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Biomedical subjects

B A Cohen

Publications and source records attributed to B A Cohen.

At least 55 records · Page 3Linked to original sources
PubMed1993

Dementia in AIDS patients: incidence and risk factors. Multicenter AIDS Cohort Study.

We determined incidence and future projections of dementia after AIDS onset in 492 homosexual men with AIDS in the Baltimore/Los Angeles sites of the Multicenter AIDS Cohort Study, 64 of whom developed dementia. We studied various risk factors for dementia, including demographic and clinical features, medical history, markers of immune status before AIDS, and zidovudine use. During the first 2 years after AIDS, HIV dementia developed at an annual rate of 7%. Overall, 15% of the cohort followed through death developed dementia. The median survival after dementia was 6.0 months. Using a proportional hazards model, risk factors for more rapid development of dementia were lower hemoglobin (relative hazard, 0.59 per additional 2 g/dl; p = 0.0005) and body mass index (relative hazard, 0.64 per additional 5 kg/m2; p = 0.05) 1 to 6 months before AIDS, more constitutional symptoms 7 to 12 months before AIDS (relative hazard, 1.68 per additional symptom, p = 0.005), and older age at AIDS onset (relative hazard, 1.60 per decade older; p = 0.009). In a multivariate model, pre-AIDS hemoglobin remained the most significant predictor of dementia. There were no significant risks defined from demographic characteristics, specific AIDS-defining illnesses, zidovudine use before AIDS, or CD4+ lymphocyte count before AIDS. We project that 12 months after the first AIDS diagnosis, 7.1% of survivors will have dementia. The observed association between anemia, low weight, constitutional symptoms, and dementia suggests a role for cytokines inducing both systemic and neurologic disease.

AIDS Dementia Complex↗
PubMed1993

Neurologic prognosis of cytomegalovirus polyradiculomyelopathy in AIDS.

Cytomegalovirus (CMV) polyradiculomyelopathy is an uncommon but distinctive clinical syndrome in HIV-infected patients in which ascending motor weakness, areflexia, loss of sphincter control, paresthesias, and varying sensory impairment develop subacutely in association with a polymorphonuclear pleocytosis, increased protein, and hypoglycorrhachia in CSF. Responses to treatment with ganciclovir have varied in reported cases. We report three additional cases: two of these patients responded to treatment and the third was demonstrated to have CMV resistant to ganciclovir. We review other reported cases and identify factors predictive of ganciclovir resistance, which include persistent polymorphonuclear pleocytosis and hypoglycorrhachia on serial CSF studies, and positive CMV cultures from CSF or blood after induction therapy. We conclude that ganciclovir may be an effective therapy for CMV polyradiculomyelopathy, but the presence of these factors, or the development of the syndrome in a patient already being treated with ganciclovir, should prompt consideration of alternative antiviral therapy.

AIDS-Related Opportunistic Infections↗
PubMed1993

Low education as a possible risk factor for cognitive abnormalities in HIV-1: findings from the multicenter AIDS Cohort Study (MACS).

The present study reports new and unexpected results of cognitive abnormalities among human immunodeficiency virus type 1 (HIV-1) asymptomatic subjects in the Multicenter AIDS Cohort Study. The major purpose of our analyses is to estimate the separate and combined effects of serostatus and education level on the prevalence of cognitive abnormality. Cognitive "abnormality" was defined as performance that deviated > or = 2 SDs below the mean of the total seronegative group on at least one of the five neuropsychological screening tests (Grooved Pegboard, Verbal Fluency, Digit Span, Symbol Digit Modalities, Rey Auditory Verbal Learning). The predicted prevalence of cognitive abnormality was 38% in seropositive individuals with no more than 12 years of education, compared with < 17% in the other education-serostatus groups. This interaction between education level and serostatus remained after controlling for the possible confounding effects of age, ethnicity, CD4 level, depression, prior drug history, and learning disability using logistic regression. To account for these findings, we suggest that low education might reflect an indirect index of lower reserve capacity (i.e., a risk factor) that lowers the threshold for neuropsychological abnormalities in cases of early HIV-1 infection.

AIDS Dementia Complex↗
PubMed1992

Tinea pedis in children.

OBJECTIVE: To demonstrate that tinea pedis should be considered in the differential diagnosis of children with foot dermatitis. DESIGN: Patient series. SETTING: Outpatient dermatology practice at the Children's Hospital of Pittsburgh (Pa). PARTICIPANTS: Children with culture-proven tinea pedis from 1987 until 1990. MEASUREMENTS/MAIN RESULTS: Fungal cultures were used to identify 13 girls and 13 boys ranging in age from 17 months to 18 years with tinea pedis. A parent was the probable source of infection in at least 25% of cases. CONCLUSIONS: Tinea pedis is not a rare occurrence in children and should be considered in any patient with a foot rash.

Adolescent↗
PubMed1992

Behavioral adjustment and self-concept of young children with hemangiomas.

