Biomedical subjects
Publications and source records attributed to C Carmichael.
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Human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome in women of childbearing age are increasing rapidly in the United States. Perinatal transmission can occur during pregnancy, delivery or breast feeding. Because 90 percent of pediatric HIV infections are caused by perinatal transmission, the U.S. Public Health Service has recommended that all pregnant women be offered HIV counseling and testing. Factors that influence perinatal transmission include high maternal viral load, low maternal CD4 count, prolonged rupture of the membranes, premature delivery and symptomatic maternal HIV infection. The results of a recent clinical trial demonstrate that if HIV-infected women become pregnant, the use of zidovudine during the prenatal, intrapartum and neonatal periods can decrease by two-thirds the likelihood of HIV transmission to the baby. The U.S. Public Health Service, in conjunction with the American Academy of Family Physicians, has strongly recommended expanding the current noncoercive, voluntary HIV testing to include routine testing of all pregnant women.
This article reviews the importance of preventing illness in HIV-infected patients. The indications and medication regimens for preventing several common opportunistic complications are discussed. Infections addressed include pneumocystis pneumonia, Mycobacterium avium complex, toxoplasmosis encephalitis, and tuberculosis, among others. Other preventive interventions such as routine immunizations are addressed briefly as well. Diagnosis and treatment of five of the most common HIV-associated opportunistic infections are reviewed.
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In common with other hospitals throughout the United Kingdom, a diabetic patient education centre has been established at the Victoria Hospital, Kirkcaldy. Many activities now take place within the centre including a 'Novopen' Clinic at which insulin requiring diabetic patients are converted to a multiple injection method of delivering soluble human insulin. An evaluation of the Novopen Clinic, including the first 60 patients attending, has demonstrated a statistically significant fall in random blood sugar estimations (mean fall 2.0 m.moles 1(-1), 95 per cent confidence intervals 1.5 m.moles 1(-1) to 2.5 m.moles) since conversion at the Novopen Clinic. Changes in mean daily insulin intake (mean increase of 1.6 units per day) and glycosylated haemoglobin (mean fall of 0.88 per cent) were not significant. One hundred per cent of patients surveyed described the Novopen Clinic as 'helpful' or very 'helpful'. Staff see the clinic offering significant opportunities for patient education. The estimated cost of the clinic per new patient was 147 pounds.
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Crew-members of the Apollo 14 lunar exploration mission underwent a pre-flight seclusion designed to stabilize their health by freeing them from exposure to potentially infectious agents. After the flight, the crew-members were quarantined to protect the biosphere from possible lunar contamination. These isolations, along with the complete isolation of the spaceflight itself, provided the opportunity for a skin flora survey which included the sampling of seven sites at five different times. Quantification and identification of all aerobic and anaerobic bacteria from each site were performed. The results indicated that the pre-flight quarantine measures resulted in a decrease in total numbers of isolates as well as a decrease in the anaerobes. This was followed by a continued decrease throughout the flight with a return to the pre-flight norm within 16 days after the flight. The quantitative load of aerobic bacteria increased during the flight, due largely to an increase in coryneforms and micrococcaceae. The quantitative load of anaerobic bacteria decreased before and during the flight. No instance of microbial shock or intercrew transfer of micro-organisms was demonstrated. These findings indicate that alterations in the skin flora do not pose any unusual problem during short duration space flights. Further, there are no indications that problems will arise on longer missions.
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Worldwide, and in pockets of poverty in the United States, there is growing evidence that poverty is a major contributor to the spread of human immunodeficiency virus infection. Specific socioeconomic forces contributing to the spread of the infection include the status of women, prostitution, drug use in poor populations, the role of prisons, economic factors that disrupt families, and cultural attitudes. A lack of awareness of or an unwillingness to address the social, cultural, and economic forces contributing to the transmission of the human immunodeficiency virus have hampered attempts to stem the epidemic. A "social prevention" strategy is called for in which socioeconomic influences on human immunodeficiency virus transmission can be ameliorated. Practicing physicians should be aware of these forces because they profoundly influence the effectiveness of patient education, prevention, and treatment.
A 6-month, Phase I clinical study evaluated Opti-Free, a new polyquaternium-1 chemical disinfectant intended for use with all types of soft contact lenses. Fifty-one patients were enrolled and divided into two groups. Group A used the product under exaggerated conditions, with daily exposure of Durasoft 3 (55%) and Hydrocurve II (55%) medium water content, ionic lenses to 5 mL of Opti-Free for 16 hours. Beginning on day 15, group A patients began a normal daily use schedule. Patients in group B wore CSI (38%), Permalens (71%), and Softcon (55%) contact lenses and used the regimen under normal daily use conditions throughout the study. The result indicate that Opti-Free is safe and effective under both normal and exaggerated use conditions. The implications of these data for patient safety are discussed.