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A Verghese

Publications and source records attributed to A Verghese.

At least 37 records · Page 2Linked to original sources
PubMed1996

An epidemiological study of dementia in a rural community in Kerala, India.

BACKGROUND: This community-based epidemiologic study of dementia in a rural population in India investigated the prevalence of various dementing disorders in the community, psychosocial correlates of the morbidity, and assessment of the risk factors associated with dementia. METHOD: A door to door survey was conducted to identify elderly people aged 60 and above. A total of 2067 elderly persons were then screened with a vernacular adaptation of the MMSE. All those who scored 23 and below had a detailed neuropsychological evaluation by CAMDEX-Section B, and the care-givers of the people with confirmed cognitive impairment were interviewed using CAMDEX-Section H to confirm the history of deterioration or impairment in social or personal functioning. In the third phase the subjects with confirmed cognitive impairment were evaluated at home as to whether they satisfied the DSM-III-R criteria for dementia. Subcategorisation of dementia was done based on ICD-10 diagnostic criteria. Five percent of those whose screening was negative were randomly selected and evaluated during each stage. RESULTS: Sixty-six cases of dementia were identified from 2067 persons aged 60 and above, a prevalence rate of 31.9 per thousand. After correction this rate was 33.9 per thousand. Fifty-eight percent of the dementia cases were diagnosed as vascular dementia and 41% satisfied the criteria for ICD-10 dementia in Alzheimer's disease. There were more women in the Alzheimer's disease group; smoking and hypertension were associated with vascular dementia while a family history of dementia was more likely in the Alzheimer's group. CONCLUSION: Dementia is an important cause of morbidity in the geriatric population in this community, where families take responsibility for the care of relatives with dementia.

Aged↗
PubMed1996

Prevalence of associated infections in community-acquired spontaneous bacterial peritonitis.

OBJECTIVES: The frequency with which other infections occur in association with spontaneous bacterial peritonitis is not known, but has implications for both pathogenesis and management. Spontaneous bacterial peritonitis that occurs in hospitalized patients is mainly a nosocomial infection, the study of which must take into account multiple confounding factors. We conducted a prospective study to compare the clinical features and the frequency of associated infections in patients with community-acquired spontaneous bacterial peritonitis to those of cirrhotic patients with ascites but without spontaneous bacterial peritonitis. Previous studies of spontaneous bacterial peritonitis have not found an infection consistently present at some other site, but those studies did not separate community-acquired from hospital-acquired spontaneous bacterial peritonitis. METHODS: Over a 5-yr study period, 176 cirrhotic patients with ascites were enrolled and were followed. There were 68 patients who had 83 admissions with spontaneous bacterial peritonitis and 108 patients with 124 admissions without spontaneous bacterial peritonitis. Of the 68 patients with spontaneous bacterial peritonitis, 56 had single episodes of peritonitis and 12 had 27 episodes of recurrent bacterial peritonitis. All episodes of spontaneous bacterial peritonitis were diagnosed within 24 h of admission. All subjects had cultures of ascitic fluid, blood, and urine. RESULTS: Patients with spontaneous bacterial peritonitis were more often symptomatic than the nonspontaneous bacterial peritonitis patients. Ascites cultures were positive in 63 (76%) episodes of spontaneous bacterial peritonitis. The frequency of bacteremia in the spontaneous bacterial peritonitis group was significantly higher than that of the nonspontaneous bacterial peritonitis (56.6% vs. 4.8%, p < 0.0001). Bacteriuria occurred in 51 episodes of spontaneous bacterial peritonitis compared with only nine in nonspontaneous bacterial peritonitis patients (61.4% vs. 7.3%, p < 0.0001). Bacteriuria was observed even more often in recurrent bacterial peritonitis patients than in single episode bacterial peritonitis patients (77.8% vs. 53.6%, p < 0.0001). Most patients with bacteriuria had no urinary tract symptoms. There was no significant difference between the frequency of pneumonia in spontaneous bacterial peritonitis patients compared with nonspontaneous bacterial peritonitis patients (8.4% vs. 10.5%, p = 0.17). CONCLUSIONS: Asymptomatic bacteriuria occurs often in association with community-acquired spontaneous bacterial peritonitis.

Bacteremia↗
PubMed1995

Profile of HIV disease in an American border city.

A previous study on patterns of migration of HIV-infected persons suggested that most patients in a rural setting in eastern Tennessee acquired their disease in an urban area, typically during a period of prolonged residence. Disease and disability were the most common reasons for returning to their hometown. We studied our urban, border-city HIV clinic population to see whether similar patterns of migration were discernible. Fifty-one of the 103 patients studied lived outside the El Paso/Juarez area when they contracted HIV infection. The major reason cited for returning home was a desire to return to family (25%). Those who returned and those who had never left showed no statistically significant difference in age, race, or risk factors. This study suggests that migration of HIV-infected patients back to their hometown does not appear to be an exclusively rural phenomenon.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Bacterial bronchitis and bronchiectasis in human immunodeficiency virus infection.

