). We analyzed ipsilateral breast tumor recurrence (IBTR), regional nodal failure (RNF), distant metastasis (DM), and overall survival (OS). Results: Mean follow-up was 4.1 years for the TNRS group and 5.1 years for the RP cohort (p = 0.11). TNRS patients had a higher histologic grade (59% TNRS vs. 13% RP; p < 0.001). Mean tumor size, stage N1 disease, and margin status were similar. Based on a 5-year actuarial analysis, the TNRS cohort experienced no IBTR, RNF, or DM, with an OS of 100% versus rates of 1.4% IBTR, 1.5% RNF, and 2.8% DM in the RP cohort (p > 0.52). OS for the RP cohort was 93% at 5 years (p > 0.28). Conclusions: In our patient population, TNRS conferred a clinical outcome similar to that of patients with RP disease treated with APBI. Further investigation with larger patient populations and longer follow-up periods is warranted to confirm that APBI is a safe and effective treatment for patients with localized TNRS breast cancer.

  20. Advanced thymic cancer treated with carboplatin and paclitaxel in a patient undergoing hemodialysis.

    PubMed

    Miura, Satoru; Kagamu, Hiroshi; Sakai, Takehito; Nozaki, Koichiro; Asakawa, Katsuaki; Moro, Hiroshi; Okajima, Masaaki; Watanabe, Satoshi; Yamamoto, Suguru; Iino, Noriaki; Goto, Shin; Kazama, Junichiro James; Yoshizawa, Hirohisa; Narita, Ichiei

    2015-01-01

    A 53-year-old man with an asymptomatic anterior mediastinal tumor undergoing hemodialysis was referred to our institution. He was diagnosed with thymic basaloid carcinoma based on the findings of a chest tomography-guided biopsy and successfully treated with carboplatin (300 mg/m(2)/day) and paclitaxel (200 mg/m(2)/day) on day 1 for six three-week cycles. To our knowledge, this is the first report regarding the efficiency of a carboplatin dose-definition method based on the body surface area with paclitaxel in a hemodialysis patient. This report may therefore be useful for treating hemodialysis patients who are candidates for carboplatin and paclitaxel therapy.

  1. [Clinical aspects of the evolution of dental caries and periodontal disease in patients treated with corticosteroids].

    PubMed

    Lăcătuşu, St; Ghiorghe, Angela

    2004-01-01

    Patients treated with adrenal glucocorticoids may run a higher risk of dental caries, both as a result of their medical condition and of the physical and physiological effects of their pharmacotherapy. Our clinical study reports about patients treated with glucocorticoids who were also having an odonto-periodontal condition. They were examined and we found rampant caries and periodontal diseases. The slow evolution of asymptomatic periodontal disease encouraged destruction of teeth in root caries. The rampant caries were correlated with immunodeficiency and treatment of these caries must take into account the general treatment.

  2. Descriptive analysis of mycological examination of patients with onychomycosis treated in private practice*

    PubMed Central

    Veasey, John Verrinder; Nappi, Flávio; Zaitz, Clarisse; Muramatu, Laura Hitomi

    2017-01-01

    This is a retrospective study of 160 patients treated in private practice in São Paulo from March 2003 to March 2015. We analyzed 171 results of direct mycological examinations and fungal cultures from nail scrapings. The agreement between direct mycological examination results and fungal culture was satisfactory, consistent with the literature (kappa 0.603). The main agent identified was Trichophyton rubrum (51%). We observed an isolation rate of non-dermatophyte filamentous fungi superior to the literature (34%). Determining the agent is key to defining the appropriate onychomycosis treatment, and knowing the epidemiology of patients treated in private practice helps the dermatologist who works in this context. PMID:28225975

  3. Dental implants in patients treated with oral bisphosphonates: a bibliographic review.

    PubMed

    Montoya-Carralero, José-Maria; Parra-Mino, Pablo; Ramírez-Fernández, Piedad; Morata-Murcia, Isabel Maria; Mompeán-Gambín, Maria del Carmen; Calvo-Guirado, José-Luis

    2010-01-01

    Bisphosphonates inhibit bone resorption and are used to treat a range of pathologies, including Paget disease, osteoporosis, multiple myeloma and metastases associated with breast or prostate cancer. At present, there is no effective treatment for bisphosphonate induced osteonecrosis, so prevention is extremely important. Since quality of life deteriorates for those suffering osteonecrosis, maximum precautions should be taken with patients at risk, and especially whenever oral surgery, including dental implant placement, is contemplated. Dentists and oral or maxillofacial surgeons must keep up to date with the latest approaches to prevention, particularly when treating patients who are presently taking, or who will be taking bisphosphonates and are also candidates for dental implants.

  4. Gastroesophageal reflux in morbidly obese patients treated with gastric banding or vertical banded gastroplasty.

    PubMed Central

    Ovrebø, K K; Hatlebakk, J G; Viste, A; Bassøe, H H; Svanes, K

    1998-01-01

    OBJECTIVE: To compare gastric banding (GB) and vertical banded gastroplasty (VBG) with respect to postsurgical gastroesophageal reflux (GER) and to investigate the role of preexisting hiatus hernia. SUMMARY BACKGROUND DATA: GB and VBG have for a long time been used in the treatment of morbidly obese patients. The introduction of laparoscopic techniques has renewed the interest in these operations. The long-term results after GB have, however, been poor. VBG was suggested to have antireflux properties because it involves repositioning and retaining the gastroesophageal junction within the abdomen and constructing an elongated intraabdominal tube. METHODS: Forty-three morbidly obese patients accepted for GB or VBG were evaluated for GER before and at regular intervals after surgery. All patients were questioned about adverse symptoms and need for antireflux medication. Both before and after surgery, 24-hour pH measurement and upper gastrointestinal endoscopies were performed. RESULTS: The prevalence of heartburn and acid regurgitation among patients treated with GB increased from 14% and 13% to 63% and 69%, respectively. Heartburn and acid regurgitation were present before surgery in 32% and 23% of patients treated with VBG, percentages unchanged by the procedure. The 24-hour reflux time increased significantly from 6.4% to 30.9% in patients treated with GB but was essentially unchanged in patients treated with VBG. The prevalence of esophagitis after GB and VBG was 75% and 20%. Acid inhibitors were needed in 81% of patients after GB and 29% of patients after VBG. CONCLUSIONS: The prevalence of GER was unchanged by VBG, but VBG did not demonstrate antireflux properties. The incidence of GER increased markedly after GB. PMID:9671066

