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Biomedical subjects

M Danis

Publications and source records attributed to M Danis.

At least 91 records · Page 5Linked to original sources
PubMed1994

Alterations of uninfected red blood cells in malaria.

Red blood cell (RBC) negative charges and resistance to linoleic acid (LNA)-induced lysis were studied in Plasmodium yoelii-infected mice and in malaria (P. falciparum)-affected individuals. RBCs from mice infected with P. yoelii showed a progressive decrease in the net surface negative charges at 24 h after infection, reaching a minimal value on day 3, followed by a second phase that was characterised by a recovery to normal levels on day 6. Resistance to linoleic acid follows similar kinetics. These alterations preceded the appearance of parasites in the peripheral blood. A similar increase in LNA-induced lysis was observed in RBCs from malaria-affected individuals. These early membrane alterations of uninfected RBCs could be responsible for spreading of infection and RBC lysis during infection.

Adult↗
PubMed1994

Association of lipid accumulation in small intestinal mucosa with decreased serum triglyceride and cholesterol levels in AIDS.

Lipid accumulation has been described in the duodenal lamina propria of human immunodeficiency virus (HIV)-infected patients with diarrhea and malabsorption. Using light and electron microscopy, we studied duodenal biopsies obtained from 54 consecutive HIV-infected patients by means of upper gastrointestinal endoscopy after an overnight fast. The presence of diarrhea and weight loss were recorded, and all the patients had standard stool study for ova, parasites, and bacteria. Serum levels of albumin, triglycerides, and cholesterol were obtained within one week of the endoscopy. Fecal fat and fecal alpha 1-antitrypsin clearance were measured in 11 patients. Lipid accumulation was observed in nine patients (16.6%). Fat droplets were seen in enterocytes, in their basolateral membrane spaces, and in the lamina propria. The mean serum levels of triglycerides (1.85 +/- 0.20 mmol/liter) and cholesterol (2.81 +/- 0.30 mmol/liter) were significantly lower in the patients with enteric steatosis than in patients without this anomaly (respectively, 3.38 +/- 0.39 and 3.97 +/- 0.18 mmol/liter, P < 0.001 P < 0.01). The mean amount of fecal fat in the three patients with lipid accumulation (16 +/- 1.60 g/24 hr) was significantly larger than in the eight patients without lipid accumulation (4.50 +/- 0.62 g/24 hr, P < 0.01). These findings suggest that fat malabsorption in HIV-infected individuals is due to a blockage of transport through the duodenal mucosa. The frequency of diarrhea, weight loss, or identified enteric pathogens did not differ significantly between patients with and without enteric steatosis. Both the etiology and the pathophysiology of these alterations remain to be documented.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Impact of patient incompetence on decisions to use or withhold life-sustaining treatment.

PURPOSE: To study the relationship of patient incompetence to decisions to withhold life-sustaining treatments. DESIGN AND PATIENTS: This prospective cohort study consisted of 311 inpatients with end-stage congestive heart failure, chronic obstructive pulmonary disease, cancer, and cirrhosis. METHODS: Daily assessments were used to classify patients as incompetent if they had depressed consciousness, major psychiatric disease, or cognitive impairment throughout their hospital stay. Treatment decisions were assessed by observation and medical record review. RESULTS: Forty-eight (15%) patients were incompetent: 33 had depressed consciousness, 11 failed cognitive screens, and 4 had major psychoses. Incompetent patients were more severely ill (APACHE II score 14.9 versus 12.6, P < or = 0.05) and more commonly had cancer (73% versus 44%, P < or = 0.05). Decisions were made to withhold cardiopulmonary resuscitation (CPR) for 71% of incompetent patients, but for only 21% of competent patients (P < or = 0.001). Decisions to withhold other treatments were also more common for incompetent patients (42% versus 16%, P < or = 0.001). After controlling for differences in severity of illness, diagnosis, race, and insurance status, patient incompetence remained strongly associated with a decision to withhold CPR (odds ratio 4.0, 95% confidence interval 1.8 to 8.9) and with decisions to withhold other treatments (odds ratio 2.4, 95% confidence interval 1.1 to 5.3). Decisions for incompetent patients were made by physicians with family surrogates 79% of the time. No decision was based on a written advanced directive. Patient preference was the rationale for 41% of decisions to withhold CPR from incompetent patients. Major conflict occurred in only 1% of all cases where a decision was made to withhold treatment. CONCLUSIONS: Despite current legal and ethical debate, incompetent patients are far more likely than competent patients to have life-sustaining treatment withheld. Most decisions are made by a consensus of physicians and family surrogates, and major conflicts rarely occur.

