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Biomedical subjects

F Mulcahy

Publications and source records attributed to F Mulcahy.

At least 73 records · Page 4Linked to original sources
PubMed1994

The natural history of HIV infection in women attending a sexually transmitted disease clinic in Dublin.

OBJECTIVE: To determine the progression rates to AIDS in women in Dublin. SUBJECTS AND METHODS: 109 HIV-1 seropositive women who presented to the Department of Genitourinary Medicine, St. James's Hospital, Dublin, were included in a retrospective analysis. Of these 101 (93%) were intravenous drug users (IVDUs), 7 were heterosexual partners of IVDUs and one had a hetero-sexual partner of no known risk group. Forty-four women (40%) had had 57 children since the time of their first known HIV seropositive test. Progression rates from CDC Stage 11/111 to AIDS are computed. Progression curves are generated according to the Kaplan-Meier method using the Statistical Analysis Software (SAS). RESULTS: The estimated cumulative progression rate at 5 years was 24% (SE 6.6%). 17 out of 109 (15.6%) developed AIDS. The mean follow up time was 2.8 years (SE 0.2). The prevalence of oesophageal candidiasis taking development of AIDS as the point in time was 9 out of 17 (53%), of Mycobacterium hominis infection (TB) 5 (29%) and of Pneumocystis carcinii pneumonia (PCP) 2 (12%). There was no statistical difference in progression rates to AIDS between those women who had children after becoming infected versus those who had none. CONCLUSIONS: Progression rates to AIDS in Irish women is higher than reported in other studies of homosexual/bisexual men, but is similar to rates estimated for both male and female IVDUs. Oesophageal candidiasis is the commonest presenting AIDS diagnosis followed by TB, while PCP is rare, contrary to the findings of similar studies in the USA.

AIDS-Related Opportunistic Infections↗
PubMed1993

Oligonucleotide fingerprinting of isolates of Candida species other than C. albicans and of atypical Candida species from human immunodeficiency virus-positive and AIDS patients.

Oligonucleotide fingerprinting of genomic DNA from oral isolates of four different Candida species other than C. albicans and atypical chlamydospore-positive isolates from human immunodeficiency virus (HIV)-positive individuals and AIDS patients was investigated as a means for differentiating between isolates within individual species. Oligonucleotides composed of simple repetitive sequence motifs, including (GACA)4, (GATA)4, (GGAT)4, (GTG)5, and (GT)8, all yielded fingerprints suitable for strain segregation of 8 C. tropicalis isolates, 12 Torulopsis (Candida) glabrata isolates, 8 atypical Candida isolates, and, except for (GATA)4, 2 C. krusei probe in turn and so generate several distinct DNA fingerprints of the same DNA sample. However, none of the probes yielded fingerprints suitable for strain segregation with three C. parapsilosis isolates. The (GATA)4 probe was also used to detect restriction fragment length polymorphisms among a genetically closely related group of atypical Candida isolates on primary isolation from an additional HIV-infected patient. These chlamydospore-positive atypical Candida isolates were sucrose positive, were of C. albicans serotype A, hybridized weakly with the C. albicans-specific mid-repeat sequence probe 27A, and yielded fingerprint profiles by random polymorphic DNA analysis that were distinct from those derived from C. albicans isolates. The C. stellatoidea ex-type strain NCPF 3108 was indistinguishable from the atypical Candida isolates in all these tests and also yielded an identical carbohydrate and nitrogen source assimilation profile by using the ID 32C yeast identification system.

AIDS-Related Opportunistic Infections↗
PubMed1993

Vitamin B12 and folate status in human immunodeficiency virus infection.

Vitamin B12 and folate status were determined in 35 male HIV seropositive patients. Of these, 16 were asymptomatic (CDC II/III) and 19 were symptomatic (CDC IV) according to the Centre for Disease Control (CDC) Classification. Deviations from normal values for serum B12, serum folate and red cell folate were not a common finding in this sample of patients. No patient had low serum B12. One CDC IV patient and two CDC II/III patients were found to have raised serum B12. Dietary intake of vitamin B12 was well above the Reference Nutrient Intake for all patients. Three patients displayed low folate values (one CDC IV patient had low serum folate, one had low red cell folate and one CDC II/III patient had both). No patient displayed elevated serum or red cell folate. Only 56% of the CDC II/III and 36% of the CDC IV group were meeting the Lower Reference Nutrient Intake for folate. The only significant difference between the CDC II/III group and the CDC IV group was a lower red cell folate (although within the normal laboratory range) in the CDC IV group. There was no significant difference in dietary intake and haematological status between the drug users and the homosexuals.

