Biomedical subjects

M Rawji

Publications and source records attributed to M Rawji.

4 recordsLinked to original sources

PubMed1997

Current trends in HIV-related hospital admissions and their impact on hospital resource utilization in Ontario.

OBJECTIVE: To assess changes in patterns of hospital admissions, in frequency of admissions and in average length of stay (ALOS) at a tertiary HIV referral centre, and to investigate the overall impact of care for patients with HIV infection of AIDS on peer hospitals in Ontario. DESIGN: Descriptive study. PARTICIPANTS: Data were obtained on patients with HIV infection or AIDS treated at the Wellesley Hospital in Toronto for the fiscal years (May 1 to Apr. 31) 1990-91, 1991-92 and 1992-93, and on admissions for HIV or AIDS in 9 peer hospitals in Ontario during the same period. INTERVENTIONS: For the Wellesley Hospital, review of medical records of HIV-related admissions to determine the reasons for admission and to examine concurrent illnesses. For the Wellesley Hospital Hospital and peer hospitals, analysis of changes in ALOS and Resource Intensity Weights (RIWs). RESULTS: Between May 1, 1990, and Apr. 31, 1993, the number of admissions for treatment of Pneumocystis carinii pneumonia (PCP) fell, but admissions for respiratory infections other than PCP remained very common, although they decreased slightly. Overall, infection remained the main reason for admission. The frequency of gastrointestinal complications necessitating admission increased. The frequency of admissions remained high, although the ALOS decreased significantly. In the period between Apr. 1, 1991, and Mar. 31, 1994, the proportion of HIV-related discharges and total hospital discharges among the 9 peer hospitals remained stable. The HIV-related ALOS decreased substantially. Although the HIV-related average RIW decreased slightly, this measure and the mortality rate are still much higher for HIV-related admissions than for overall admissions. CONCLUSIONS: This contemporary survey suggests that nonrespiratory infection complications have become the main reason for admission of patients with HIV infection or AIDS, but that the HIV tertiary hospitals are coping with the load of HIV-related admissions and the high average RIW associated with these patients by reducing the ALOS.

Female↗

PubMed1992

Bleomycin-induced pulmonary function abnormalities.

The usefulness of serial PFTs in identifying patients who are developing BIP was assessed in 59 men with non-seminomatous testicular carcinoma. The mean age was 27.7 years and all the patients received a standard three-course chemotherapy regimen consisting of vinblastine, bleomycin, and cis-diamminedichloroplatinum. The average dose of bleomycin was 555.5 units. Serial PFTs, chest roentgenograms, and medical assessments were done prior to each course of bleomycin. Nine (15.3 percent) patients developed pulmonary symptoms due to bleomycin and 23 (39 percent) had significant changes on chest x-ray films. The Dsb dropped significantly with bleomycin treatment; therefore, it is the most sensitive indicator of pulmonary response to bleomycin. However, the Dsb failed to differentiate patients with BIP from those without. The TLC was found to be a much more specific indicator of BIP because reduction in TLC correlated with the development of pulmonary symptoms and roentgenologic changes.

Adolescent↗

PubMed1992

Changes in hospital admissions pattern in patients with human immunodeficiency virus infection in the era of Pneumocystis carinii prophylaxis.

BACKGROUND: Pneumocystis carinii pneumonia (PCP) was the leading cause of hospital admissions in patients with human immunodeficiency virus (HIV) infection before the widespread use of PCP prophylaxis. We studied retrospectively the changes in annual hospital admission patterns after the start of a population-based PCP prophylaxis program in Toronto. The purpose of the study was to identify the cogent diseases requiring hospitalization of HIV patients in the current era of PCP prophylaxis. This information is important for the allocation of health care resources in the future as well as for targeting research in the prevention of specific HIV-related diseases. METHODS: The annual HIV-related hospital admissions before and after the start of the Toronto aerosol pentamidine program (May 1989) were studied. All admission records due to AIDS-defining illnesses or occurring in patients with known HIV status in three major referral centers were reviewed. The two periods for comparison were May 1988 through April 1989 and May 1989 through April 1990. The data obtained were stratified according to the following: (1) cause of the illness prompting hospital admission; (2) PCP admissions; and (3) admissions according to the major organ system involved. These categoric data were compared by nonparametric chi 2 tests. RESULTS AND CONCLUSIONS: Population-based prophylaxis of PCP with aerosol pentamidine resulted in a significant reduction in the total number of PCP hospital admissions. Infection remains the principal cause of hospital admission in HIV patients after the start of the PCP prophylaxis program. However, there was an increase in the proportion of hospital admissions due to nonrespiratory-related infections. There was also a modest increase in admissions due to neurologic and gastrointestinal diseases. Central nervous system lymphoma and cytomegalovirus retinitis accounted for the majority of the rise in the nervous system. These data suggest there is a changing pattern of the diseases leading to the hospitalization of patients with HIV infection in the era of PCP prophylaxis.

AIDS-Related Opportunistic Infections↗

PubMed1992

The long-term effects of aerosol pentamidine on pulmonary function. The Toronto Aerosolized Pentamidine Study (TAPS) Group.

Aerosolized pentamidine (AP) has been widely used for prophylaxis of pneumocystis carinii pneumonia (PCP) since 1988. The objective of this study was to evaluate the long-term effects of AP on pulmonary function. Of 36 patients with AIDS who were receiving AP for secondary prophylaxis of PCP, 13 patients had been using AP continuously for more than 52 weeks. AP was given using a Fisoneb ultrasonic nebulizer with five loading doses of 60 mg over two weeks, followed by one dose of 60 mg every two weeks. Baseline PFT were TLC 92 +/- 14% pred, FVC 90 +/- 11% pred, FEV1 91 +/- 11% pred, FEF25-75 95 +/- 17% pred, and DLCO (corrected for hemoglobin) 70 +/- 22% pred. No significant change in TLC, FVC, FEV1, or DLCO was seen after 56 weeks of AP. There was a 20% fall in FEF25-75 seen after 56 weeks, which was statistically significant. However, the clinical significance of a fall of this magnitude in the FEF25-75 is uncertain. Similar results were seen in a smaller subset of patients who received AP for at least 76 weeks. Although the small sample size must be considered, this data suggests that there is no clinically significant change in pulmonary function associated with the use of AP for up to 76 weeks.

Acquired Immunodeficiency Syndrome↗