Aged↗
PubMed1994

Emergency triage to intensive care: can we use prognosis and patient preferences?

OBJECTIVE: To identify predictors of 6-month mortality known before emergent admission to intensive care (IC) and to describe obstacles to the use of patient preferences in emergency triage decisions. DESIGN: Historical cohort. SETTING: A 600-bed university hospital. PATIENTS: 263 consecutive patients triaged in the emergency room to receive intensive care. MEASUREMENTS AND MAIN RESULTS: Medical records were abstracted for age, performance status, and chronic disease severity as predictors of 6-month survival. Acute Physiology Score (APS) in the emergency room was used as a measure of acute illness severity. Deaths during the 6 months following IC admission were determined from record review and death certificate data. Obstacles to communication of patient treatment preferences at the time of triage were described. Six-month mortality was 19 percent, and increased with increasing APS, age > or = 80 (43%), poor performance status (56%), and severe chronic disease (33%) (P < or = 0.01). In multivariate analysis, APS, age > or = 80 and performance status were independent predictors of 6-month mortality. Only APS predicted mortality in hospital. The most common obstacles to use of patient preferences in triage decisions were absence of documented advance directives (95%) and the brief duration of acute illness (72%). Mental status changes were very common in the emergency room for nonsurvivors (61%), but chronic cognitive impairment was rare (3%). CONCLUSIONS: Patients with poor performance status or very advanced age have increased mortality within 6 months of emergent triage to IC. Mental status changes, absence of advance directives, and time constraints are common barriers to communication of patient preferences at the time of triage. Primary care physicians need to elicit and record patients' preferences before the time of emergent decisions about IC.

Activities of Daily Living↗
PubMed1994

[Subacute Plasmodium falciparum malaria in 43 patients returning from areas with chloroquine in Africa].

PURPOSE: To identify clinical and biological features of subacute falciparum malaria, risk factors, and to evaluate the efficacy of curative treatment. PATIENTS AND METHODS: Diagnostic criteria were the association of apyrexia, anemia, little or no parasitemia and a high titer of anti-Plasmodium antibodies. Forty-three cases were observed in subjects returning from chloroquine-resistant areas in Africa. They were matched with controls for age, country of residence and duration of stay. Controls were missionaries who attended our unit for a routine medical check-up during the study period. RESULTS: The clinical presentation and biological features were similar to "malarial cachexia", a condition mainly described in non-immune children in endemic areas. Splenomegaly was present in 58% of the patients. Biological features included little or no parasitemia, an overall decrease in the blood cell count, an increased erythrocyte sedimentation rate and a high titer of anti-Plasmodium antibodies. This syndrome was not correlated with the frequency of chloroquine resistance, the area of stay (urban or rural) or to the kind of chemoprophylaxis. CONCLUSIONS: This study describes subacute resistant falciparum malaria in patients who had prolonged stay in chloroquine-resistant areas of Africa associating splenomegaly, cytopenia and a low or absent parasitemia. Subacute chloroquine-resistant malaria could be due to host factors which remained to be determined by prospective immunological studies. Curative treatment with mefloquine is effective.

Adult↗
PubMed1993

[Symptoms and development of Schistosoma haematobium infestation seen in a metropolis].

Urogenital schistosomiasis is often diagnosed in France where, contrary to its severity, its initial presentation (mainly haematuria) has not changed. The frequency of major renal abnormalities seems to have diminished since 1965, but above all cystoscopy and intravenous urography have been superseded by ultrasonography, a totally harmless and painless method which provides the same information as that obtained with the previous two methods, except as regards the ureters. In particular, cystoscopy is now indicated only when tumours of the bladder are suspected at ultrasonography. Cutaneous schistosomiasis, with its characteristic features, deserves to be known and recognized.

Female↗
PubMed1993

Life-sustaining treatments during terminal illness: who wants what?