  5. A comprehensive analysis of treatment outcomes in patients with pemphigus vulgaris treated with rituximab.

    PubMed

    Ahmed, A Razzaque; Shetty, Shawn

    2015-04-01

    Approximately 500 treatment recalcitrant pemphigus vulgaris patients have been treated with rituximab. They were treated according to the lymphoma protocol (N=224) or rheumatoid arthritis protocol (RAP) (N=209) patients. Others were treated with modifications or combinations of the two. The mean duration of follow-up with the lymphoma protocol was 28.9months and 21.9 in the rheumatoid arthritis protocol. The majority of the patients received corticosteroids and immunosuppressive therapy before, during, and after rituximab therapy. A clinical remission on therapy was observed in 90%-95% of patients within less than six weeks. A complete resolution occurred within three to four months. A small percentage of patients were able to stay in clinical remission without the need for additional systemic therapy. The incidence of relapse was at least 50%. The number of patients who required additional rituximab was 60% to 90%. A majority of patients in clinical remission post-rituximab therapy, were still on CS and ISA, albeit at lower doses. Serious adverse events were reported in a mean of five patients (range 2-9), the most important was infection and frequently resulting in septicemia. The mortality rate related to rituximab was a mean of 2 patients (range 1-3). Hence, the preliminary conclusions that can be drawn are that rituximab is an excellent agent to induce early remission. The protocols that were used were not ideal for producing a prolonged and sustained remission without additional therapy. The advantages and specificity of targeting B-cells demonstrate that rituximab is one of the best biological agents, currently available for treating recalcitrant pemphigus. Its further use is encouraged. Future research needs to focus on modifying, improving and possibly adding additional agents, so that prolonged and sustained remissions can be obtained by its use.

  6. Nasal symptoms and clinical findings in adult patients treated for unilateral cleft lip and palate.

    PubMed

    Morén, Staffan; Mani, Maria; Lundberg, Kristina; Holmström, Mats

    2013-10-01

    The aim of the study was to investigate self-experienced nasal symptoms among adults treated for UCLP and the association to clinical findings, and to evaluate whether palate closure in one-stage or two-stages affected the symptoms or clinical findings. All people with UCLP born between 1960-1987, treated at Uppsala University Hospital, were considered for participation in this cross-sectional population study with long-term follow-up. Eighty-three patients (76% participation rate) participated, a mean of 37 years after the first operation. Fifty-two patients were treated with one-stage palate closure and 31 with two-stage palate closure. An age-matched group of 67 non-cleft controls completed the same study protocol, which included a questionnaire regarding nasal symptoms, nasal inspection, anterior rhinoscopy, and nasal endoscopy. Patients reported a higher frequency of nasal symptoms compared with the control group, e.g., nasal obstruction (81% compared with 60%) and mouth breathing (20% compared with 5%). Patients also rated their nasal symptoms as having a more negative impact on their daily life and physical activities than controls. Nasal examination revealed higher frequencies of nasal deformities among patients. No positive correlation was found between nasal symptoms and severity of findings at nasal examination. No differences were identified between patients treated with one-stage and two-stage palate closure regarding symptoms or nasal findings. Adult patients treated for UCLP suffer from more nasal symptoms than controls. However, symptoms are not associated with findings at clinical nasal examination or method of palate closure.

  7. Estimated Glomerular Filtration Rate Changes in Patients with Chronic Myeloid Leukemia Treated with Tyrosine Kinase Inhibitors

    PubMed Central

    Yilmaz, Musa; Lahoti, Amit; O'Brien, Susan; Nogueras-González, Graciela M.; Burger, Jan; Ferrajoli, Alessandra; Borthakur, Gautam; Ravandi, Farhad; Pierce, Sherry; Jabbour, Elias; Kantarjian, Hagop; Cortes, Jorge E

    2015-01-01

    Background Chronic use of tyrosine kinase inhibitor (TKI) may lead to previously unrecognized adverse events. We evaluated the incidence of acute kidney injury (AKI) and chronic kidney disease (CKD) in chronic phase (CP) chronic myeloid leukemia (CML) patients treated with imatinib, dasatinib and nilotinib. Methods Four hundred and sixty-eight newly diagnosed CP CML patients treated with TKIs were analyzed. Molecular and cytogenetic response data, creatinine, glomerular filtration rate (GFR) were followed from start of therapy to last follow-up (median 52 months). GFR was estimated using the Modification of Diet in Renal Disease (MDRD) equation. Results Nineteen patients (4%) had TKI-associated AKI. Imatinib was associated with higher incidence of AKI compared to dasatinib and nilotinib (p=0.014). 58 patients (14%) developed CKD while receiving TKI, 49 of them (84%) while treated with imatinib (p<0.001). Besides imatinib, age, history of hypertension and diabetes mellitus were also associated with development of CKD. In patients with no CKD at baseline, imatinib was shown to decrease GFR overtime. Interestingly, imatinib did not cause significant decline in GFR of patients with history of CKD. Imatinib, dasatinib and nilotinib increased mean GFR after three months of treatment, and nilotinib led with the most significant increase (p<0.001). Acute or chronic kidney disease had no significant impact on overall cytogenetic and molecular response rates or survival. Conclusion Administration of TKI may be safe in the setting of CKD in CP CML patients, but close monitoring is still warranted. PMID:26217876

  8. Outcome analysis of 300 prostate cancer patients treated with neoadjuvant androgen deprivation and hypofractionated radiotherapy

    SciTech Connect

    Higgins, Geoffrey S. . E-mail: geoffrey.higgins@luht.scot.nhs.uk; McLaren, Duncan B.; Kerr, Gillian R.; Elliott, Tony; Howard, Grahame

    2006-07-15

    Purpose: Neoadjuvant androgen deprivation and radical radiotherapy is an established treatment for localized prostate carcinoma. This study sought to analyze the outcomes of patients treated with relatively low-dose hypofractionated radiotherapy. Methods and Materials: Three hundred patients with T1-T3 prostate cancer were treated between 1996 and 2001. Patients were prescribed 3 months of neoadjuvant androgen deprivation before receiving 5250 cGy in 20 fractions. Patients' case notes and the oncology database were used to retrospectively assess outcomes. Median follow-up was 58 months. Results: Patients presented with prostate cancer with poorer prognostic indicators than that reported in other series. At 5 years, the actuarial cause-specific survival rate was 83.2% and the prostate-specific antigen (PSA) relapse rate was 57.3%. Metastatic disease had developed in 23.4% of patients. PSA relapse continued to occur 5 years from treatment in all prognostic groups. Independent prognostic factors for relapse included treatment near the start of the study period, neoadjuvant oral anti-androgen monotherapy rather than neoadjuvant luteinizing hormone releasing hormone therapy, and diagnosis through transurethral resection of the prostate rather than transrectal ultrasound. Conclusion: This is the largest reported series of patients treated with neoadjuvant androgen deprivation and hypofractionated radiotherapy in the United Kingdom. Neoadjuvant hormonal therapy did not appear to adequately compensate for the relatively low effective radiation dose used.

