Biomedical subjects

B Afessa

Publications and source records attributed to B Afessa.

23 records · Page 2Linked to original sources

PubMed1995

Pneumococcal bacteremia in adults: a 14-year experience in an inner-city university hospital.

We retrospectively reviewed 304 episodes of pneumococcal bacteremia in 293 adults to compare the clinical features, prognostic factors, and case-fatality rate associated with this illness to those in previous studies. We studied patients at an inner-city university hospital who had pneumococcal bacteremia from January 1980 through December 1993. We analyzed patient demographics, risk factors for pneumococcal infection, pneumococcal vaccination status, initial vital signs, findings on chest roentgenograms, arterial blood gases, and laboratory values. Ninety-six percent of our study population was African American and 61% were male; pneumococcal vaccination was documented for 2%. The case-fatality rate in our study was 36%. Older age, lower mean arterial pressure, lower mean temperature, higher respiratory rate, multilobar pneumonia, leukopenia, low platelet count, hypoalbuminemia, low arterial pH, low arterial oxygen tension, and high arterial carbon dioxide tension were associated with higher mortality. Our study suggests that mortality due to pneumococcal bacteremia has not changed significantly in the last 6 decades, that the number of patients in high-risk groups who are receiving pneumococcal vaccine is insufficient, and that higher mortality can be predicted from the history, vital signs, and laboratory values at initial presentation.

Adult↗

PubMed1993

Pulmonary complications of orthotopic liver transplantation.

We retrospectively reviewed the pulmonary complications and associated morbidity and mortality of 44 consecutive patients who underwent 52 orthotopic liver transplantations (OLTs) at the Mayo Clinic during 1987. All survivors participated in follow-up for 1 year after OLT. Of the five deaths in the study group, three were associated with pulmonary infections. On postoperative chest roentgenograms, 24 cases of pulmonary infiltrates were noted; 12 were caused by infections. Ten opportunistic pulmonary infections developed in nine patients: four cytomegalovirus, three Pneumocystis carinii pneumonia, and one each of Cryptococcus, Aspergillus, and Candida. All except one of the opportunistic infections were diagnosed after the sixth postoperative week. Fiberoptic bronchoscopy was helpful for diagnosing opportunistic pulmonary infections in six patients. One Aspergillus pulmonary infection was diagnosed by transthoracic needle aspiration. Bacterial pneumonia occurred in five patients. Preoperative pulmonary function tests, performed in 40 patients, revealed a restrictive ventilatory defect in 28% and impaired gas transfer in 52%. Pleural effusion was present in 18% of patients preoperatively and in 77% during the first week after OLT. Preoperative severity of liver disease and results of arterial blood gas determinations, pulmonary function tests, and chest roentgenography were not associated with postoperative mortality and pulmonary infections. Infectious and noninfectious pulmonary complications are common in liver transplant recipients. Attempts to decrease the frequency and severity of pulmonary complications by early diagnosis and effective treatment may diminish the morbidity and mortality associated with OLT.

Adult↗

PubMed1992

Outcome of recipients of bone marrow transplants who require intensive-care unit support.

To determine the outcome and prognostic factors associated with bone marrow transplantation (BMT), we reviewed the clinical course of 35 adult recipients of such a transplant who were admitted to our intensive-care unit (ICU). This constituted 24% of patients who underwent BMT for treatment of hematologic disorders during the study period. The reasons for admission to the ICU were postsurgical care in 5, respiratory failure in 25, shock in 4, and renal failure in 1. The in-hospital mortality was 20% for the postsurgical patients and 87% for the others. None of the postsurgical patients required mechanical ventilation, whereas 90% of the others did, and the associated mortality was 93%. Infection was the cause of the respiratory failure in all but 3 of the 25 patients and was associated with 95% mortality. Complications that involved multiple organs increased the mortality to 100%. No significant differences were found in age, sex, type of BMT, serologic tests for cytomegalovirus, history of graft-versus-host disease, conditioning regimen for BMT, and duration of stay in the ICU and the hospital between survivors and nonsurvivors. The APACHE II (acute physiology and chronic health evaluation) prognostic scoring system underestimated mortality and had no correlation with the duration of stay in the ICU or the hospital. Vasopressors, total parenteral nutrition, and transfusion of blood components in the ICU had no influence on the outcome. Open-lung biopsy was helpful in making specific diagnoses, and pulmonary artery catheters were used in most patients to guide therapy but did not improve survival.(ABSTRACT TRUNCATED AT 250 WORDS)

Academic Medical Centers↗

PubMed1992

Autopsy findings in HIV-infected inner-city patients.

To assess the importance of the autopsy in HIV-1 infection, we retrospectively reviewed the autopsy reports of 70 HIV-1-seropositive patients at Howard University Hospital. Of the 58 patients with AIDS, the diagnosis of AIDS was made after autopsy in 24 (41%) cases. The lung was the most common site of AIDS-diagnostic diseases, and was affected in 90% of patients. Pneumocystis carinii infection was the most common AIDS-diagnostic disease, and was present in 50% of the AIDS patients. Thirty-eight percent of AIDS diagnostic diseases were diagnosed antemortem, including 15 of the 29 Pneumocystis carinii infections. Most of the AIDS-diagnostic diseases were disseminated at autopsy and two or more diseases were found in some organs. Overall, Pneumocystis carinii pneumonia was the most common cause of death, accounting for a mortality of 43% among AIDS patients. Bacterial infections were common and contributed to the mortality and morbidity of both AIDS and non-AIDS patients. Bacterial infection was the cause of death in 15 AIDS and 9 non-AIDS patients. The clinical cause of death concurred with the pathological cause in 53% of our cases.

Adult↗

PubMed1988

Pneumocystis carinii pneumonia complicated by lymphadenopathy and pneumothorax.

A case of generalized Pneumocystis carinii infection presented as hilar and mediastinal lymphadenopathy and was complicated by spontaneous pneumothorax. Extrapulmonary P carinii infection in patients with acquired immunodeficiency syndrome is rare, and pneumothorax is even rarer. The purpose of this report is to call attention to these atypical features of P carinii infection in patients with the acquired immunodeficiency syndrome.

AIDS-Related Complex↗