Diet Records↗
PubMed1992

Phlebotomy practices/needles stick injuries/hepatitis B status/among interns in a Dublin hospital.

Needlestick injury is the most important risk event for human immunodeficiency virus (HIV) and hepatitis B Virus (HBV) transmission to health-care workers. We examined phlebotomy practices, the frequency of needle stick injuries, the reporting of such injuries and hepatitis B status among interns in St James's Hospital during a six month period. This study took the form of a questionnaire. The response rate was 100%. 72% had at least one needlestick injury during this time period, 23% had injuries from known HIV sero-positive or hepatitis B surface antigen positive patients, less than 5% of all injuries were reported and only 41% of interns were definitely hepatitis B immune. The majority (77%) resheated needles by hand.

Accidents, Occupational↗
PubMed1991

Evidence of brain methyltransferase inhibition and early brain involvement in HIV-positive patients.

The myelopathy associated with human immunodeficiency virus (HIV) infection closely resembles that in subacute combined degeneration, a disorder of vitamin B12 metabolism. To investigate whether the disorders share a pathogenetic mechanism, S-adenosylmethionine (SAM) and S-adenosylhomocysteine (SAH) were measured in the cerebrospinal fluid (CSF) of 20 HIV-seropositive patients and 30 HIV-negative patients who were undergoing lumbar puncture for other medical reasons. The HIV-seropositive patients had significantly lower CSF concentrations of SAM (mean 77 [SD 25] vs 131 [35] nmol/l; p less than 0.001) and significantly higher concentrations of SAH (30.5 [6.8] vs 19.0 [7.1] nmol/l; p less than 0.001) than the controls. There was therefore a significant difference between the groups in the SAM/SAH (methylation) ratio (HIV 2.7 [1.0] vs control 7.6 [3.4]; p less than 0.001). There were no correlations between SAM or SAH concentrations or methylation ratio and age or sex in both groups, or serum B12 and folate concentrations, CSF folate, serum or CSF methylmalonic acid, risk factors, body mass index, specific drug treatment received, or disease stage in the HIV group. This finding suggests that HIV affects the brain from a very early stage of the infection. We suggest that, as in the pig, the CSF methylation ratio closely reflects that in the brain. In HIV-infected patients a reduced brain methylation ratio would inhibit methyltransferase enzymes, which would lead to hypomethylation in the central nervous system and ultimately to neurological lesions. In a pig model of subacute combined degeneration and in vitamin-B12-deficient human beings, the primary cause of the low methylation ratio is impaired recycling of SAH back to SAM, a process which requires vitamin-B12-dependent methionine synthase. The HIV patients in this study were vitamin B12 and folate replete, which suggests a different cause for the low methylation ratio.

Adult↗
PubMed1990

Cryptococcal meningitis occurring in HIV infected individuals.

Three cases of cryptococcal meningitis in patients with HIV infection are described. A high index of suspicion is required for diagnosis. India ink preparation and culture of the CSF for cryptococcus is mandatory in HIV seropositive patients irrespective of the CSF white cell count and biochemistry.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Nutrition in the management of HIV antibody positive patients: a longitudinal study of dietetic out-patient advice.

The efficacy of a dietetic service was evaluated in an AIDS clinic; 17 asymptomatic (CDC II) and 17 symptomatic (CDC IV) patients participated in a 12 week evaluation of out-patient dietetic advice. The symptomatic group, classified as CDC stage IV according to the Centre for Disease Control classification, were significantly lighter (P less than 0.05) and had significantly lower values for usual weight, current body mass index, mid-upper arm and mid-arm muscle circumferences and triceps and subscapular skinfold thicknesses (P less than 0.05) at the outset of the study. There were no significant differences in nutrient intakes between the two groups. After 12 weeks of dietetic intervention which included personalised advice, prescription of food supplements and the provision of a special food allowance as social welfare payments for the unemployed, there were significant increases in the intakes of most nutrients, the effect being greater with the symptomatic CDC IV group. It is concluded that dietetic intervention has a significant role to play in the management of HIV antibody positive patients.

Adult↗
PubMed1990

Lung pathology in HIV positive patients.

