Cytomegalovirus infection of liver transplant recipients: comparison of antigenemia and molecular biology assays.
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Antigens, Viral↗
Biomedical subjects
N Singh
Publications and source records attributed to N Singh.
Evolving trends in multiple-antibiotic-resistant bacteria in liver transplant recipients: a longitudinal study of antimicrobial susceptibility patterns.
The incidence, sources, impact on outcome, and temporal trends in multiple-antibiotic-resistant bacteria in liver transplant recipients over the last decade (from 1990 through 1999) were assessed. Of 165 consecutive patients who underwent transplantation, 31% (51 of 165 patients) had at least 1 infection caused by multiple-antibiotic-resistant bacteria. Overall, 69% (66 of 96 infections) of all bacterial infections were multiple-antibiotic resistant. Ninety-one percent (45 of 49 isolates) of the Staphylococcus aureus isolates, 50% (6 of 12 isolates) of the enterococci, and 54% of the gram-negative bacteria (47%; 7 of 15 Pseudomonas aeruginosa, and 60%; 12 of 20 Enterobacteriaceae) were multiple-antibiotic resistant. A significant trend toward an increase in infections caused by multiple-antibiotic-resistant bacteria (P =.003), largely caused by an increase in gram-positive infections, was documented through the decade. There was a significant increase in infections caused by methicillin-resistant S aureus (P =.0001) and vancomycin-resistant enterococci (P =.04) over time. The proportion of gram-negative isolates that were multiple-antibiotic resistant (P =.447) did not increase significantly over time. However, a strikingly high frequency of resistance to piperacillin or ceftazidime suggests that extended-spectrum beta-lactamase production in our Enterobacteriaceae may have been more prevalent than realized. Mortality at 1 year was significantly greater in patients with multiple-antibiotic resistant bacteria compared with all other patients (P =.001). These longitudinal trends have implications not only for guiding therapeutic practices, but ultimately for devising strategies to curtail multiple-antibiotic resistance in liver transplant recipients.
Drug Resistance, Microbial↗
Posttransplantation dialysis-associated infections: morbidity and impact on outcome in liver transplant recipients.
The aim of this study is to assess the predictors, impact on infectious morbidity, and outcome of posttransplantation dialysis in liver transplant recipients and to compare the results with data from patients who did not require dialysis after transplantation. The study sample included 176 consecutive patients undergoing liver transplantation; the median follow-up was 4.3 years. All patients were administered tacrolimus as primary immunosuppression. Overall, 16% (28 of 176 patients) of the patients required dialysis after transplantation. Patients requiring dialysis had significantly greater pretransplantation creatinine levels (2.4 v 1.2 mg/dL; P =.009), were more likely to require pretransplantation dialysis (21% v 1%; P =.0001), and had a greater rate of biopsy-proven rejection episodes (50%, 14 of 28 episodes v 20%, 30 of 148 episodes; P =.0009) and longer posttransplantation intensive care unit lengths of stay (P =.0001). The incidence of infections (91% v 41%; P =.0001) and episodes of infection per patient (2.4 v 0.7 episodes; P =.0001) were significantly greater in patients undergoing dialysis compared with those not undergoing dialysis. There was no difference in the frequency of cytomegalovirus (CMV) infection or disease; however, bacterial infections (87% v 31%; P =.0001) and invasive fungal infections (39% v 7%; P =.0001) were significantly more likely to occur in patients requiring dialysis. In logistic regression, dialysis (P =.0006) and CMV infection (P =.007) were independent significant predictors of major infections. Overall survival (assessed by Kaplan-Meier probability) was less in patients undergoing dialysis compared with those not undergoing dialysis (P =.0001). Among dialyzed patients, only 10% of those who survived had an invasive fungal infection compared with 46% of those who died (P =.08); 5 of 6 patients died within 1 month of the fungal infection. The need for dialysis portended a grave outcome in liver transplant recipients and identified a subgroup of patients at a significantly greater risk for major infections, particularly fungal infections, after liver transplantation.
Adult↗
Seasonal pattern of early mortality and infectious complications in liver transplant recipients.
