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Biomedical subjects

B Gazzard

Publications and source records attributed to B Gazzard.

At least 145 records · Page 8Linked to original sources
PubMed1991

A comparison of several agents with two delivery systems for the prevention of airway narrowing induced by nebulised pentamidine isethionate.

Bronchial narrowing is the major side effect of inhaled nebulised pentamidine isethionate, used for the prophylaxis and treatment of Pneumocystis carinii pneumonia. Several agents and delivery systems were assessed for prophylaxis of bronchial narrowing in HIV-positive males receiving regular nebulised pentamidine isethionate. In a previous study we found the mean maximum fall in FEV1 with nebulised pentamidine alone to be 21%. FEV1 was measured before and after inhaling nebulised pentamidine, preceded by one of the following bronchodilator/immunoregulatory agents: Terbutaline metered dose inhaler (500 micrograms), nebulised salbutamol (5 mg), nebulised ipratropium bromide (500 micrograms), nebulised sodium cromoglycate (20 mg), and nedocromil sodium metered dose inhaler (4 mg). Each agent was administered once only to ten different subjects. Nebulised salbutamol gave most effective prophylaxis against bronchial narrowing induced by nebulised pentamidine (mean maximum fall in FEV1 = 5% vs. 21%, P less than 0.001). Terbutaline given by metered dose inhaler was significantly less effective than high dose terbutaline (10 mg) given by nebuliser, demonstrated in the previous study (mean maximum fall in FEV1 = 14% vs. 6%, P less than 0.05). Mean maximum falls in FEV1 for ipratropium bromide, sodium cromoglycate and nedocromil sodium were 16, 17 and 16%, respectively. High dose beta 2-agonists administered by nebuliser give more effective prophylaxis against nebulised pentamidine-induced bronchial narrowing than either lower doses given by metered dose inhaler, anticholinergics or immunoregulatory drugs.

Adult↗
PubMed1991

Recovery of the human immunodeficiency virus from fibreoptic bronchoscopes.

Ten bronchoscopes that had been used on patients with the acquired immunodeficiency syndrome were sampled to determine the nature and extent of microbial contamination. Samples were taken by irrigating the suction biopsy channel with modified viral transport medium and by swabbing the insertion tube. Sampling was repeated after they had been cleaned in detergent and after two minutes' disinfection in 2% alkaline glutaraldehyde. Before being cleaned the seven bronchoscopes tested by polymerase chain reaction were contaminated with the human immunodeficiency virus, though infectivity and antigen assays gave negative results. Other organisms identified were hepatitis B virus (1), commensal bacteria (9), and Pneumocystis carinii (4). Mean bacterial contamination was 2.27 log colony forming organisms per millilitre. Cleaning the bronchoscope before disinfection removed all detectable contaminants with a reduction in bacterial growth of up to 8 log colony forming units/ml.

Bronchoscopes↗
PubMed1991

Treatment and prophylaxis of Pneumocystis carinii pneumonia in AIDS patients.

Pneumocystis carinii pneumonia (PCP) is seen in people with a defect in cell-mediated immunity. Today the most common cause for this is the Acquired Immunodeficiency Syndrome (AIDS). There have been some remarkable advances recently in the development of new drug regimens to combat this otherwise fatal infection. Although cotrimoxazole (trimethoprim-sulfamethoxazole) is still the drug of first choice it cannot be tolerated by a significant proportion of patients, and therapies such as pentamidine (pentamidine-isethionate) [intravenous or nebulised], dapsone-trimethoprim, eflornithine (DFMO; difluoromethylornithine), trimetrexate, and clindamycin-primaquine are finding therapeutic niches. The major advantage in these other agents is not improved efficacy but different toxicity profiles, enabling therapy to be most appropriately tailored to individual patients' conditions. Although the majority of patients should now survive an attack of PCP, relapses will occur if prophylaxis is not used. There is also the capacity to predict accurately which patients are at risk for this pneumonia and prevent it through the use of chemoprophylaxis. These advances in the treatment and prevention of PCP, together with anti-retroviral therapy, mean that this is an area of AIDS management that has resulted in improved long term survival.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Model of care for the hospital treatment of individuals with HIV infection.

This study was undertaken and completed in 1988, in an attempt to determine the reasons for admission to hospital, and the optimum care required for patients with Human Immunodeficiency Virus related illnesses. Approximately half of the total medical admissions stayed for less than a week, and patients admitted for terminal care and social care occupied a relatively small proportion of the beds. The single largest group of admissions were those for inpatient management of AIDS-related pneumonias. The results of this study provide a greater understanding of the resources currently required for such care, and suggest initiatives for meeting future needs.

Bed Occupancy↗
PubMed1990

Surgical management of anorectal disease in HIV-positive homosexuals.

One thousand and ninety human immunodeficiency virus (HIV)-positive homosexual or bisexual males were seen in one hospital for management of HIV disease over a 9-year period. One hundred and fifty-five patients were referred by acquired immunodeficiency syndrome (AIDS) physicians for general surgical management. The most frequent reason for surgical referral (64 patients) was anorectal disease which occurred in 5.9 per cent of all HIV-positive patients. One or more diagnoses were reached in 61 of the 64 patients referred with anorectal disease: warts (38 per cent of diagnoses), anorectal ulceration (26 per cent), perianal sepsis (15 per cent), neoplasia (14 per cent) and haemorrhoidal disease (8 per cent). Anorectal symptoms were relieved in 68 per cent of patients and the median survival of those treated was 17.5 months from the time of surgical referral. Both warts and perianal sepsis were associated with in situ neoplasia, but no case of progression from in situ to invasive anal squamous carcinoma was detected. The aetiology of anorectal ulcers was not clear, but surgical excision of anal ulcers and skin tags can produce healing. Palliation of anorectal symptoms in HIV-positive homosexual patients is possible but some conditions are unusual and surgeons should be familiar with their presentation and management.

