Search PubMed⌕ Search

Biomedical subjects

M L Metersky

Publications and source records attributed to M L Metersky.

25 records · Page 2Linked to original sources
PubMed1992

Lack of utility of bronchial brush biopsy in patients infected with the human immunodeficiency virus.

While bronchoalveolar lavage has been shown to be more sensitive than brush biopsy (BB) for the diagnosis of Pneumocystis carinii pneumonia in AIDS patients, some have reported that BB occasionally is positive in spite of a negative BAL. Many bronchoscopists, therefore, continue to perform routine BB when doing bronchoscopy on AIDS patients. We performed a retrospective study of all fiberoptic bronchoscopies done on human immunodeficiency virus-infected patients over a one-year period at our institution to determine if the use of BB added to the diagnostic yield of bronchoscopy over that of BAL alone. Of 84 bronchoscopies in which BB was performed in addition to BAL, BB yielded no diagnoses that were not obtained by BAL. Brush biopsy added approximately $400 to the cost of bronchoscopy. We conclude that BB should not be routinely done when performing bronchoscopy on HIV-infected patients.

Biopsy↗
PubMed1991

Diagnostic approach to Pneumocystis carinii pneumonia in the setting of prophylactic aerosolized pentamidine.

Recurrent Pneumocystis carinii pneumonia is common in patients with the acquired immunodeficiency syndrome who receive prophylaxis with aerosolized pentamidine. In this setting, the number of organisms is reduced and the clinical presentation may be altered. These observations have led to doubts regarding the use of induced sputum to diagnose PCP in patients receiving prophylactic AP. To determine if the examination of induced sputum is useful for patients receiving prophylactic AP, we examined our results over a 12-month period. We also examined several clinical criteria to ascertain if they could predict the likelihood of a positive induced sputum. As assessed by P(A-a)O2, need for admission and mortality, patients receiving AP presented with less severe disease than those not receiving AP. Twelve of 19 (63 percent) patients who developed PCP while receiving prophylactic AP were diagnosed by induced sputum. Induced sputum was positive for 35 of 55 (64 percent) patients who developed PCP and had not been receiving AP. However, there were no clinical characteristics which predicted a positive induced sputum. We conclude that induced sputum is an effective method for diagnosing PCP in patients receiving prophylactic AP.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Nosocomial dermatitis and pruritus caused by pigeon mite infestation.

We report an outbreak of pigeon mite infestation involving two patients, two nurses, and one physician on a medical ward in a municipal hospital. The index patient developed a diffuse, pruritic erythematous maculopapular rash on his trunk and extremities. Dermanyssus gallinae, a nonburrowing, blood-sucking avian mite was identified on the patient and his bedding. A second patient who complained of scalp pruritus had mites present on her pillow and bed linen. The intern taking care of both patients, and two nurses who had contact with these patients, had mite infestation. Pigeons roosting on the air conditioners and near the doors connecting the patients' rooms to a sunporch were the source of the mites. The outbreak abated after control measures were instituted that prevented pigeons from roosting on the porch. This outbreak illustrates an unusual cause of nosocomial pruritic dermatitis that may be misdiagnosed as scabies or pediculosis. Physicians and health care personnel working in metropolitan areas are alerted to mites as a cause of pruritic dermatitis that may be chronic, recurrent, or unresponsive to ectoparasiticides.

Adult↗
PubMedDate not supplied

Temporal trends in outcomes of older patients with pneumonia.

BACKGROUND: It is unclear how outcomes of care for patients hospitalized for pneumonia have changed as patterns of health care delivery have changed during the 1990s. This study was performed to determine trends in outcomes of care for older patients hospitalized for pneumonia. METHODS: This retrospective analysis was based on Medicare claims and included most patients with pneumonia who were older than 65 years and admitted to acute care hospitals in Connecticut between October 1, 1991, and September 30, 1997 (fiscal years 1992-1997). We assessed the trends in hospital costs, discharge destination, hospital mortality rates, mortality rates within 30 days of discharge, and 30-day readmission rates for pneumonia. Multivariate logistic regression analyses were used to adjust for differences in patient characteristics. RESULTS: The mean (+/- SD) length of stay declined from 11.9 + 11.4 days to 7.7 + 7.2 days between 1992 and 1997. During this period, adjusted in-hospital mortality rates declined (P =.02), while the adjusted risk of discharge to a nursing facility increased (P<.001) and the adjusted risk of hospital readmission for pneumonia within 30 days of discharge increased (P =.05). The adjusted risk of death 30 days after discharge increased, although the difference was not statistically significant (P =.09). CONCLUSIONS: Between 1992 and 1997, the adjusted risks of mortality after discharge, placement in a nursing facility, and hospital readmission for pneumonia increased among older patients hospitalized for pneumonia, in association with a decline in mean hospital length of stay. These findings raise the question of whether the declining hospital length of stay has negatively affected patient outcomes. Arch Intern Med. 2000;160:3385-3391.

Aged↗
PubMedDate not supplied

Pneumocystis carinii pneumonia diagnosed by non-induced sputum stained with a direct fluorescent antibody.

Non-induced expectorated sputum (NIS) stained with tinctorial stains is not considered useful in the diagnosis of Pneumocystis carinii pneumonia (PCP). The diagnostic yield of NIS was evaluated in human immunodeficiency virus (HIV)-infected patients, when stained with a more sensitive direct fluorescent antibody for PCP-direct fluorescent antibody (PC-DFA). A retrospective analysis was carried out on fifty-five HIV-infected patients with PCP, who had NIS submitted for staining with PC-DFA. Thirty had positive NIS with PC-DFA and all had clinical courses consistent with PCP. Twenty-five had negative NIS with PC-DFA and were diagnosed as having PCP, by autopsy (n = 2), by a positive bronchoalveolar lavage (n = 10), or by having a clinical course consistent with PCP (n = 13). Thus, the sensitivity of NIS stained with PC-DFA was 55 percent (30/55). This is within the range reported in the literature for induced sputum for the diagnosis of PCP. Non-induced sputum stained with PC-DFA can be useful for the diagnosis of PCP in HIV-infected patients.

Adult↗
PubMedDate not supplied

Identification of human immunodeficiency virus-infected individuals by delayed type hypersensitivity skin testing.

OBJECTIVE: To determine if more useful information could be derived from delayed type hypersensitivity skin testing of human immunodeficiency virus (HIV)-infected patients by measuring the amount of induration in response to skin testing in contrast to assessing for the presence of anergy. DESIGN: Prospective, double-blind trial. SETTING: Two HIV clinics. PATIENTS: A sample of 60 ambulatory, HIV-infected patients and 18 normal controls. INTERVENTIONS: Delayed type hypersensitivity skin testing with a panel of recall antigens. MAIN OUTCOME MEASURES: Anergy, total induration in response to the panel of antigens, and CD4 lymphocyte count. RESULTS: Anergy was present in only 28 of 60 (46.7 percent) HIV-infected subjects. A low skin test score (under 20 mm of total induration) was present in 43 of 60 (71.7 percent) HIV-infected subjects (p < 0.01 vs anergy). One control patient was anergic, while two had a low skin test score (p = NS). Among HIV-infected subjects, there was poor correlation between CD4 lymphocyte count and skin test score (R2 = 0.12). CONCLUSIONS: Skin testing by this method identifies more HIV-infected patients than does assessing the presence or absence of anergy.

Adult↗