Seasonal variation has been documented in the frequency and attributable mortality of a number of medical illnesses and infections in the nontransplantation setting. Whether similar trends exist in transplant recipients is not known. Seasonal rates of overall and early mortality and contributory variables stratified by season were assessed in 190 consecutive liver transplant recipients who underwent transplantation over a 10-year period. The frequency of infectious complications and rejection was also assessed and stratified by season of transplantation. Early (deaths occurring in the first year posttransplantation), but not overall, mortality correlated significantly with seasonality. Of patients with early mortality, 43% (13 of 30 patients) died in winter; 23% (7 of 30 patients), in spring; 13% (4 of 30 patients), in summer; and 20% (6 of 30 patients), in fall. The frequency of deaths in winter was significantly greater than for all other seasons (P = .022). The high wintertime mortality could not be explained by previously recognized risk factors portending a poor outcome, e.g., United Network for Organ Sharing status, Child-Pugh score, surgical time, blood loss, pretransplantation and posttransplantation dialysis, infections, rejection, or increased immunosuppression. Strong trends toward a higher rate of cytomegalovirus disease in patients who underwent transplantation in fall (P = .09) and bacterial infections in those who underwent transplantation in winter were documented (P = .09). There was no correlation between seasonality and rejection. Early mortality in winter in liver transplant recipients was significantly greater than if the deaths were totally random. Whether the seasonal clustering of deaths and infections is triggered by respiratory viruses, yet unrecognized viruses, or unknown exogenous factors remains to be determined.
Adult↗
Malaria during pregnancy and infancy, in an area of intense malaria transmission in central India.
The clinico-epidemiological pattern of malarial infection in a cohort of pregnant women and infants was analysed during a malaria epidemic (1997-1998). The subjects were all members of tribal communities in an isolated and almost inaccessible area of central India. Overall, 151 (55%) of the 274 pregnant women investigated were found to have malarial infections at some time during the study, with Plasmodium falciparum predominating (88% of infections). All of the women investigated, whether primigravidae (42% found infected), secundigravidae (68%) or multigravidae (54%), were at great risk of developing severe malaria. When trimesters were compared, the highest prevalence of P. falciparum infection was recorded in the second (59% infected), irrespective of parity. Of the women found infected with P. falciparum, 3% had abortions, 4% stillbirths and 2% had babies who died while neonates. The small number of P. vivax infections observed prevented similar analyses for this species of parasite. Malarial infection was also seen in 218 (41%) of the 535 infants investigated. The values of age-specific prevalences revealed that > 30% of the infants examined at 2 months of age were then found to have P. vivax and/or P. falciparum parasitaemias. At 1 year of age, overall malaria prevalence was 50%, with P. vivax representing 25% of the infections and P. falciparum the rest. Subsequent follow-up revealed that three of the infants investigated, each of whom had had P. falciparum infections previously, died before their first birthdays. Re-infections (or treatment failures) were found to be common, both in the infants and the pregnant women. Pregnant women and infants from the study area clearly require systematic intervention to reduce their malaria-attributable morbidity.
Cohort Studies↗
Sorption behavior of metolachlor, isoproturon, and terbuthylazine in soils.
The sorption-desorption of metolachlor [2-chloro-N-(ethyl-6-methyl phenyl)-N-(2-methoxy-1-methyl ethyl) acetamide], isoproturon [3-(4-isopropyl phenyl)-1,1-dimethyl urea] and terbuthylazine [N6-tert butyl-6-chloro-N4-ethyl-1,3,5-triazine-2,4-diamine] herbicides was studied in two German soils at 1:10 soil to water ratio by batch method. Equilibrium of herbicides between soil and water (0.01 M CaCl2) was attained in 2 h. Sorption data fitted very well to Freundlich equation, represented by very high correlation coefficient (r2 > 0.934). Comparison of Freundlich K values indicated that sorption of all the three herbicides was most pronounced in soil having higher organic carbon content. Koc values were as expected nearly identical for each herbicide in the two soils. The Freundlich constant (1/n) was about 1 for metolachlor and less than 1 for terbuthylazine and isoproturon indicating a L-type of sorption isotherms. Desorption of all the three herbicides showed hysteresis. Nearly equal amounts of metolachlor, isoproturon and terbuthylazine were desorbed from both soils. There was a good correlation between Koc and solubility.
Acetamides↗
The acute effect of calcium carbonate on the intestinal absorption of levothyroxine.