  9. Polymorphisms and Mutational Covariation Associated with Death in a Prospective Cohort of HIV/AIDS Patients Receiving Long-Term ART in China

    PubMed Central

    Liu, Pengtao; Feng, Yi; Wu, Jianjun; Tian, Suian; Su, Bin; Wang, Zhe; Liao, Lingjie; Xing, Hui; You, Yinghui; Shao, Yiming; Ruan, Yuhua

    2017-01-01

    Background HIV drug resistance is associated with faster clinical progression of AIDS. However, the effect of significant polymorphisms and mutational covariation on mortality among HIV/AIDS patients receiving long-term antiretroviral therapy (ART), have rarely been studied. Methods In this prospective cohort study from December 2003 to December 2014, we present a new computational modelling approach based on bioinformatics-based models and several statistical methods to elucidate the molecular mechanisms involved in the acquisition of polymorphisms and mutations on death in HIV/AIDS patients receiving long-term ART in China. Results This study involved 654 ART-treated patients, who had been followed for 5473.4 person-years, a median of 9.8 years, and 178 died (25.2%, 3.3/100 person-years). The first regimens included AZT/d4T + NVP+ ddI (78.9%) or AZT/d4T + NVP+ 3TC (20.0%). We calculated an individual Ka/Ks value for each specific amino acid mutation. Result showed that 20 polymorphisms (E6D, Q18H, E35D, S37N, T39A, K43E, S68N, L74I, I93L, K103N, V106A, E169D, Y181C, G190A, Q197K, T200V, T200E, T215I, E224D and P225H) were strongly associated with AIDS related deaths. Among them, 7 polymorphisms (L74I, K103N, V106A, Y181C, G190A, T215I and P225H) were known to be drug resistance mutations, 7 polymorphisms (E6D, E35D, S37N, I93L, E169D, T200V and T200E were considered to be potential drug resistance mutations, and 6 polymorphisms (T39A, K43E, S68N, Q197K, T200V and E224D) were newly found to have an association with drug resistance mutations, which formed a complex network of relationships. Conclusions Some polymorphisms and mutational covariation may be the important influencing factors in the failure of treatment. Understanding these mechanisms is essential for the development of new therapies, designing optimal drug combinations, and determining effective clinical management of individual patients. PMID:28099515

  10. Autograft HIV-DNA load predicts HIV-1 peripheral reservoir after stem cell transplantation for AIDS-related lymphoma patients.

    PubMed

    Zanussi, Stefania; Bortolin, Maria Teresa; Pratesi, Chiara; Tedeschi, Rosamaria; Basaglia, Giancarlo; Abbruzzese, Luciano; Mazzucato, Mario; Spina, Michele; Vaccher, Emanuela; Tirelli, Umberto; Rupolo, Maurizio; Michieli, Mariagrazia; Di Mascio, Michele; De Paoli, Paolo

    2015-01-01

    Autologous stem cell transplantation (ASCT) is a widely used procedure for AIDS-related lymphomas, and it represents an opportunity to evaluate strategies curing HIV-1 infection. The association of autograft HIV-DNA load with peripheral blood HIV-1 reservoir before ASCT and its contribution in predicting HIV-1 reservoir size and stability during combination antiretroviral therapy (cART) after transplantation are unknown. Aiming to obtain information suggesting new functional cure strategies by ASCT, we retrospectively evaluated HIV-DNA load in autograft and in peripheral blood before and after transplantation in 13 cART-treated HIV-1 relapse/refractoring lymphoma patients. Among them seven discontinued cART after autograft infusion. HIV-DNA was evaluated by a sensitive quantitative real-time polymerase chain reaction (PCR). After debulking chemotherapy/mobilization, the autograft HIV-1 reservoir was higher than and not associated with the peripheral HIV-1 reservoir at baseline [median 215 HIV-DNA copies/10(6) autograft mononuclear cells, range 13-706 vs. 82 HIV-DNA copies/10(6) peripheral blood mononuclear cells (PBMCs), range 13-479, p = 0.03]. After high dose chemotherapy and autograft infusion, HIV-DNA levels reached a plateau between month 6 and 12 of follow-up. No association was found between peripheral HIV-DNA levels at baseline and after infusion in both cART interrupting and not interrupting patients. Only in the last subgroup, a stable significant linear association between autograft and peripheral blood HIV-1 reservoir emerged from month 1 (R(2) = 0.84, p = 0.01) to month 12 follow-up (R(2) = 0.99, p = 0.0005). In summary, autograft HIV-1 reservoir size could be influenced by the mobilization phase and predicts posttransplant peripheral HIV-1 reservoir size in patients on continuous cART. These findings could promote new research on strategies reducing the HIV-1 reservoir by using the ASCT procedure.

  11. Coaching and guidance with patient decision aids: A review of theoretical and empirical evidence

    PubMed Central

    2013-01-01

    Background Coaching and guidance are structured approaches that can be used within or alongside patient decision aids (PtDAs) to facilitate the process of decision making. Coaching is provided by an individual, and guidance is embedded within the decision support materials. The purpose of this paper is to: a) present updated definitions of the concepts “coaching” and “guidance”; b) present an updated summary of current theoretical and empirical insights into the roles played by coaching/guidance in the context of PtDAs; and c) highlight emerging issues and research opportunities in this aspect of PtDA design. Methods We identified literature published since 2003 on shared decision making theoretical frameworks inclusive of coaching or guidance. We also conducted a sub-analysis of randomized controlled trials included in the 2011 Cochrane Collaboration Review of PtDAs with search results updated to December 2010. The sub-analysis was conducted on the characteristics of coaching and/or guidance included in any trial of PtDAs and trials that allowed the impact of coaching and/or guidance with PtDA to be compared to another intervention or usual care. Results Theoretical evidence continues to justify the use of coaching and/or guidance to better support patients in the process of thinking about a decision and in communicating their values/preferences with others. In 98 randomized controlled trials of PtDAs, 11 trials (11.2%) included coaching and 63 trials (64.3%) provided guidance. Compared to usual care, coaching provided alongside a PtDA improved knowledge and decreased mean costs. The impact on some other outcomes (e.g., participation in decision making, satisfaction, option chosen) was more variable, with some trials showing positive effects and other trials reporting no differences. For values-choice agreement, decisional conflict, adherence, and anxiety there were no differences between groups. None of these outcomes were worse when patients were exposed

  12. Long-term results in 144 localized Ewing's sarcoma patients treated with combined therapy

    SciTech Connect

    Bacci, G.; Toni, A.; Avella, M.; Manfrini, M.; Sudanese, A.; Ciaroni, D.; Boriani, S.; Emiliani, E.; Campanacci, M.