We describe the results of 43 bronchoscopic examinations carried out on 35 patients who were HIV positive. Of these, 13 were intravenous drug abusers, 13 were homosexual or bisexual, six were haemophiliacs, two were homosexual intravenous drug abusers and one was a heterosexual contact of a drug abuser. All underwent investigation because of respiratory symptoms. Aetiological diagnosis could not be made from physical examination, x-ray or routine laboratory tests but, was usually made using bronchoscopy and its associated investigations. Using these techniques, Pneumocystis carinii pneumonia was the commonest diagnosis (19 cases) followed by bacterial infection. Mycobacterial infection accounted for two cases and non-specific interstitial pneumonitis accounted for three. Kaposi's sarcoma was found in one instance and eight investigations were non-diagnostic.

Adult↗
PubMed1990

The emerging AIDS epidemic in Ireland--clinicopathological findings in 23 early cases.

A longitudinal study with follow up to the end of 1989 was carried out on 23 patients with AIDS who had attended St. James's Hospital, Dublin, by the end of 1987. Until then only 33 cases of AIDS had been reported in Ireland. The patients, all of whom had antibodies to human immunodeficiency virus (HIV), were predominantly male, young (mean age 31.3 years) and belonged about equally to three major risk groups: homosexuals, intravenous drug abusers (IVDA) and haemophiliacs. AIDS was diagnosed because of oesophageal candidiasis (8 cases), Kaposi's sarcoma (4), mycobacterial infection (4), pneumocystis carinii pneumonia (3), toxoplasmosis (2) or encephalopathy (2). Malignant lymphoma and a variety of infections occurred in the course of illness, and neurological involvement developed in 11 patients (48%). Mortality following diagnosis of AIDS was 39% at one year and 64% after two years. Autopsy in 10 of the 16 deaths contributed much to defining the extent and nature of the disease. The demographic pattern, risk group status, survival and range of complications were broadly similar to the pattern of AIDS as seen elsewhere in developed countries. However, compared to the profile of disease reported from the United States, oesophageal candidiasis (52%) and Mycobacterium tuberculosis (22%) were more prominent, pneumocystis carinii pneumonia (39%), Kaposi's sarcoma (22%) and Mycobacterium avium intracellulare (13%) were less frequent and cryptococcal infection was not identified. These regional variations in the frequency of the various complications and particularly the prominence of tuberculosis, probably reflect the interaction of the immunocompromised patient with the local environment and may have important diagnostic and therapeutic implications.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Admission for HIV-1 related disease in a Dublin hospital 1987-1990.

Between January 1987 and December 1990, 179 patients (131 men, 48 women) infected with human immunodeficiency virus type 1 (HIV-1) were admitted 408 times to St James's Hospital, Dublin. One hundred and thirty-two (73.7%) patients were intravenous drug users. The commonest cause of admission was bacterial lower respiratory tract infection (84 patients, 21%). At the time of study 95 (53%) patients fulfilled Centers for Disease Control (CDC) criteria for stage IV disease. HIV antibody status in 26 of these patients with stage IV disease was unknown prior to their admission to hospital with symptomatic disease. Pneumocystis carinii pneumonia was the most frequent stage IV defining diagnosis. The mean length of hospital stay for patients with CDC stage II/III and stage IV disease was 8.5 (median 7) and 13.5 (median 8) days respectively.

Bacterial Infections↗
PubMedDate not supplied

The impact of HIV disease on an Irish prison population.

Between January 1987 and January 1991, 168 known HIV-infected prisoners have been incarcerated in Dublin's Mountjoy prison. This figure constitutes 16.6% of the total HIV-infected population in the Republic of Ireland over the same period. One hundred and forty-one (84%) of these prisoners have attended the Department of Genitourinary Medicine, St James's Hospital, Dublin. This group displayed considerable morbidity from HIV-related disease. Respiratory tract infection was the most frequent complication seen. Much additional morbidity was directly attributable to intravenous drug use. A survey of a representative group of inmates revealed that 64.7% were diagnosed HIV-positive in prison. The mean length of time spent incarcerated since the diagnosis of HIV infection was 38.9 months. Twenty-nine of 34 individuals who answered a questionnaire were imprisoned for drug-related crimes and 32 of 34 prisoners admitted to parenteral drug use within the prison. As the HIV epidemic unfolds in Dublin, increasing numbers of prisoners with symptomatic HIV disease will spend time incarcerated in Mountjoy prison. This will pose a considerable burden on prison and hospital medical services alike.

Acquired Immunodeficiency Syndrome↗