To determine the acute effect of calcium, we measured levothyroxine absorption after ingestion of thyroxine (T4) with and without simultaneous ingestion of calcium (as calcium carbonate) in seven volunteers without thyroid disease. Serum total T4, total triiodothyronine (T3), free T4, and thyrotropin (TSH) levels were measured after ingestion of 1,000 microg of levothyroxine on two separate visits at 4-week intervals: (1) levothyroxine alone and (2) levothyroxine together with 2.0 g of calcium as calcium carbonate. The amount of absorbed levothyroxine was calculated as the incremental rise in serum T4 level during the first 6 hours multiplied by the volume of distribution for the hormone. When 1,000 microg of levothyroxine alone was given to subjects, the maximum average total T4 absorption was 837 microg (83.7% of the dose ingested) at 120 minutes. When levothyroxine was coadministered with 2.0 g of calcium (as calcium carbonate), the maximum average T4 absorption decreased to 579 microg (57.9% of the dose ingested) at 240 minutes. The total levothyroxine absorption over 6 hours was significantly greater with thyroxine than that with thyroxine and calcium (p = 0.02). The administration of calcium and levothyroxine in these subjects was associated with a significant reduction in the peak increment in serum total T4 (p = 0.02) and free T4 levels (p = 0.03), as well as a significant reduction in the overall increment in serum total T4 (p = 0.003), free T4 (p = 0.002), and total T3 levels (p = 0.01) over four time points (120 minutes, 240 minutes, 360 minutes, 1,440 minutes). In summary, this pharmacokinetic study in seven volunteers indicates that calcium carbonate acutely reduces T4 absorption.
Adult↗
Tracheal injury during endoscopic hemithyroidectomy.
Unsuspected tracheal injury during endoscopic hemithyroidectomy is described. The diagnosis was delayed because of absent symptomatology. Surgical repair was planned but deferred because of infection. The patient was managed with a tracheostomy tube and antibiotics, and the wound healed completely without any residual abnormality or complications.
Adult↗
Nosocomial bloodstream infection and cost.
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Costs and Cost Analysis↗
Complex ocular choristomas in linear nevus sebaceus syndrome: a report of two cases.
Two cases of linear nevus sebaceus syndrome (LNSS) are described in which ipsilateral facial nevus of Jadassohn was associated with complex ocular choristoma. One patient also had scleral osteomas, a rare occurrence in LNSS.
Adult↗
Changing spectrum of invasive candidiasis and its therapeutic implications.
Emerging trends in invasive candidiasis are notable for a dramatic increase in infections due to non-albicans Candida species. An increasing number of immunocompromised patients at risk from fungal infections, an overall greater acuity of illness in the hospitalized patients, particularly those in the critical care units, escalating rates of broad-spectrum antibiotic usage, and wide utilization of azoles as prophylaxis have probably contributed towards the changing epidemiology of invasive candidiasis. Given the inherent decreased susceptibility of many of the non-albicans Candida species to currently available antifungal agents, these evolving trends have far-reaching clinical relevance.
Antifungal Agents↗
Dyslipidaemia in HIV-infected patients: association with adherence to potent antiretroviral therapy.
Metabolic complications are being increasingly recognized among HIV-infected patients treated with potent combination antiretroviral therapies. We sought to assess the association of dyslipidaemia with adherence to protease inhibitor (PI) therapy and with the markers of clinical response to antiretroviral therapy (CD4 count, HIV RNA viral level) through a prospective, cross-sectional cohort study. Fifty-six HIV-infected patients who were already on, or who were started on PI-containing antiretroviral therapy were monitored for the development of dyslipidaemias. Therapy with PI-containing antiretroviral therapy was significantly associated with elevated serum triglyceride level (>250 mg/dl) (52% vs 8%, P=0.001). Patients with an adherence rate of at least 80% to a PI-containing regimen were significantly more likely to have elevated low density lipoprotein (LDL) cholesterol level as compared to patients with an adherence rate of <80% (79% vs 26%, P=0.03). Patients with an adherence rate of at least 80% to a PI-containing regimen were also significantly more likely to have severe hypertriglyceridaemia (>800 mg/dl) as compared to patients with an adherence rate of <80% (21% vs 4%, P=0.04). Viral load at the last study visit did not correlate with total cholesterol (r=-0.39, P=0.30), LDL cholesterol (r=0.57, P=0.30), or triglyceride level (r=0.55, P=0.20). However, there was a significant correlation between the last viral load and high density lipoprotein (HDL) cholesterol (r=0.79, P=0.035), i.e. lower viral load was associated with higher HDL cholesterol level. In conclusion, dyslipidaemia in patients with HIV infection was significantly associated with adherence to PI-containing antiretroviral therapy. Patients who are adherent to PI-containing regimens at least 80% of the time warrant close monitoring for the development of dyslipidaemia.