    1989-04-15

    The results of 144 previously untreated cases of primary Ewing's sarcoma of bone are reported with a minimum follow-up of 5 years. This series was treated between 1972 and 1982 at Istituto Ortopedico Rizzoli with a combined therapy. The local control of the disease consisted of amputation (ten cases), resection followed by radiation therapy (35-45 Gy) (48 cases) and radiation therapy alone (40-60 Gy) (86 cases). Adjuvant chemotherapy, rigorously standardized, was performed according two different protocols: the first (85 cases treated in the period 1972-1978) consisted of vincristine (VCR) Adriamycin (doxorubicin) (ADM), and cyclophosphamide (EDX); the second (59 cases treated in the period 1979-1982) of VCR, ADM, EDX and dactinomycin (DACT). At a follow-up of 5 to 16 years (median, 9), 59 patients (41%) are continuously disease-free (CDF), 81 (56%) developed metastatic disease and/or local recurrence, and four (3%) had a second malignancy. Three factors seem to be correlated to prognosis: the site of the initial lesion (only 23% of the pelvic lesions are represented in the CDF group versus 46% of the other locations); the chemotherapy protocol (32% of the cases in the first protocol are CDF versus 54% in the second); the type of local treatment (60% of the patients treated with amputation or resection plus radiotherapy versus 28% of those treated with radiation therapy alone are CDF). A local recurrence was observed in 24% of the patients (8% in the group locally treated with surgery or surgery plus radiation therapy versus 36% in the group treated with radiation therapy alone). These data suggest that even though adjuvant chemotherapy can improve the long-term results in localized Ewing's sarcoma patients, this disease still represents, in a high percentage of cases, a lethal process whose final prognosis widely depends on the local control of the lesion.

  13. Thyroid abnormalities in patients previously treated with irradiation for acne vulgaris

    SciTech Connect

    Thomson, D.B.; Grammes, C.F.; Starkey, R.H.; Monsaert, R.P.; Sunderlin, F.S.

    1984-01-01

    Of 1,203 patients who received radiation treatment for acne vulgaris between 1940 and 1968, 302 patients were recalled and examined, 121 at Geisinger Medical Center and the remainder by their local physicians. Radiation records were reviewed on all patients. Lead-rubber and cones had been used as shielding. Mean age at the time of exposure was 21 years and mean total exposure was 692 R. Palpable nodular thyroid disease was found in eight patients (2.6%). Of these, thyroid carcinoma was detected in two patients (0.66%). Although the number of patients examined was small, the incidence of carcinomas was unexpectedly high. We conclude that follow-up examination is worthwhile for patients previously treated by irradiation for acne vulgaris.

  14. An observational study of insomnia and nightmare treated with trazodone in patients with advanced cancer.

    PubMed

    Tanimukai, Hitoshi; Murai, Tasuku; Okazaki, Namiko; Matsuda, Yoichi; Okamoto, Yoshiaki; Kabeshita, Yasunobu; Ohno, Yumiko; Tsuneto, Satoru

    2013-06-01

    Patients with cancer often experience insomnia. Nightmares are also a strong factor that interferes with the maintenance of comfortable and satisfying sleep. However, the prevalence and standard treatment of nightmares in patients with cancer have not been established yet. We aimed to treat insomnia and nightmares with trazodone. From 2008 to 2011, trazodone was prescribed to 30 patients with cancer who reported experiencing insomnia with or without nightmares to the palliative care team in Osaka University Hospital. Effective treatment was seen in 15 patients (50%). Four patients with cancer reported having severe nightmares and 2 patients had beneficial effects, with frightening dreams transformed into acceptable ones. Trazodone may be an effective drug for the treatment of insomnia and nightmares in patients with advanced cancer.

  15. Effects of vitamins, including vitamin A, on HIV/AIDS patients.

    PubMed

    Mehta, Saurabh; Fawzi, Wafaie

    2007-01-01

    increase lymphoid cell differentiation, which leads to an increase in CCR5 receptors. These receptors are essential for attachment of HIV to the lymphocytes and therefore, an increase in their number is likely to increase HIV replication. Vitamin A supplementation in HIV-infected children, on the other hand, has been associated with protective effects against mortality and morbidity, similar to that seen in HIV-negative children. The risk for lower respiratory tract infection and severe watery diarrhea has been shown to be lower in HIV-infected children supplemented with vitamin A. All-cause mortality and AIDS-related deaths have also been found to be lower in vitamin A-supplemented HIV-infected children. The benefits of multivitamin supplementation, particularly vitamins B, C, and E, have been more consistent across studies. Multivitamin supplementation in HIV-infected pregnant mothers has been shown to reduce the incidence of adverse pregnancy outcomes such as fetal loss and low birth weight. It also has been shown to decrease rates of MTCT among women who have poor nutritional or immunologic status. Further, multivitamin supplementation reduces the rate of HIV disease progression among patients in early stage of disease, thus delaying the need for ART by prolonging the pre-ART stage. In brief, there is no evidence to recommend vitamin A supplementation of HIV-infected pregnant women; however, periodic vitamin A supplementation of HIV-infected infants and children is beneficial in reducing all-cause mortality and morbidity and is recommended. Similarly, multivitamin supplementation of people infected with HIV, particularly pregnant women, is strongly suggested.

  16. Gene Expression Profiles of HIV/AIDS Patients with Qi-Yin Deficiency and Dampness-Heat Retention

    PubMed Central

    Liu, Sa; Chen, Yulong; Xu, Qianlei; Chen, Jianshe; Wang, Changhai; Wang, Zhao; Ma, Suna; Wu, Xingwei; Zhang, Ning

    2016-01-01

    Abstract Objectives: Traditional Chinese Medicine (TCM) applied in the clinic as a complementary and alternative therapy has helped improve immunity and reduce side effects and symptomatic treatment in patients with HIV/AIDS. However, the mechanisms of TCM syndromes are not clear. Transcriptomics enables the study of such TCM syndromes. Design: This study compared the messenger RNA (mRNA) expressions of healthy persons and patients with HIV/AIDS who had two common TCM syndromes, qi-yin deficiency and dampness-heat retention, to find the difference in HIV/AIDS with TCM syndromes. Results: Comparison with healthy persons identified 113 mRNAs—41 enhanced and 72 decreased—in the qi-yin deficiency group. Additionally, 76 mRNAs were found in the dampness-heat retention group: 14 increased and 62 decreased. Functional genetic analysis of the mRNAs indicated that two TCM syndromes were correlated with cell apoptosis, immunoinflammatory responses, and lymphocyte activation. Differentially expressed mRNAs in the qi-yin deficiency group were obviously associated with cellular activity, communication, protein localization, cellular ion homeostasis, and regulation of cell motion, whereas mRNAs in the dampness-heat retention group were associated with sequence-specific DNA binding, cellular response to stress, and hemopoietic or lymphoid organ development. Conclusions: These results suggest that the formation of different TCM syndromes in patients with HIV/AIDS were founded on biological transcriptomics, which reveal mechanisms of the formation of these syndromes in HIV/AIDS. Differentially expressed mRNAs in two TCM syndrome groups tended to normalize after TCM intervention, which indicates that TCM might remit symptoms by changing genetic expression. PMID:27759429

  17. [Somatic and psychiatric disorders in alcohol-addicted patients treated in a detoxification unit].

