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Biomedical subjects

M D Stein

Publications and source records attributed to M D Stein.

107 records · Page 6Linked to original sources
PubMed1983

Defective neutrophil chemotaxis resulting from thermal injury: restoration of directed migration by increasing Boyden chamber filter pore size.

Decreased chemotaxis of burn patient neutrophils has been observed in many studies. This study attempts to analyze the basis of this defect by determining the effect of filter pore size on chemotaxis, utilizing the Boyden chamber technique. Directed migration of burn patient neutrophils, as compared to normal controls, was greatly decreased when 3.0-micron filters were used. When 8.0-micron filters were used, however, the directed migration of burn patient neutrophils was identical to that of the normal controls. These findings indicate that the failure of burn patient neutrophils to undergo directed migration using Boyden chambers is not due to an inability to migrate toward a chemoattractant. Our data suggests that when utilizing the Boyden chamber technique to measure chemotaxis, the failure to give a normal response should not necessarily be interpreted as a chemotactic defect. In fact, mechanical impediments may play a major role in the decreased migration.

Adolescent↗
PubMed1983

Sodium hypochlorite decontamination of split-thickness cadaveric skin infected with bacteria and yeast with subsequent isolation and growth of basal cells to confluency in tissue culture.

The ability of sodium hypochlorite to decontaminate skin while leaving sufficient epidermal cell viability for growth in tissue culture was investigated with an in vitro system. Split-thickness cadaveric skin was infected with Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans and subsequently treated with various concentrations of sodium hypochlorite for various time intervals. Exposure to a 0.5% solution of sodium hypochlorite for 6 min effectively decontaminated the skin while leaving 66% of the basal cells viable. The basal cells were subsequently grown to confluency in tissue culture. This study demonstrates that microbial colonization of skin can be eliminated by exposure to dilute hypochlorite. This procedure, while decontaminating the skin, leaves sufficient viability of epidermal cells for subsequent growth and expansion in tissue culture, elements essential for grafting over wounds.

Bacteria↗
PubMed1980

Bacterial endotoxin and the generation of suppressor T cells following thermal injury.

Patients with several thermal injuries often display an impaired cell-mediated immune response. Clinically, this expressed as an increased susceptibility to infection and, occasionally, as a decreased ability to reject unmatched allograft skin. Experimentally, patient serum is suppressive to the PHA response of normal human lymphocytes, which we have found to be mediated through B cell participation in the generation of suppressor T cells. We herein document the ability of bacterial endotoxin to produce these effects, both in vivo and in vitro.

Adult↗
PubMedDate not supplied

HIV-positive women: reasons they are tested for HIV and their clinical characteristics on entry into the health care system.

STUDY OBJECTIVE: To describe the reasons for the HIV testing of HIV-positive women and their clinical presentation and to make specific laboratory comparisons between women intravenous drug users (IVDUs) and non-IVDUs who were heterosexually infected (HTs). DESIGN: Consecutive case series. SETTING: Four primary care sites associated with the Brown University AIDS Program. PARTICIPANTS: 140 consecutive HIV-seropositive women. RESULTS: The most common reason for HIV testing in both groups was self-perception of risk. Presenting T-helper lymphocyte counts, leukocyte counts, and hematocrits did not differ significantly between the groups. Intravenous drug users were significantly more likely than HTs to have evidence of hepatitis B virus exposure (p less than 0.0001) and to report the history of a sexually transmitted disease (p = 0.005). Twenty percent of HTs versus 10% of IVDUs were tested only after they had HIV-related symptoms. The most frequent clinical presentation for both groups was Centers for Disease Control Group IV/A constitutional symptoms. CONCLUSIONS: Many HIV-seropositive women do not enter the health care system until they are symptomatic, but those infected heterosexually and those using parenteral drugs have similar laboratory indices at presentation. AIDS education strategies toward all women at risk must include information about manifestations of HIV disease in women, as well as preventive measures, to ensure early access to the health care system.

AIDS Serodiagnosis↗
PubMedDate not supplied

The ambulatory care of HIV-infected persons: a survey of physician practice patterns.

OBJECTIVE: To describe the use of various counseling practices, examinations, and laboratory tests used by general internists in the primary care of HIV-infected persons. DESIGN: Mailed questionnaire survey. SUBJECTS: Random sampling of members of the Society of General Internal Medicine. RESULTS: Based on a 64% response rate (131/205), there are many areas of physician agreement in the ambulatory care of HIV-infected persons. Greatest physician consensus was seen in the use of viral serologic testing, vaccinations, and Pap tests. Most (70-80%) primary care physicians do not use surrogate markers such as beta 2-microglobulin and p24 antigen to follow disease progression; instead, they rely mostly on CD4 lymphocyte counts. Sixty percent of physicians continue to order CD4 lymphocyte counts when a baseline count is under 200 cells/mm3. All studies are ordered more frequently for patients with more advanced disease. As a group, those physicians following the largest number of patients do not manage patients significantly differently from the less HIV-experienced physicians. CONCLUSIONS: Despite some variation, there is substantial consensus on the "routine" management of HIV-infected persons. Clinical guidelines would be one mechanism for defining appropriate care of HIV-infected patients. The majority judgments of the practitioners studied here could be one component among various sources of information used by expert panels to define guidelines except where studies clearly indicate a different and more effective approach. Such incorporation might increase guideline acceptance by practicing clinicians.

Adult↗
PubMedDate not supplied

Differences in access to zidovudine (AZT) among symptomatic HIV-infected persons.

OBJECT: To evaluate socioeconomic factors that determine whether symptomatic HIV-infected persons are offered zidovudine (AZT). DESIGN: Cross-sectional survey conducted as part of the Robert Wood Johnson Foundation's AIDS Health Services Program. SETTING: Public hospital clinics and community-based AIDS organizations in nine American cities. PATIENTS: 880 HIV-seropositive outpatients interviewed between October 1988 and May 1989. MAIN RESULTS: Males were more likely to have been offered AZT than were females (adjusted odds ratio 2.99; 95% confidence interval 1.67 to 5.36), those with insurance were more likely to have been offered AZT than were those without (adjusted odds ratio 2.00; 95% confidence interval 1.25 to 3.21), and whites more likely to have been offered AZT than were non-whites (adjusted odds ratio 1.73; 95% confidence interval 1.11 to 2.69). Intravenous drug users were less likely to have been offered AZT than were non-drug users (adjusted odds ratio 0.44; 95% confidence interval 0.28 to 0.69). Persons who had had an episode of Pneumocystis carinii pneumonia were more likely to have been offered AZT than were persons who had AIDS and had not had Pneumocystis carinii pneumonia (adjusted odds ratio 2.95; 95% confidence interval 1.71 to 5.11). CONCLUSION: The authors conclude that traditionally disadvantaged groups have less access to AZT, the only antiretroviral agent demonstrated to increase survival of patients who have symptomatic HIV infection.

Acquired Immunodeficiency Syndrome↗