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Biomedical subjects

A M Fournier

Publications and source records attributed to A M Fournier.

At least 19 recordsLinked to original sources
PubMed1999

Human immunodeficiency virus infection in Haiti.

This article reviews human immunodeficiency virus (HIV) infection in Haiti. The evolution of the epidemic in Haiti, its spread from urban to rural areas, its varied clinical manifestations, and the attitudes of Haitian people toward HIV infection provide important lessons on understanding and managing this infection in a developing country. The heterosexual spread of HIV, particularly among the poor, is well-documented as is the role of other sexually transmitted diseases along with tuberculosis. Coinfection of HIV and tuberculosis have led researchers to study the effects of six-month supervised intermittent tuberculosis therapy both in controlling tuberculosis and slowing the progression of HIV. Various surveys and discussion groups about acquired immunodeficiency virus knowledge and beliefs demonstrate a large deficit in HIV education despite campaigns to educate the population. The great impact of HIV disease on morbidity and mortality in Haiti indicates that a great deal of work still needs to be accomplished and demonstrates the frustration in fighting the infection in countries with inadequate resources and infrastructure. Advances in HIV vaccine research seem to be the most promising option for developing countries such as Haiti.

Acquired Immunodeficiency Syndrome↗
PubMed1998

The Gram stain.

Explore the source record for details and available documents.

Adult↗
PubMed1998

Resolving the conflicts between general and subspecialty medicine: the internist as consulting physician-scientist.

Internal medicine is confronting a conflict between its generalist and specialty roles, coupled with a conflict between the needs of academic internal medicine in contrast to those of private practice. The historical origins of these conflicts are explored. To resolve these conflicts, internal medicine must rediscover the common ground shared by the general internist and specialist, academician and practitioner. This common ground is best found in the role of internist as physician-scientist. In the future, specialists and general internists will need to emphasize their roles as consultants. In the process, internal medicine will become smaller and more "academic." The benefits of this role for internal medicine should be rapidly demonstrated through outcomes based research in order to win over skeptical payors, peers, and the public at large.

Conflict of Interest↗
PubMed1998

Intracellular starvation in the insulin resistance syndrome and type II diabetes mellitus.

Statistical associations of insulin resistance, type II diabetes, hypertension and hyperlipidemia have been well documented, but the pathophysiology of the 'insulin resistance syndrome' is unknown. This article explores the hypothesis that intracellular starvation plays a central role in the development of type II diabetes, hypertension and hyperlipidemia. According to this hypothesis, insulin resistance leads to inadequate intracellular glucose, which in turn leads to insufficient amounts of adenosine triphosphate needed for ion transfer, and to drive energy-requiring reactions. Indirect evidence supporting this hypothesis is presented. Intracellular starvation is also discussed as an alternative to the 'glucose hypothesis' to explain certain complications of diabetes.

Cells↗
PubMed1997

The health care delivery crisis in Haiti.

BACKGROUND AND OBJECTIVES: This article documents the history, politics, and economics that have contributed to a health care delivery crisis in Haiti and why family medicine will be crucial for the recovery of Haiti's health care. Since the United Nations intervention, there has been some improvement in health conditions. However, the embargo and political turmoil left little infrastructure on which to build. Developing family medicine, one of the priorities of the Ministry of Health, will reverse traditional forces that favor emigration and specialization and will provide the country with well-trained physicians who can treat most of the common health problems of Haiti. These common preventable and treatable problems are now contributing to short life expectancy and high infant mortality. While the ultimate responsibility for Haiti's health rests with Haitian health professionals, the country has an immediate need for international humanitarian assistance, particularly for general medical care.

Delivery of Health Care↗
PubMed1993

Lessons from a clinic for the homeless. The Camillus Health Concern.

OBJECTIVE: To present the educational opportunities provided by a model clinic for homeless persons. DESIGN: Descriptive. PATIENTS OR OTHER PARTICIPANTS: Patients are those who are cared for at Camillus Health Concern clinic for the homeless in Miami, Fla. Other participants include students, residents, and faculty affiliated with the University of Miami (Fla) School of Medicine. INTERVENTION: Affiliation of the clinic with the medical school has shifted the clinic from a pure service model to an education and service model. MAIN OUTCOME MEASURES: Numbers of patients and encounters are presented, as well as student and resident rotations, numbers, and hours. RESULTS: Shifting to an education and service model has increased productivity of the clinic while providing a unique, multifaceted educational experience to students, residents, and faculty. CONCLUSIONS: Those factors that contribute to the success of this education and service model include the professional satisfaction that results from providing care to patients who previously have not had access to health care; a team approach that includes faculty, students, nurses, and social workers; an environment that fosters clinical judgment rather than expensive tests; and the opportunity to teach social responsibility in the process of providing health care. We encourage other schools to consider the development of clinics for the homeless as alternative ambulatory training sites.

Clinical Clerkship↗
PubMed1993

The degree of blood pressure evaluation and end organ damage with severe hypertension: a case-control study.

