Search PubMed⌕ Search

Biomedical subjects

J A Pilheu

Publications and source records attributed to J A Pilheu.

At least 19 recordsLinked to original sources
PubMed1998

Tuberculosis 2000: problems and solutions.

The incidence of tuberculosis is expected to increase, from 8.8 million cases in 1995, to 10.2 million cases by the year 2000 and 11.9 million by 2005. Three million deaths due to tuberculosis occurred in 1995, and 3.5 million can be expected in the year 2000. The most important causes of the world-wide increase in tuberculosis are: 1) non-compliance with control programmes; 2) inadequate diagnosis and treatment; 3) migration; 4) endemic human immunodeficiency virus (HIV); 5) ambulatory and self-administered treatment. In the 1970s it was stated that treatment needed to be supervised-a recommendation that went unheeded. A number of fundamental changes should be introduced in order to make treatment effective, to cure patients and thus to arrest the transmission of the disease: 1) supervision during the whole period antituberculosis drugs are taken, and 2) hospitalization during the initial treatment stage for all groups at risk. It is already 50 years since the first antituberculosis drugs were discovered; effective treatments capable of curing all patients in 6 months have been available for the last 25 years, and the result is failure plus a growing mortality curve at the beginning of the twenty-first century. If we wish to alter this trend, we need trained doctors all over the world who possess enough clinical knowledge of tuberculosis; hospitalization for specific groups of tuberculosis patients; true supervision during the whole treatment period; fixed-dose combinations of drugs; and prophylaxis or preventive treatment whenever possible. We also need to take into account other factors such as drug resistance, endemic HIV, and migration.

Antitubercular Agents↗
PubMed1997

CD4+ T-lymphocytopenia in severe pulmonary tuberculosis without evidence of human immunodeficiency virus infection.

SETTING: A large public hospital in Buenos Aires, Argentina. OBJECTIVE: To determine the number of blood CD4 and CD8 T-lymphocytes in male human immunodeficiency virus (HIV) negative patients with severe pulmonary tuberculosis. DESIGN: Seventeen patients with severe pulmonary tuberculosis (SPT), with a mean age of 44.1 years, all HIV negative, had on admission lost 20% or more of their normal weight. Ten male HIV negative pulmonary tuberculosis patients (PT), with a mean age of 25.2 years, in good general condition, acted as a control group. Patients from both groups had a blood CD4/CD8 count before treatment. RESULTS: In the SPT patients, the CD4/CD8 count before treatment yielded a mean of 341.25 +/- 142.73/ mm3 for CD4 and 259.33 +/- 100.89/mm3 for CD8. Three patients died a few weeks after starting treatment; on admission they had 180,220 and 280 CD4/ mm3, respectively. Patients in good general condition yielded 721.40 +/- 272.20 for CD4 (P < 0.01, t = 4.216) and 416.67 for CD8. At the same time, five normal volunteers, with a mean age of 35.60 +/- 10.45 years, had mean CD4 and CD8 counts of 906 +/- 75.37 and 360 +/- 190.79, respectively. CONCLUSION: Based on the findings of this study, we feel that it is of value to measure the CD4 and CD8 T-lymphocyte counts in STP patients with a compromised general condition and with significant weight loss at the beginning of treatment. Those patients with a CD4 count of < 300/mm3 have a very poor prognosis and, in addition to the regular antituberculosis drugs, will require intensive care during the first weeks of treatment.

Adult↗
PubMed1989

[Pharmacokinetic interaction of ketoconazole, isoniazid and rifampicin].

Eight male tuberculous patients, between 20 and 60 years of age, were given Isoniazid 5 mg/kg and Ketoconazole 200 mg, first one at a time and then associated. Plasma concentrations were measured 0, 2 and 5 hs after taking the drugs. Isoniazid was measured by spectrophotometry and Ketoconazole by the microbiologic method with Candida albicans as test microorganism. When both drugs were given simultaneously Ketoconazole plasma concentration decreased 75% at 2 hs (p less than 0.025) and 85% at 5 hs (p less than 0.05), whereas that of Isoniazid remained unchanged (Table 1). Mean half-life of Isoniazid was 3.9 +/- 1.4 hs in 7 slow acetylators and 1.1 hs in one fast acetylator when given one at a time and 4.4 +/- 1.5 hs when given simultaneously. A similar study was conducted on 11 tuberculous patients who were given Rifampicin 10 mg/kg and Ketoconazole 200 mg, one at a time and concurrently. Rifampicin was measured by high pressure liquid chromatography. When Rifampicin and Ketoconazole were given concurrently plasma concentration of both drugs was reduced: Ketoconazole decreased 85% at 2 hs (p less than 0.025) and 98% at 5 hs (p less than 0.025) whereas Rifampicin decreased 45% at 2 hs (p less than 0.005) and 40% at 5 hs (p less than 0.005) (Table 2). Mean half-life of Rifampicin was 3.5 +/- 0.8 and 4.2 +/- 1.1 hs, respectively, when it was given alone and concurrently. Studies on chemical interactions between Isoniazid and Ketoconazole and between Rifampicin and Ketoconazole yielded negative results.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1981

Liver alterations in antituberculosis regimens containing pyrazinamide.

A group of alcoholic tuberculous patients was given a pyrazinamide-containing regimen, and the liver was studied on admission and after two months of intensive treatment with IRSZ. Alterations in liver histology and in liver function tests found on admission improved or disappeared after two months' chemotherapy. A control group, give IRSE, showed similar results. A third group of nonalcoholic patients was given Z alone for 15 days, and liver tolerance was also excellent. These data support the conclusion that tuberculous alcoholic patients, in the absence of significant and persistent hepatic dysfunction, can be given Z-containing regimens. In all cases, a careful monitoring of hepatic function, with monthly SGPT and bilirubin determinations, is recommended.

Adolescent↗
PubMed1977

Short-duration treatment of pulmonary tuberculosis.

In this study, pulmonary tuberculosis was treated on an ambulatory basis, with the patients engaging in their usual activities and with a shortened period of chemotherapy. During the first year of the study, patients with pulmonary tuberculosis were randomly included in one of the following two groups: (1) group 1 received isoniazid (5 to 6 mg/kg of body weight), ethambutol (25 mg/kg), and rifampin (rifampicin, 10 mg/kg) daily for a total of six months; and (2) group 2 received the same therapy as group 1, but treatment was continued for a further six months with only isoniazid (5 mg/kg three days per week). At the beginning of the second year of the study, all subsequent patients included in the study were placed into group 1. Of the 163 patients who started the study, 136 patients (99 from group 1 and 37 from group 2) completed the treatment and converted their bacteriologic findings. There was one relapse in group 1. Adverse reactions were observed in six patients, but they did not have to interrupt treatment.

Adolescent↗