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Biomedical subjects

C C Carpenter

Publications and source records attributed to C C Carpenter.

At least 19 recordsLinked to original sources

The treatment of cholera: clinical science at the bedside.

In 1959-1961, two major international centers for the study of cholera were established in Calcutta and in Dacca, Bangladesh. As the result of collaborative work in these centers, a simple effective oral therapy for cholera, using ingredients available in virtually every part of the world, was defined. Through the well-coordinated efforts of the World Health Organization (WHO), knowledge of how to prepare and administer oral rehydration therapy has now been disseminated throughout most of the world. With this background, when Peru was attacked in 1991 by a massive and totally unanticipated outbreak of cholera, a remarkably well-organized national response to the epidemic achieved a survival rate greater than 99% in greater than 300,000 cholera patients during the first year of the epidemic. Thus the results of clinical research on the Indian subcontinent, widely disseminated through educational programs by the WHO, have resulted in unparalleled success in the treatment of the largest epidemic outbreak of cholera in the 20th century.

Animals

Women and AIDS.

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Acquired Immunodeficiency Syndrome

Human immunodeficiency virus infection in North American women: experience with 200 cases and a review of the literature.

This study was designed to define the epidemiology and natural history of human immunodeficiency virus (HIV) infection in women in Rhode Island. Two hundred women referred to Brown University physicians from 1986 through 1990 were evaluated at 3-to-6-month intervals for 12 to 60 months. All received antiretroviral therapy and prophylaxis against opportunistic infections when indicated on the basis of CD4 lymphocyte counts. Major findings included: 1) rapid shift of dominant mode of transmission from intravenous drug sharing to heterosexual route; 2) significant gender-specific differences in clinical presentation; 3) increased frequency of cervical dysplasia in women infected via intravenous needle sharing; 4) no definite gender-specific differences in progression of HIV infection; 5) enormous societal impact of HIV infection in women. Principal conclusions are: 1) rapid change to predominantly heterosexual HIV transmission can occur in North America, with serious societal impact; 2) gender-specific clinical features can lead to earlier diagnosis of HIV infection in women; 3) HIV infection in women does not pursue an inherently more rapid course than that observed in men.

Adolescent

Plasma adenosine deaminase2: a marker for human immunodeficiency virus infection.

Plasma concentrations of the two isoenzymes of adenosine deaminase (ADA, E.C. 3.5.4.4), adenosine deaminase1 (ADA1) and adenosine deaminase2 (ADA2), were measured in a cohort of ambulatory patients infected with the human immunodeficiency virus (HIV) and controls. A sensitive isoenzyme-specific radioisotopic assay system was developed for these studies. Among 22 HIV-infected patients, plasma ADA2 was significantly elevated as compared with 16 control subjects (p less than 0.01) and 6 uninfected subjects having a risk factor for HIV infection (p less than 0.01). Plasma ADA2 was not associated with the stage of disease as defined by clinical status (p greater than 0.05) or helper (CD4) lymphocyte count (p greater than 0.05). Available evidence suggests that elevated plasma ADA2 could be a useful surrogate marker for HIV infection that occurs early in the disease process.

Adenosine Deaminase

Hierarchical pattern of mucosal candida infections in HIV-seropositive women.

PURPOSE: Candida is the most common cause of opportunistic mucosal infections in human immunodeficiency virus (HIV)-positive women. We had observed an apparent correlation between the severity of immunodeficiency and the site of mucosal candida infection. The current study was designed to determine whether significant correlations existed between the sites of mucosal candida infection and the degree of immunodeficiency, as determined by subsets of lymphocyte populations. PATIENTS AND METHODS: The subjects in this study are 66 HIV-seropositive women evaluated by members of the Brown University Acquired Immunodeficiency Syndrome (AIDS) Program during the 3-year period, September 1, 1986, through August 30, 1989. All patients had thorough clinical evaluations and relevant laboratory studies at defined intervals. All patients with CD4 lymphocyte counts below 0.2 X 10(9)/L received zidovudine therapy as soon as it became available. After July 1988, all patients with CD4 counts below 0.2 X 10(9)/L received prophylaxis against Pneumocystis carinii pneumonia. All patients were counseled about HIV infection, its modes of transmission, and the early symptoms of opportunistic infections. RESULTS: The longitudinal data demonstrated that candida often infected vaginal mucosa when there was no significant reduction in CD4 lymphocyte counts. Candida infection of the oropharyngeal mucosa was associated with highly significant reductions in CD4 lymphocyte counts. Esophageal candidiasis occurred only with advanced immunodeficiency associated with CD4 counts below 0.1 X 10(9)/L. CONCLUSIONS: Candida mucosal infections occur in a hierarchical pattern in women with HIV infection. Determination of the basis for the differences in susceptibility to candida of the vaginal, oropharyngeal, and esophageal mucosal surfaces will require further studies.