    PubMed

    Kroch, Stanisław; Kamenczak, Aleksandra; Chrostek Maj, Jan; Polewka, Andrzej

    2004-01-01

    The aim of the presented study was the assessment of somatic and psychiatric disorders in alcohol addicted patients, treated in the Department of Clinical Toxicology detoxification unit in Kraków in 2002 year. The total number of 443 patients (377 men and 66 women) were considered for the research. More than 50% patients were hospitalized repeatedly (2 or more times) due to alcohol problems. Medical history as well as detail medical examination and diagnostic evaluation revealed the concomitance with alcohol disease different somatic illnesses and psychiatric disorders. In 194 patients (43.8%) the alcoholic liver damage was diagnosed, frequently (in 5.2% patients) with chronic pancreatitis. Only 22 patients (5%) were infected with hepatitis virus type B. Diabetes type 2 and different cardiovascular disorders were present in almost one third of patients. In the past 55 patients (12.4%) have had severe head trauma, and 51 (11.3%) were treated because multiorgan trauma. Psychiatric examination revealed in 102 patients (23%) affective disorders, and in 92 (20.7%) personality disturbances. The presented data should be a ground for discussion about treatment model alcohol dependency in Poland.

  18. Cardiac morbidity and mortality in deferoxamine- or deferiprone-treated patients with thalassemia major.

    PubMed

    Borgna-Pignatti, Caterina; Cappellini, Maria Domenica; De Stefano, Piero; Del Vecchio, Giovanni Carlo; Forni, Gian Luca; Gamberini, Maria Rita; Ghilardi, Roberta; Piga, Antonio; Romeo, Maria Antonietta; Zhao, Huaqing; Cnaan, Avital

    2006-05-01

    Deferoxamine (DFO) therapy has been associated with improved survival of thalassemia patients. However, cardiac disease remains the main cause of death in those patients. In 1995, the oral chelator deferiprone became available for clinical use. We compared the occurrence of cardiac disease in patients treated only with DFO and in those whose therapy was switched to deferiprone during the period of observation, from January 31, 1995, to December 31, 2003. All patients with thalassemia major treated in 7 Italian centers who were born between 1970 and 1993 and who had not experienced a cardiac event prior to January 1995 were included. DFO only was given to 359 patients, and 157 patients received deferiprone for part of the time. A total of 3,610 patient-years were observed on DFO and 750 on deferiprone. At baseline, the 2 groups were comparable for age and sex, while ferritin levels were significantly higher in patients switched to deferiprone. Fifty-two cardiac events, including 10 cardiac deaths, occurred during therapy with DFO. No cardiac events occurred during deferiprone therapy or within at least 18 months after the end of it. In the setting of a natural history study, deferiprone therapy was associated with significantly greater cardiac protection than deferoxamine in patients with thalassemia major.

  19. [Home care for cancer patients previously treated at other medical facilities].

    PubMed

    Okino, Takashi; Okino, Akie; Miyamoto, Hiroko; Yamawaki, Mitsuko; Yamamoto, Toshiyuki; Tanaka, Toshiki

    2013-12-01

    Nine cancer patients who were treated at other medical facilities were referred to the Kohka Public Hospital (KPH) to receive further cancer treatment or terminal care. Of these patients, 7 were men and 2 were women, and their mean age was 58.8 years. All the patients had unresectable cancer invasion or metastases. Their Eastern Cooperative Oncology Group performance status was either 3 or 4. Six of the 9 patients were first admitted to KPH and then discharged to home care. Two of these 6 patients died at home. The other 4 patients were ultimately re-admitted. The problem was that prognosis was not predicted accurately in some of these patients. Two of the 9 patients were managed by home care and died on days 8 and 13 after the initiation of home care. One patient returned to the previous hospital with the hope of receiving further treatment and palliative care. Patient information had to be available at presentation to all persons involved in the management of the patient and we had to prepare for patient care. Additionally, patients should be informed about serious conditions and poor prognosis without delay.

  20. "Because I was in pain, I just wanted to be treated": competing therapeutic goals in the performance of healing HIV/AIDS in rural Zimbabwe.

    PubMed

    Taylor, Tonya N

    2010-01-01

    Zimbabwe is experiencing one of the most severe AIDS epidemics in the world, with an estimated one out of seven people infected with HIV. For both palliative care and pragmatic treatment of HIV-related opportunistic infections, people turn to Un'anga (the traditional system of health and healing), not as a substitute for Western therapeutics but as an alternative explanatory model for the diagnosis and management of illness. Through the use of highly charged symbols and ritualized communication, n'angas (traditional healers) seek to transform patients' understandings and experiences of HIV-related illness. Using performance theory and discourse analysis, this article seeks to expand our understanding of how competing therapeutic goals in the performance of healing affect the structure and content of performance, its subsequent meaning, and the therapeutic effect on those afflicted with HIV.

  1. [Use of Verapamil and Dilthiasem in treating patients at high cardiovascular risk (review of literature)].

    PubMed

    Baryshnikova, G A; Chorbinskayva, S A; Stepanova, I I; Blochina, O E; Zverkov, I V; Maslovskyi, L V; Korchazhkina, N B; Maslennikova, O M

    2016-01-01

    The article deals with usage of nondihydropiridine calcium antagonists--verapamil and dilthiasem--in treating patients with arterial hypertension, cardiomyopathy and arrhythmia, for secondary prevention of IHD. Data also concern cardio-, angio--and nephroprotective activity of the medications, their ability to prevent left ventricle hypertrophy, possible usage in patients after myocardial infarction. The authors also discuss problems of tolerance and safety of calcium antagonists with prolonged action vs. those with short-term action.

  2. Thrombolysis and thrombectomy in patients treated with dabigatran with acute ischemic stroke: Expert opinion.

    PubMed

    Diener, H C; Bernstein, R; Butcher, K; Campbell, B; Cloud, G; Davalos, A; Davis, S; Ferro, J M; Grond, M; Krieger, D; Ntaios, G; Slowik, A; Touzé, E

    2017-01-01

    Systemic thrombolysis with rt-PA is contraindicated in patients with acute ischemic stroke anticoagulated with dabigatran. This expert opinion provides guidance on the use of the specific reversal agent idarucizumab followed by rt-PA and/or thrombectomy in patients with ischemic stroke pre-treated with dabigatran. The use of idarucizumab followed by rt-PA is covered by the label of both drugs.