OBJECTIVE: To determine patient characteristics associated with the desire for life-sustaining treatments in the event of terminal illness. DESIGN: In-person survey from October 1986 to June 1988. SETTING: 13 internal medicine and family practices in North Carolina. PATIENTS: 2,536 patients (46% of those eligible) aged 65 years and older who were continuing care patients of participating practices, enrolled in Medicare. The patients were slightly older than the 65+ general population, 61% female, and 69% white, and most had one or more chronic illnesses. MEASUREMENTS AND MAIN RESULTS: The authors asked the patients whether they would want each of six different treatments (hospitalization, intensive care, cardiopulmonary resuscitation, surgery, artificial ventilation, or tube feeding) if they were to have a terminal illness. The authors combined responses into three categories ranging from the desire for more treatment to the desire for less treatment. After adjustment for other factors, 53% of women chose less treatment compared with 43% of men; 35% of blacks vs 15% of whites and 23% of the less well educated vs 15% of the better educated expressed the desire for more treatment. High depression scores also were associated with the desire for more treatment (26% for depressed vs 18% for others). CONCLUSION: Patients' choices for care in the event of terminal illness relate to an intricate set of demographic, educational, and cultural factors. These results should not be used as a shortcut to determine patient preferences for care, but may provide new insights into the basis for patients' preferences. In discussing choices for future life-sustaining care, physicians need to explore with each individual the basis for his or her choices.

Aged↗
PubMed1993

A randomized trial of ivermectin versus albendazole for the treatment of cutaneous larva migrans.

In an open study, we compared the efficacy of single doses of oral ivermectin (12 mg) and oral albendazole (400 mg) for the treatment of cutaneous larva migrans. Twenty-one patients were randomly assigned to receive ivermectin (n = 10) or albendazole (n = 11). All patients who received ivermectin responded and none relapsed (cure rate = 100%). All but one patient in the group receiving albendazole responded, but five relapsed after a mean of 11 days (cure rate = 46%; P = 0.017). No major adverse effects were observed. We conclude that a single 12-mg dose of ivermectin is more effective than a single 400-mg dose of albendazole for the treatment of cutaneous larva migrans.

Administration, Oral↗
PubMed1993

[Soluble antigens of intra-erythrocyte stages of Plasmodium falciparum: diagnostic and vaccinal value].

A wide variety of soluble antigens also called exoantigens or excretory-secretory antigens are released by asexual blood stages of P. falciparum at the time of schizont burst and subsequent merozoite invasion. At present, most of these soluble malarial proteins have been purified and have had their genes cloned; the primary sequence displays considerable polymorphism upon tandem repeats. However, its function and the relevance of the polymorphism for the induction of host immune response, predominantly IgM and T-cell-independent type, has yet to be determined. The potential of P. falciparum exoantigens as immunodiagnostic tools has been the focus of numerous studies. Enzyme immunoassays or radioimmunoassays for the detection of malarial antigens in blood of suspected peoples have been reported. Their development requires increasing both specificity and sensitivity. Recently, some P. falciparum exoantigens have been proposed as candidates for inclusion in an anti-disease vaccine which induces a clinical but not parasiticidal immunity against malaria. There is much interest in this concept and their efficiency remains to be confirmed, as new strategies are needed in the prevention of malaria.

Animals↗
PubMed1993

Disseminated Penicillium marneffei infection associated with human immunodeficiency virus: a report of two cases and a review of 35 published cases.

Penicillium marneffei, a dimorphic fungus that is endemic in southeast Asia, causes deep-seated infection in humans and rodents. About 20 cases have been reported among the local populations of China, Thailand, and Hong Kong, and 35 cases have now been described in patients infected with the human immunodeficiency virus (HIV). We present a review of the literature and report two additional cases. Both immunocompromised and apparently immunocompetent hosts tend to develop disseminated, symptomatic infection. HIV-infected patients having travelled to southeast Asia and presenting with fever, skin lesions, hepatomegaly, adenopathies, or lung disease should be investigated for Penicillium marneffei infection. The diagnosis is based on the demonstration of the organism in clinical specimens. Treatment with amphotericin B or itraconazole is generally successful, but maintenance therapy is warranted for patients with an underlying immunodeficiency.

Acquired Immunodeficiency Syndrome↗