Adolescent

Natural history of acquired immunodeficiency syndrome in women in Rhode Island.

PURPOSE: Current recommendations for treatment of human immunodeficiency virus (HIV) infection and for prophylaxis against associated opportunistic infections in North America are largely based on observations of HIV infection in males. In an effort to determine whether the natural history and clinical course may be different, with implications relevant to prophylaxis against opportunistic infections, we have documented the clinical courses of the first 24 known cases of acquired immunodeficiency syndrome (AIDS) in women in Rhode Island, most of whom developed Centers for Disease Control-defined AIDS before the availability of an effective antiviral agent (i.e., zidovudine) or a well-defined approach to prophylaxis against opportunistic infections (e.g., oral trimethoprimsulfa). PATIENTS AND METHODS: The subjects in this study are 24 women with AIDS who were treated by members of the Brown University medical faculty from June 1982 through June 1988. All patients had thorough clinical evaluations and appropriate laboratory studies as they became available. All were followed at intervals no greater than two months. All opportunistic infections were treated by appropriate, specific antimicrobial therapy. When zidovudine became available, it was administered to all remaining patients in the study. All subjects were counseled about HIV infection, its modes of transmission, and the early symptoms of opportunistic infections. RESULTS: These observations yielded the following three major findings: (1) Candida esophagitis was the most common (38%) AIDS-defining event; (2) Pneumocystis carinii pneumonia was less frequently the AIDS-defining event (13%) and occurred less commonly during the illness (29%) than in North American males with AIDS; (3) Of 14 women in whom the diagnosis of AIDS was established before January 1, 1987, the mean survival time after diagnosis was greater than 20 months. CONCLUSION: More information on the natural history of HIV infection in North American women is urgently needed. If more extensive data from other geographic regions confirm the observations in this study, the optimal approach to prophylaxis against opportunistic infections in women with AIDS may be substantially different from that which is most appropriate for males.

Acquired Immunodeficiency Syndrome

Epidemiology of human T cell leukemia virus type I infection in East Sepik Province, Papua New Guinea.

A serological survey of 317 healthy residents of rural Papua New Guinea (PNG) showed a 26% prevalence of antibodies to human T cell leukemia virus type I (HTLV-I). Antibody to HTLV-I was detected in 16% of children less than or equal to 10 years old (including an 18-month-old child) and increased to greater than or equal to 24% in subjects greater than 20 years old. Prospective examination for antibody in 104 residents of one village revealed a seroconversion rate of 13% over a one-year period. The mean titer of antibody in these subjects (1:183) was lower (P less than .0005) than that in persons who were persistently seropositive (1:718). Analysis for clustering of infected subjects suggested that personal contact within the home played a role in the horizontal spread of HTLV-I. These data indicate that HTLV-I infection has a higher prevalence in PNG than in other endemic parts of the world, exposure occurs at an early age, and infection and/or seroconversion is common in adults as well as in children.

Adolescent

Skin turgor.

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Body Water

Effect of intra-arterial injection of crude cholera enterotoxin on canine small bowel.

Injection of a crude preparation of cholera enterotoxin into the superior mesenteric artery caused isotonic fluid secretion by the canine small bowel. In dogs previously exposed to cellular antigens of Vibrio cholerae, the time course of the intestinal response to intra-arterial injection of crude enterotoxin was similar to that observed after intraluminal exterotoxin challenge.

Animals