  3. VIP (etoposide, ifosfamide, and cisplatin) in patients with previously treated soft tissue sarcoma.

    PubMed

    Moon, Ji Young; Baek, Seung-Woo; Ryu, Hyewon; Choi, Yoon-Seok; Song, Ik-Chan; Yun, Hwan-Jung; Jo, Deog-Yeon; Kim, Samyong; Lee, Hyo Jin

    2017-01-01

    We retrospectively reviewed outcomes of treatment with VIP (combination of etoposide, ifosfamide, and cisplatin) in patients with previously treated soft tissue sarcoma (STS).We analyzed the medical records of patients with advanced or relapsed STS who had undergone VIP treatment as second-line or more chemotherapy between January 2000 and December 2015. The patients were treated with a combination of etoposide (100 mg/m for 5 days), ifosfamide (2000 mg/m for 2 days), and cisplatin (20 mg/m for 5 days) once every 4 weeks. Treatment response, progression-free survival (PFS), and overall survival (OS) were analyzed in all patients and between responder and nonresponder groups (responders showed a tumor response to any prior systemic chemotherapy before VIP).Twenty-four patients with a median age of 50 years (range: 20-68 years) were treated with VIP. Eleven (45.8%) patients were male and 7 (29.2%) received 2 or more chemotherapy regimens before VIP. Median PFS was 3.7 months (95% confidence interval [CI], 1.3-6.1 months) and median OS was 10.0 months (95% CI, 6.6-13.5). The overall response rate was 37.5%, and the disease control rate was 50%. The responder group showed better PFS (7.7 months vs 3.0 months; P = 0.101) and significantly improved OS (11.0 months vs 8.8 months; P = 0.039) compared to those of nonresponders. All patients reported some grade of hematological toxicity. The most frequently encountered hematological toxicity was neutropenia (any grade, 77.7%; grade 3 or 4, 74.0%).VIP might be effective in patients with previously treated STS.

  4. VIP (etoposide, ifosfamide, and cisplatin) in patients with previously treated soft tissue sarcoma

    PubMed Central

    Moon, Ji Young; Baek, Seung-Woo; Ryu, Hyewon; Choi, Yoon-Seok; Song, Ik-Chan; Yun, Hwan-Jung; Jo, Deog-Yeon; Kim, Samyong; Lee, Hyo Jin

    2017-01-01

    Abstract We retrospectively reviewed outcomes of treatment with VIP (combination of etoposide, ifosfamide, and cisplatin) in patients with previously treated soft tissue sarcoma (STS). We analyzed the medical records of patients with advanced or relapsed STS who had undergone VIP treatment as second-line or more chemotherapy between January 2000 and December 2015. The patients were treated with a combination of etoposide (100 mg/m2 for 5 days), ifosfamide (2000 mg/m2 for 2 days), and cisplatin (20 mg/m2 for 5 days) once every 4 weeks. Treatment response, progression-free survival (PFS), and overall survival (OS) were analyzed in all patients and between responder and nonresponder groups (responders showed a tumor response to any prior systemic chemotherapy before VIP). Twenty-four patients with a median age of 50 years (range: 20–68 years) were treated with VIP. Eleven (45.8%) patients were male and 7 (29.2%) received 2 or more chemotherapy regimens before VIP. Median PFS was 3.7 months (95% confidence interval [CI], 1.3–6.1 months) and median OS was 10.0 months (95% CI, 6.6–13.5). The overall response rate was 37.5%, and the disease control rate was 50%. The responder group showed better PFS (7.7 months vs 3.0 months; P = 0.101) and significantly improved OS (11.0 months vs 8.8 months; P = 0.039) compared to those of nonresponders. All patients reported some grade of hematological toxicity. The most frequently encountered hematological toxicity was neutropenia (any grade, 77.7%; grade 3 or 4, 74.0%). VIP might be effective in patients with previously treated STS. PMID:28121937

  5. Rocky Mountain Spotted Fever in a patient treated with anti-TNF-alpha inhibitors.

    PubMed

    Mays, Rana M; Gordon, Rachel A; Durham, K Celeste; LaPolla, Whitney J; Tyring, Stephen K

    2013-03-15

    Rocky Mountain Spotted Fever (RMSF) is a tick-bourne illness, which can be fatal if unrecognized. We discuss the case of a patient treated with an anti-TNF-alpha inhibitor for rheumatoid arthritis who later developed a generalized erythematous macular eruption accompanied by fever. The clinical findings were suggestive of RMSF, which was later confirmed with serology. Prompt treatment with doxyclycine is recommended for all patients with clinical suspicion of RMSF.

  6. All stories are not alike: a purpose-, content-, and valence-based taxonomy of patient narratives in decision aids.

    PubMed

    Shaffer, Victoria A; Zikmund-Fisher, Brian J

    2013-01-01

    The use of patient stories in decision aids is a highly controversial practice. However, the resulting debates and research have yielded little consensus about the impact of patient stories due to vague operational definitions of narratives. In this article, we argue that narratives are not homogeneous in either content or effect and hence should not be considered a single construct in research. The purpose of this article is to provide a taxonomy that guides both the development of decision aids and future research on this topic. We define three dimensions of narratives that are likely to moderate their impact on decision making: 1) the purpose of the narrative, 2) the content of the message, and 3) the evaluative valence, or overall tone, of the message. In addition, we describe predicted effects of different types of narratives on decision making and discuss their potential interactions. Our taxonomy provides a framework that will allow for the precise documentation of different narrative types, the use of appropriate outcome measures, and a systematic evaluation of narratives in all types of decision aids. Failures to recognize the complex structure of narratives will result both in research that does little to inform our understanding of the impact of patient stories and in the use of narratives in patient education materials that have unintended consequences on both decision processes and behavior.

  7. Serum free fatty acid levels in PCOS patients treated with glucophage, magnesium oxide and spironolactone.

    PubMed

    Muneyyirci-Delale, Ozgul; Kaplan, Julie; Joulak, Ibrahim; Yang, Lianfu; Von Gizycki, Hans; Nacharaju, Vijaya L

    2013-05-01

    To assess the effect of glucophage, magnesium oxide and spironolactone in altering free fatty acids (FFAs), 36 PCOS women were randomly divided into three groups. Group 1 (n = 14) was treated with 500 mg glucophage po bid, group 2 (n = 10) was treated with 400 mg magnesium oxide po bid and group 3 (n = 12) was treated with 50 mg spironolactone po bid for 12 weeks. A glucose tolerance test with 75 g glucose load was performed before and after treatment, collecting blood at 0, 1 and 2 h for insulin, glucose, FFA and aldosterone. Amount of FFA before and after treatment were compared by repeated measure ANOVA and represented as area under the curve. FFA levels before treatment were 0.83 ± 0.23, 0.77 ± 0.15 and 0.85 ± 0.28 and after treatment were 0.77 ± 0.48, 0.71 ± 0.18 and 0.66 ± 0.25 for glucophage, magnesium oxide and spironolactone-treated patients, respectively. The FFA levels were unchanged in the groups treated with glucophage and magnesium oxide but were significantly (p < 0.03) decreased in the group treated with spironolactone. Since FFAs are known to be involved in the development of insulin resistance, these results suggest that spironolactone may be useful for lowering insulin resistance in PCOS patients.