This study was conducted to determine the behavioral responses and self-concepts of young children with self-limited but transiently disfiguring capillary hemangiomas involving the head and neck. Nineteen children with hemangiomas, age 3 to 5 years, and their parents were compared with an age-matched control group without lesions. Responses to a parental checklist, informal interview, and self-concept test showed few differences between young children with hemangiomas and those without this neoplasm.

Adaptation, Psychological↗
PubMed1992

The diagnostic utility of elevation in cerebrospinal fluid beta 2-microglobulin in HIV-1 dementia. Multicenter AIDS Cohort Study.

We measured serum and CSF beta 2-microglobulin (beta 2M) levels in HIV-1 seropositive individuals with and without dementia to determine the frequency and diagnostic utility of elevation of CSF beta 2M. We compared 34 samples from 27 patients with HIV-1 dementia with 110 samples from 54 HIV-1 seropositive participants in the Multicenter AIDS Cohort Study, none of whom had progressive dementia. Neurosyphilis and CNS opportunistic processes were excluded in all subjects. We stratified the nondemented subjects by duration of HIV seropositivity and peripheral blood CD4 count. Compared with the nondemented group, demented subjects had significantly higher CSF total protein, IgG%, and CSF albumin/serum albumin ratios. A highly significant association was found between elevated CSF beta 2M and reduced CD4 count (p less than 0.0001). No significant differences were noted between the demented and nondemented groups in CSF WBC count or in the frequency of CSF HIV-1 isolation. The mean CSF beta 2M was 1.9 mg/l in the nondemented subjects compared with 4.2 mg/l in those with dementia (p less than 0.0001). We derived a cutoff of 3.8 mg/l from the distribution of CSF beta 2M in the nondemented group. The determination of CSF beta 2M had a sensitivity of 44%, specificity of 90%, and a positive predictive value of 88% for diagnosis of HIV dementia when compared with nondemented subjects with CD4 counts less than 200. In those without dementia, there was a strong correlation between serum and CSF beta 2M (r = 0.50, p less than 0.0001), but in demented subjects CSF beta 2M was elevated independently of serum levels, suggesting that CSF beta 2M is produced within the brain in HIV dementia. In the absence of CNS opportunistic processes, elevated CSF beta 2M greater than 3.8 mg/l is a clinically useful marker for HIV dementia.

AIDS Dementia Complex↗
PubMed1992

Hemorrhagic stroke due to cerebral vasculitis and the role of immunosuppressive therapy.

Cerebral vasculitis may occur in isolation or in conjunction with a systemic illness. Although a relatively infrequent cause of intracerebral or subarachnoid hemorrhage, it should be considered in a setting of relevant systemic symptoms, an unexplained progressive neurologic disorder, or in a patient lacking risk factors for hemorrhagic stroke. Diagnosis may be difficult because the results of most studies may be normal or nonspecific. Because treatment is effective in many of the cerebral vasculitides, vigorous pursuit of the diagnosis is warranted.

Adrenal Cortex Hormones↗
PubMed1991

Predictability of adequacy of spinal root decompression using evoked potentials.

Dermatomal evoked potentials are being used to obtain accurate information concerning the viability of specific nerve root pathways and the quality and extent of nerve root decompression. Twelve patients with quantifiable weakness were selected and tested before, during, and after surgery. Nine patients showed dramatic intraoperative electrical improvement, including decreased latencies and/or increased amplitudes; all had postoperative relief of pain and motor return. Three patients showed variable intraoperative electrical responses with complete pain relief but no motor improvement. No patients had false-negative findings. Intraoperative monitoring of dermatomal evoked potentials appears to be of value in predicting the quality of spinal decompression. Similar monitoring of somatosensory evoked potentials alone cannot provide the specificity for individual root levels that is available by monitoring individual dermatomes.

Adult↗
PubMed1991

Pudendal nerve evoked potential monitoring in procedures involving low sacral fixation.

Pudendal nerve evoked potentials were used in orthopaedic surgical procedures involving fixation below the S1 level. Pudendal nerve stimulation was used to monitor 154 patients. Eleven patients (7.14%) had responses that were either difficult or impossible to interpret in that they were not consistently replicable. In one case (0.65%), responses were lost during surgery, and there were no subsequent neurologic sequelae (false-positive response). No patients had postoperative deficit to the sacral roots or to the global cord. Although it is possible to obtain definitive dermatomal responses down to S1, the use of pudendal nerve stimulation was found to provide additional means of monitoring lower sacral roots. Since the pudendal nerve is intimately associated with bowel, bladder, and sexual dysfunction, easily obtainable routine monitoring of this nerve can provide significant safety that the conventional somatosensory and dermatomal responses give to higher spinal levels.

Adolescent↗
PubMed1990

Anogenital warts in children. Clinical and virologic evaluation for sexual abuse.

Seventy-three children with anogenital warts were examined for sexual abuse during a 2-year period. Our data suggest that nonsexual transmission is common, particularly in children under 3 years of age. Approximately 25% of these children were younger than age 1 year, and another 50% were between the ages of 1 and 3 years. No evidence of sexual abuse was detected in 66 children.

Child↗