To investigate the association of blood pressure and end-organ damage in patients with severe hypertension in a case-controlled manner, 26 patients with syndromes of acute end-organ damage and severe hypertension were compared with 25 patients with severe but asymptomatic hypertension for a variety of demographic, clinical, and basic laboratory values. Differences were assessed with the Chi-square test and multiple logistic regression analysis. End-organ damage was significantly associated with a degree of systolic and diastolic blood pressure elevation, a history of hypertensive crisis, serum creatinine, and a history of alcohol use, in multivariate analysis. The relationship to creatinine and a history of hypertensive crisis were not present in univariate analysis. The possible relationships of these factors to the pathophysiology of hypertensive crisis are discussed.

Blood Pressure↗
PubMed1992

Increased oxidative metabolism in PMA-activated lymphocytes: a flow cytometric study.

Flow cytometry and the fluorescent dyes DCF and R123 were used to examine oxygen metabolite production in human leukocytes and T-lymphoblastoid Jurkat cells, activated by PMA or by FMLP. When unseparated leukocytes were activated by PMA, oxidative products were generated not only in PMN and monocytes but also to a lower extent in lymphocytes. These responses were correlated with protein kinase C activation. PMA did not, however, induce the synthesis of reactive oxygen species in isolated lymphocytes. FMLP did not affect lymphocyte oxidative metabolism when added to the whole leukocyte mixture, but activated only the phagocyte populations. Similarly, Jurkat cells which alone were unresponsive to PMA, became strongly fluorescent when they were mixed with PMN and treated with this activator. In all cases, they did not respond to FMLP. Superoxide dismutase and catalase addition did not prevent the lymphoid cell response in the presence of phagocytes, whereas Desferal did. These data indicate that under physiological conditions, activated lymphocytes are capable of oxidative metabolism and also evidence some close relation between the leukocyte populations. We discuss the putative mechanism of oxygen metabolite generation in lymphocytes and the role of these metabolites in the immune response.

Flow Cytometry↗
PubMed1992

The relationship of total lymphocyte count to CD4 lymphocyte counts in patients infected with human immunodeficiency virus.

A simple, inexpensive alternative to CD4 counts would facilitate the management of asymptomatic and early symptomatic patients with HIV infection. In this report, a high correlation was found between CD4 counts and total lymphocyte counts calculated from complete blood counts in a cohort of ambulatory HIV-infected patients. Using these data, patients with CD4 counts above and below 500 cells/mm3, 200 cells/mm3, and those with and without symptoms can be identified with a high degree of predictive value. The availability and lower cost of lymphocyte counts make them an attractive alternative to CD4 counts in managing asymptomatic and early symptomatic patients with HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Courvoisier's sign revisited: two patients with palpable gallbladder.

More than a century ago, Courvoisier published his observation on the significance of a palpable gallbladder in the differential diagnosis of obstructive jaundice. We have described two patients with newly described conditions--AIDS-associated cholangiopathy and diet-induced cholecystitis--who had a palpable gallbladder and have discussed possible pathogenetic mechanisms.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Spontaneous in vitro secretion of antibody to cytomegalovirus (CMV) by human peripheral blood mononuclear cells: a new approach to studying the CMV-immune system interaction.

The in vitro secretion of cytomegalovirus (CMV)-specific antibodies by peripheral blood mononuclear cells (PBMC) was analyzed in patients with acute CMV infection and CMV-seropositive patients infected with human immunodeficiency virus. This active and spontaneous in vitro secretion was not affected by the depletion of T cells or adherent cells. The number of anti-CMV antibody-secreting cells was estimated to be 28-176/10(6) PBMC; 30%-65% of the total in vitro antibody production was CMV-specific. This secretion seemed to be independent of in vitro polyclonal B cell activation, in vitro antigen-specific lymphocyte stimulation, or in vivo Epstein-Barr virus-induced B cell transformation. In vitro anti-CMV antibody production may therefore result from an in vivo stimulation of the immune system by CMV antigens and might indicate CMV replication in the host.

Acute Disease↗
PubMed1991

The impact of National Health Service Corps physicians in the lowering perinatal mortality rate in Dade County, Florida.

In some parts of Dade County, Florida, perinatal mortality rates have revealed serious problems in the delivery of health care to poor pregnant women. From 1982-1985, the reported perinatal mortality rates varied from 32-36 per 1000 live births, more than double the national average. Under the leadership of the Primary Health Care Consortium of Dade County (a federation of community health centers and other primary care providers), National Health Service Corps obstetricians and pediatricians served inner-city, medically needy patients as part of a coordinated perinatal plan from 1987-1989. Data on fetal and neonatal deaths, collected from census tracts adjacent to the community health centers, were used to study the impact of Corps obstetrician and pediatrician placement. The respective perinatal mortality rates were compared with those of 1986 as historic controls. Within a year, the overall perinatal mortality rate was reduced by 45%. As a result, an estimated 320 lives were saved between 1987-1989. This public health achievement represents a measurable impact due to assignment of National Health Service Corps physicians and can be used as a working model to reduce perinatal mortality in medically underserved communities in the United States.

Evaluation Studies as Topic↗