  8. Clinical results evaluation of dentinary hypersensitivity patients treated with laser therapy

    NASA Astrophysics Data System (ADS)

    Brugnera, Aldo, Jr.; Cruz, Fabio M.; Zanin, Fatima A. A.; Pecora, Jesus D.

    1999-05-01

    The purpose of this investigation was to show the percentage of cured patients treated with low level laser therapy clinically diagnosed dentinary hypersensitivity. The authors report on this investigation more than 300 human teeth treated at the Laser Center of Camilo Castelo Branco University during the years of 1995, 1996 and 1997. Pulpal vitality was verified using thermal tests, and only reversible process was treated. The teeth were dried with cotton pellets and laser beam was applied, using He-Ne (632.8 nm)laser, and ArGaAl Lasers(780 nm and 830 nm). All teeth received 4 joules/session, and were treated until 5 sessions. 79.13% of our patients were treated in 3 sessions with success; 8.58% were cure in 4 sessions; and 4.29% were successfully treated in 5 sessions, obtaining a 92% of success. The authors concluded that low level laser therapy is an effective and useful treatment to dentinary hypersensibility.

  9. The effect of crutches, an orthosis TheraTogs, and no walking aids on the recovery of gait in a patient with delayed healing post hip fracture: A case report.

    PubMed

    Maguire, Clare; Sieben, Judith M; Scheidhauer, Heike; Romkes, Jacqueline; Suica, Zorica; de Bie, Robert A

    2016-01-01

    Accelerated rehabilitation following hip fracture and joint replacement, including early unrestricted weight-bearing and muscle strengthening, has gained importance in hastening functional recovery and hospital discharge. The influence of walking aids on these parameters is sparsely investigated. In this case report, we document the effect of walking with crutches; an orthotic garment and strapping system, TheraTogs; and no walking aids over 3-4-week periods on walking speed, trunk sway, and muscle activity measured with electromyography (EMG). The patient was a 49-year-old female showing delayed healing following a conservatively treated avulsion fracture of the greater trochanter 12 weeks previously with a 14-year history of total hip arthroplasty. EMG analysis showed muscle activity increased with TheraTogs and decreased with crutches compared with walking with no aids. Walking speed improved at a faster rate in the TheraTogs phase than in the crutches phase and reduced in no-walking-aids phase. Mean speed (SD) for each phase was: crutches 1.11 (0.08) m/s, TheraTogs 1.35 (0.11) m/s, and no-aids 1.19 (0.14) m/s. Trunk sway increased in the crutch and no-aids phases, and became more stable in the TheraTogs phase. In this patient, function and recovery rate of all measured parameters increased more in the TheraTogs phase than the crutches or no-aids phase. This may be because muscle activity was facilitated enabling active support of recovering structures.

  10. Survival Difference in Patients with Malignant Pleural Effusions Treated with Pleural Catheter or Talc Pleurodesis.

    PubMed

    Liou, Douglas Z; Serna-Gallegos, Derek; Chan, Joshua L; Borgella, Jerald; Akhmerov, Shah; Soukiasian, Harmik J

    2016-10-01

    Malignant pleural effusions (MPE) are commonly managed with either pleural catheter (PC) or talc pleurodesis (TP). The aim of this study was to compare survival in MPE patients treated with either PC or TP. A retrospective review of our cancer center database was performed. Patients with metastatic cancer and MPE were analyzed. Demographic and clinical data were tabulated and compared. A total of 238 patients with MPE treated by either PC or TP were included. Of these, 79 patients comprised the PC group and 159 the TP group. PC had a higher incidence of advanced disease (stage III or IV) at initial diagnosis compared with TP (70.9% vs 57.2%, P = 0.05). TP had a longer postprocedure length of stay compared with PC (7.1 vs 5.0 days, P = 0.02); however, overall length of stay was similar (9.7 vs 11.1 days, P = 0.34). Readmissions were significantly lower in TP (11.9% vs 22.8%, P = 0.04). Mean survival was higher in TP compared with PC (18.7 vs 4.1 months, P < 0.001). Patients with metastatic cancer and MPE treated with TP had significantly higher survival compared with PC. This is likely related to a greater disease burden in PC, as 70 per cent of patients in this group had stage III or IV disease on initial presentation.

  11. The long-term outcome of treated sensitized patients who undergo heart transplantation

    PubMed Central

    Kobashigawa, Jon A.; Patel, Jignesh K.; Kittleson, Michelle M.; Kawano, Matt A.; Kiyosaki, Krista K.; Davis, Stephanie N.; Moriguchi, Jaime D.; Reed, Elaine F.; Ardehali, Abbas A.

    2013-01-01

    Background Sensitized patients prior to heart transplantation are reportedly at risk for hyperacute rejection and for poor outcome after heart transplantation. It is not known whether the reduction of circulating antibodies pre-transplant alters post-transplant outcome. Methods and Results Between July 1993 and July 2003, we reviewed 523 heart transplant patients of which 95 had pre-transplant panel reactive antibody (PRAs) >10%; 21/95 were treated pre-transplant for circulating antibodies. These 21 patients had PRAs > 10% (majority 50–100%) and were treated with combination therapy including plasmapheresis, intravenous gamma globulin and rituximab to reduce antibody counts. The 74 untreated patients with PRAs > 10% (untreated sensitized group) and those patients with PRAs < 10% (control group) were used for comparison. Routine post-transplant immunosuppression included triple-drug therapy. After desensitization therapy, circulating antibody levels pre-transplant decreased from a mean of 70.5 to 30.2%, which resulted in a negative prospective donor-specific crossmatch and successful heart transplantation. Compared to the untreated sensitized group and the control group, the treated sensitized group had similar five-yr survival (81.1% and 75.7% vs. 71.4%, respectively, p = 0.523) and freedom from cardiac allograft vasculopathy (74.3% and 72.7% vs. 76.2%, respectively, p = 0.850). Conclusion Treatment of sensitized patients pre-transplant appears to result in acceptable long-term outcome after heart transplantation. PMID:20973825

  12. Incidence and risk of hypomagnesemia in advanced cancer patients treated with cetuximab: A meta-analysis.

    PubMed

    Chen, Peng; Wang, Long; Li, Hao; Liu, Bing; Zou, Zui

    2013-06-01

    Hypomagnesemia is a serious adverse event for patients treated with cetuximab, an inhibitor of endothelial growth factor receptor (EGFR). However, no significant association has yet been established between cetuximab and hypomagnesemia in randomized controlled clinical trials (RCTs). The present study conducted a systematic review and meta-analysis of published RCTs to assess the overall risk of hypomagnesemia associated with cetuximab. PubMed, the Cochrane Central Register of Controlled Trials, Embase and the American Society of Clinical Oncology conferences were searched for relevant RCTs. Quantitative analysis was carried out to evaluate the association between hypomagnesemia and cetuximab. A total of 7,045 patients with a variety of advanced cancers from 10 trials were included in the analysis. The overall incidence of grade 3/4 hypomagnesemia in patients receiving cetuximab was 3.9% [95% confidence interval (CI), 2.6-4.3%]. Patients treated with cetuximab had a significantly increased risk of grade 3/4 hypomagnesemia compared with patients treated with control medication, with a relative risk (RR) of 8.60 (95% CI, 5.08-14.54). Risk was observed to vary with tumor type. The study concluded that cetuximab is associated with a significant risk of hypomagnesemia in patients with advanced cancer receiving concurrent chemotherapy.