Abscess↗
PubMed1990

The value of serum cryptococcal antigen in the diagnosis of cryptococcal infection in patients infected with the human immunodeficiency virus.

Serum cryptococcal antigen titres were measured in 828 HIV-infected patients with pyrexia, 69 of whom had meningism. Serum cryptococcal antigen was positive in 17 patients of whom 16 had meningism with cryptococcus isolated from their CSF. The other patient had no meningism, had no evidence of cryptococcal infection on repeated CSF examination and remains well. A positive serum cryptococcal antigen test was therefore valuable in the diagnosis of cryptococcal meningitis, although in all 16 patients meningism was present and a diagnostic lumbar puncture was therefore carried out. In our experience routine screening for serum cryptococcal antigen did not predict patients who subsequently developed cryptococcal meningitis.

Amphotericin B↗
PubMed1990

AIDS: an overview.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Treatment of acquired immune deficiency syndrome (AIDS)-related pneumonitis with foscarnet: a double-blind placebo controlled study.

A double-blind placebo controlled trial of foscarnet was conducted in 32 Human Immunodeficiency Virus (HIV) antibody positive male homosexuals with a presumed AIDS pneumonia. The study was designed to evaluate the importance of treating cytomegalovirus (CMV) as a possible lung pathogen of these patients and as a toxicity study of foscarnet. Trial subjects were randomised to receive either foscarnet or placebo as a continuous intravenous infusion for 2 weeks along with conventional therapy against Pneumocystis carinii (PC) pneumonia. Bronchoscopy or post-mortem showed PC to be present in 24 patients and the bronchoalveolar lavage fluid had early antigen foci of CMV in nine, five of these being double infections. The incidence of CMV infection in this group of patients was not sufficiently high to prove or disprove that treatment of CMV speeds recovery or improves prognosis in AIDS pneumonias. Overall however foscarnet was well tolerated with a slight increase in adverse reactions in the treated groups. This agent is therefore a relatively non-toxic drug to use in the treatment of established CMV disease.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Polymerase chain reaction evidence for human immunodeficiency virus 1 neutralization by passive immunization in patients with AIDS and AIDS-related complex.

We tried to assess the long-term safety and potential efficacy of passive immunization in AIDS-related-complex (ARC) and AIDS patients. We also wanted to establish whether hyperimmune plasma from healthy human immunodeficiency virus 1 (HIV-1)-infected individuals clears the cell-free virus from circulation. Using the polymerase chain reaction (PCR), we were able to provide conclusive evidence that hyperimmune plasma is effective and maintains long-term neutralization of viremia. Using the cell test, we found that in most patients the total antibody level was maintained; in one of the ARC patients, it actually increased 8-fold and has remained at that level for nearly 2 years. The CD4+ cell count decreased in the AIDS patients but was stable in the ARC patient. Clinically, there was an initial improvement in all patients, but five of six of the advanced/terminal AIDS patients had died by month 17. Our studies suggest that passive immunization may be safe in ARC and AIDS patients. It reduces HIV-1 viremia to levels undetectable even by PCR. To advanced/terminal patients, the benefit is of limited duration, while to ARC patients it may be long-term. Therefore, passive immunization should start early in the disease.

AIDS-Related Complex↗
PubMed1990

Voluntary HIV testing in the antenatal clinic: differing uptake rates for individual counselling midwives.

This study looked at 12 midwives in the Riverside Health Authority who counselled parturient women about having the HIV antibody test. Results showed that the uptake rate of the test varied considerably across midwives (82% to 3%). Uptake rate varied, to some extent, by ethnic group of the midwife; Afro-Caribbeans having 36% uptake, others 11%. However, the wide variation within these groups suggests that ethnicity alone does not explain the difference in uptake rate. Factors which could be associated with uptake rate are the individual characteristics of both the midwife and of the antenatal clinic attender, such as age, ethnicity, knowledge of and attitudes to HIV and antibody testing, as well as the counselling approach of the individual midwife.

AIDS Serodiagnosis↗
PubMed1990

Anti-CD4 autoantibodies and screening for anti-idiotypic antibodies to anti-CD4 monoclonal antibodies in HIV-seropositive people.

The cell-surface antigen CD4 is the major receptor for HIV. Anti-CD4 autoantibodies and anti-idiotypic antibodies to murine monoclonal anti-CD4 antibodies have been described in HIV-infected people. Ninety-seven sera from HIV-infected people at all stages of disease were examined for the presence of anti-idiotypic antibodies to three anti-CD4 monoclonal antibodies. None were found. The same sera were screened for antibodies reactive with soluble CD4, and five (5.2%) were positive. These antibodies did not recognize native CD4, and it is thought unlikely that they arise as anti-idiotypes to anti-gp120 antibodies.

Antibodies, Anti-Idiotypic↗
PubMed1990

Pneumocystis carinii pneumonia treated with eflornithine in AIDS patients resistant to conventional therapy.

Eflornithine (DFMO) was used to treat 31 AIDS patients with confirmed Pneumocystis carinii pneumonia who had clinically failed treatment with pentamidine, sulphamethoxazole-trimethoprim or both agents as their first-line therapy. Twenty-one of 31 (68%) responded to second-line treatment with 400mg/kg per day of eflornithine. Five patients discontinued treatment because of bone marrow toxicity. Eflornithine appears to be a useful salvage therapy in patients failing first-line treatments.

Acquired Immunodeficiency Syndrome↗