BACKGROUND: Bacterial pneumonia and sinusitis are important causes of morbidity in patients with human immunodeficiency virus (HIV) infection. We noted an increased incidence of bacterial bronchitis and bronchiectasis in our patients with HIV infection. METHODS: This study was conducted on persons with HIV infection at a county hospital and clinic. Bronchiectasis was diagnosed by bronchogram and computed tomography in one patient and by computed tomography alone in two others. Bacterial bronchitis was defined by a Gram's stain showing an abundance of neutrophils with a predominance of one or more bacteria and by a confirmatory sputum culture. Bronchoscopy with broncho-alveolar lavage was performed in patients with bronchitis to eliminate other causes of bronchial inflammation. RESULTS: Eighteen episodes of bacterial bronchitis in 10 patients are described. The mean CD4 lymphocyte counts for these patients was 0.061 x 10(9)/L (range, 0.001 to 0.203 x 10(9)/L). The most common pathogens in 18 episodes of bacterial bronchitis were Haemophilus influenzae and Streptococcus pneumoniae (five episodes each) and Pseudomonas aeruginosa (four episodes). Response to antibiotic therapy was usually rewarding though recurrences were frequent. Three patients with well-defined bronchiectasis who appeared to have developed, or who became symptomatic during the course of, HIV infection are described. Their mean CD4 cell count was 0.03 x 10(9)/L (range, 0.024 to 0.037 x 10(9)/L). Haemophilus influenzae, Staphylococcus aureus, Pseudomonas cepacia, and P aeruginosa were recovered from these patients; the P aeruginosa was a mucoid strain. CONCLUSIONS: Recurrent bacterial bronchitis should be added to the list of bacterial infections that occur with increased frequency with HIV infection. Repeated bacterial bronchitis may lead to bronchiectasis, which may be more common in HIV infection than generally appreciated.

Adult↗
PubMed1994

Disseminated cutaneous cryptococcosis. Comparison of clinical manifestations in the pre-AIDS and AIDS eras.

A review of the literature suggests some differences in the cutaneous manifestations of cryptococcosis present in patients in the pre-acquired immunodeficiency syndrome (AIDS) era compared with those manifestations that are present in today's AIDS era. In both periods, cutaneous manifestations can precede and be the sole clue to disseminated cryptococcal infection. Today, cutaneous cryptococcal involvement is often mistaken for molluscum contagiosum or Kaposi's sarcoma. We describe a patient with disseminated cryptococcosis who presented with skin lesions mimicking molluscum contagiosum, and who was subsequently shown to have AIDS.

AIDS-Related Opportunistic Infections↗
PubMed1994

New pathogens in pneumonia.

It appears that many commonly recognized syndromes such as the ARDS may well be caused by agents that have only recently emerged as respiratory pathogens. HPS represents one such entity. It appears likely that the increasing pressure of antibiotic use as well as the reemergence of certain pathogens will continue to challenge the clinician. Paramount to the identification and treatment of unusual pneumonias will be the degree with which an effort is made to make an etiologic diagnosis through sputum examination, transtracheal aspirate, bronchoscopy, or lung biopsy. Although pneumococcal pneumonia is the most common community-acquired pneumonia seen by practicing physicians, in all likelihood from time to time a physician will encounter pneumonia caused by one of the unusual pathogens described in this article or else by an altogether new pathogen.

Humans↗
PubMed1994

Acute exacerbations of chronic bronchitis. Preventing treatment failures and early reinfection.

Although antimicrobial agents from a number of classes have been used with a good degree of clinical success for acute bacterial exacerbations of chronic bronchitis, the incidence of resistance by beta-lactamase-producing strains to certain penicillins and cephalosporins continues to increase and represents a growing clinical problem. There also have been reports of significant resistance by Streptococcus pneumoniae to tetracyclines and of treatment failures caused by this organism among patients receiving fluoroquinolones. The emergence of penicillin-resistant pneumococci in North America also is of concern. Although first-generation cephalosporins are no longer regarded as first-line therapy or optimal alternatives for acute exacerbations of chronic bronchitis, more recently developed agents of this class have better activity against the primary pathogens, and their efficacy and safety have been demonstrated in a number of clinical trials. Newer macrolide agents probably should be reserved for infections caused by atypical organisms.

Acute Disease↗
PubMed1994

Ileal perforation due to cytomegalovirus infection.

This article reports a case of cytomegalovirus (CMV) ileitis with perforation in a woman with transfusion-acquired human immunodeficiency virus (HIV) infection. The clinical problem of small bowel perforation due to CMV disease in association with HIV infection is emphasized. Typically, a patient with a history of chronic diarrhea, fever, and abdominal pain develops the superimposed picture of an acute abdomen and has pneumoperitonium on radiograph. The prognosis is poor.

Acquired Immunodeficiency Syndrome↗
PubMed1993

"AIDS-ology": an interventional specialty.

The AIDS Commentaries have focused primarily upon the clinical aspects of infection due to the human immunodeficiency virus as documented in academic centers based in large metropolitan areas. Clinicians outside the epicenters of the epidemic face a different set of problems. Dr. Verghese has previously shared his experience in caring for persons with AIDS in rural Tennessee (J Infect Dis 1989;160:1051-5). In this latest contribution, he discusses the potential value of training infectious diseases physicians to perform procedures that they usually do not learn in fellowship programs but that are required for optimal management of patients with AIDS. This is a controversial issue that reflects a shift in the infectious disease specialty from a consultative to a primary care practice as a result of the AIDS epidemic. It is an issue worthy of consideration by the directors of infectious disease training programs.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Rapid response of AIDS-related bacillary angiomatosis to azithromycin.

A 28-year-old male with AIDS and a CD4 cell count of 100/mm3 presented with fever, hepatosplenomegaly, weight loss, and multiple, polypoid, angiomatous lesions on his face. It was determined by means of biopsy that the lesions were due to bacillary angiomatosis. The patient was treated with oral azithromycin (1 g daily as a single dose). Rapid resolution of the skin lesions was noted. After 1 week of therapy, diminution in the size of the liver and spleen was noted. The only significant side effect noted was diarrhea, which was controlled with symptomatic therapy.

AIDS-Related Opportunistic Infections↗