  13. Efficacy response in CF patients treated with ivacaftor: post-hoc analysis.

    PubMed

    Konstan, Michael W; Plant, Barry J; Elborn, J Stuart; Rodriguez, Sally; Munck, Anne; Ahrens, Richard; Johnson, Charles

    2015-05-01

    Clinical studies in patients with cystic fibrosis and G551D-CFTR showed that the group treated with ivacaftor had improved clinical outcomes. To better understand the effect of ivacaftor therapy across the distribution of individual FEV(1) responses, data from Phase 3 studies (STRIVE/ENVISION) were re-examined. In this post-hoc analysis of patients (n = 209) who received 48 weeks of ivacaftor or placebo, patients were assigned to tertiles according to FEV(1) response. These groups were then used to evaluate response (FEV(1), sweat chloride, weight, CFQ-R, and pulmonary exacerbation). The number needed to treat (NNT) was calculated for specific thresholds for each outcome. Across all tertiles, numerical improvements in FEV(1), sweat chloride, CFQ-R and the frequency of pulmonary exacerbations were observed in ivacaftor-treated patients: the treatment difference versus placebo was statistically significant for all outcomes in the upper tertile and for some outcomes in the lower and middle tertiles. The NNT for a ≥ 5% improvement in %predicted FEV(1) was 1.90, for a ≥ 5% body weight increase was 5.74, and to prevent a pulmonary exacerbation was 3.85. This analysis suggests that the majority of patients with clinical characteristics similar to STRIVE/ENVISION patients have the potential to benefit from ivacaftor therapy.

  14. Second lymphoid malignant neoplasms occurring in patients treated for Hodgkin's disease

    SciTech Connect

    Armitage, J.O.; Dick, F.R.; Goeken, J.A.; Foucar, M.K.; Gingrich, R.D.

    1983-03-01

    Patients who have been treated for Hodgkin's disease are at increased risk for second malignant neoplasms, particularly acute nonlymphoblastic leukemia and non-Hodgkin's lymphoid malignant neoplasms (NHLMs). We diagnosed five cases of NHLM in 242 patients initially treated for Hodgkin's disease between 1973 and 1980, giving a minimum incidence for this occurrence of 2.1%. The initial therapy for Hodgkin's disease, irradiation in three patients and chemotherapy in two patients, resulted in a complete remission in each case. The NHLM appeared 12, 13, 26, 30, and 54 months after the diagnosis of Hodgkin's disease. The cell type of NHLM and immunologic phenotype were as follows: large cell, immunoblastic T; large cell, immunoblastic null; large cell, cleaved and noncleaved B; large cell, cleaved and noncleaved (not studied); and lymphoblastic T. A review of 24 other cases of NHLMs, occurring in patients treated for Hodgkin's disease, reported in the literature, confirm the morphologic and immunologic heterogeneity. The poor response to therapy in our patients and those previously described demonstrate the seriousness of this phenomenon.

  15. Testicular function in patients with differentiated thyroid carcinoma treated with radioiodine

    SciTech Connect

    Pacini, F.; Gasperi, M.; Fugazzola, L.

    1994-09-01

    The aim of the present study was to assess whether {sup 131}I therapy for differentiated thyroid carcinoma (DTC) can affect endocrine testicular function. Serum follicle-stimulating hormone (FSH) and testosterone (T) concentrations were measured in 103 patients periodically submitted for radioiodine therapy for residual or metastatic disease. Mean follow-up was 93.7{+-}54 mo (range 10-243 mo). Mean FSH values in {sup 131}I-treated patients tested after their last treatment were 15.3{+-}9.9 mU/ml, significantly higher than those of 19 untreated patients (6.5{+-}3.1 mU/ml). Considering the mean +3 s.d. FSH of untreated subjects as the upper limit of normal range, 36.8% of the patients had an abnormal increase in serum FSH. Longitudinal analysis performed in 21 patients showed that the behavior of FSH in response to {sup 131}I therapy was not universal. Six patients had no change or a slight increase in serum FSH after {sup 131}I administration; eleven patients had a transient increase above normal values 6-12 mo after {sup 131}I treatment, with return to normal levels in subsequent months. The administration of a second dose was followed by a similar increase in FSH levels. Finally, four patients, followed for a long period of time and treated with several {sup 131}I doses, showed a progressive increase in serum FSH, which eventually became permanent. Semen analysis, performed in a small subgroup of patients, showed a consistent reduction in the number of normokinetic sperm. No change was found in serum T levels between treated and untreated patients. The results indicate that {sup 131}I therapy for thyroid carcinoma is associated with transient impairment of testicular germinal cell function. The damage may become permanent for high-radiation activities delivered year after year and might pose a significant risk of infertility. 14 refs., 8 figs., 1 tab.

  16. Survival Predictors for Severe ARDS Patients Treated with Extracorporeal Membrane Oxygenation: A Retrospective Study in China

    PubMed Central

    Liu, Xiaoqing; Xu, Yonghao; Zhang, Rong; Huang, Yongbo; He, Weiqun; Sang, Ling; Chen, Sibei; Nong, Lingbo; Li, Xi; Mao, Pu

    2016-01-01

    Extracorporeal membrane oxygenation (ECMO) is increasingly being applied as life support for acute respiratory distress syndrome (ARDS) patients. However, the outcomes of this procedure have not yet been characterized in severe ARDS patients. The aim of this study was to evaluate the outcomes of severe ARDS patients supported with ECMO and to identify potential predictors of mortality in these patients. A total of 38 severe ARDS patients (aged 51.39±13.27 years, 32 males) who were treated with ECMO in the specialized medical intensive care unit of Guangzhou Institute of Respiratory Diseases from July 2009 to December 2014 were retrospectively reviewed. The clinical data of the patients on the day before ECMO initiation, on the first day of ECMO treatment and on the day of ECMO removal were collected and analyzed. All patients were treated with veno-venous ECMO after a median mechanical ventilation duration of 6.4±7.6 days. Among the 20 patients (52.6%) who were successfully weaned from ECMO, 16 patients (42.1%) survived to hospital discharge. Of the identified pre-ECMO factors, advanced age, a long duration of ventilation before ECMO, a higher Acute Physiology and Chronic Health Evaluation II (APACHE II) score, underlying lung disease, and pulmonary barotrauma prior to ECMO were associated with unsuccessful weaning