Adult↗
Acute ventricular rate control in atrial fibrillation: IV combination of diltiazem and digoxin vs. IV diltiazem alone.
OBJECTIVE: To analyze the efficacy of an IV combination of diltiazem and digoxin vs IV diltiazem alone for acute ventricular rate control in patients with atrial fibrillation. DESIGN: Prospective, randomized, open-label study. PATIENTS AND METHODS: Fifty-two patients with atrial fibrillation and uncontrolled ventricular rates were randomized to receive either an IV combination of diltiazem and digoxin or IV diltiazem alone and were observed for 12 h. The successful rate control was defined as a ventricular rate < 100 beats per minute (bpm) persisting for 1 h or conversion to sinus rhythm. The loss of rate control was defined as an increase in the ventricular rate to > 100 bpm persistently for > 30 min or rebound to atrial fibrillation. RESULTS: In both treatment arms (n = 26 each), all patients achieved successful and comparable ventricular rate control at 12 h. The mean (+/- SD) time taken to achieve successful rate control was shorter in the combination arm (15 +/- 16 vs. 22 +/- 22 min). Six patients in the combination arm and 11 in the diltiazem-alone arm experienced episodes of loss of rate control. This loss in the combination arm was less than that in the diltiazem-alone arm (14 vs 39 episodes; p = 0.05). The loss of rate control per patient in the combination arm was also less than that in the diltiazem-alone arm (2.0 +/- 1.0 vs. 3.5 +/- 1.9 episodes per patient; p = 0.04). CONCLUSIONS: This study demonstrates that in patients with atrial fibrillation who have a rapid ventricular response, the IV combination of diltiazem and digoxin results in a more efficacious ventricular rate control with fewer fluctuations than that achieved by therapy with IV diltiazem alone.
Adolescent↗
Respiratory acidosis.
Respiratory acidosis, or primary hypercapnia, is the acid-base disorder that results from an increase in arterial partial pressure of carbon dioxide. Acute respiratory acidosis occurs with acute (Type II) respiratory failure, which can result from any sudden respiratory parenchymal (eg, pulmonary edema), airways (eg, chronic obstructive pulmonary disease or asthma), pleural, chest wall, neuromuscular (eg, spinal cord injury), or central nervous system event (eg, drug overdose). Chronic respiratory acidosis can result from numerous processes and is typified by a sustained increase in arterial partial pressure of carbon dioxide, resulting in renal adaptation, and a more marked increase in plasma bicarbonate. Mechanisms of respiratory acidosis include increased carbon dioxide production, alveolar hypoventilation, abnormal respiratory drive, abnormalities of the chest wall and respiratory muscles, and increased dead space. Although the symptoms, signs, and physiologic consequences of respiratory acidosis are numerous, the principal effects are on the central nervous and cardiovascular systems. Treatment for respiratory acidosis may include invasive or noninvasive ventilatory support and specific medical therapies directed at the underlying pathophysiology.
Acidosis, Respiratory↗
Surgical extirpation of a chest wall desmoid tumor: a case report.
A case is described of an anterior chest wall desmoid tumor in a 20-year-old Micronesian male that had been previously incompletely resected one year prior to presentation. A radical chest wall resection was performed with reconstruction accomplished using a gortex patch and latissimus dorsi myocutaneous flap. The patient developed a massive local recurrence within eight months following surgery. This report illustrates the local aggressiveness of these benign tumors. A historical perspective, etiology, and treatment principles are discussed.
Adult↗
A multicentric study with arteether in patients of uncomplicated falciparum malaria.
Two hundred and sixty seven patients of uncomplicated P. falciparum malaria completed study in a multicentric phase III clinical trial of Arteether. Arteether was given intramuscularly in a dose of 150 mg daily for three consecutive days. Each patient was followed upto 28 days of alpha, beta arteether therapy. The cure rate was 97% with fever clearance time between 1-7 days (24-168 hours) and parasite clearance time between 1-3 days (24-72 hours). Parasite reappearance rate was found to be 3% and reported at only three of the centres. Following the treatment no adverse effect was observed on haematological, biochemical and vital clinical parameters.
Adolescent↗
Factors affecting quality of life in patients with HIV infection.
Given the longevity achievable with current prophylactic and therapeutic strategies for persons with HIV infection, quality of life (QOL) has emerged as a significant medical outcome measure, and its enhancement as an important goal. This review highlights current knowledge about the relevance and complexity of physical, psychological, and social factors as determinants of health-related quality of life (HRQOL) in HIV-infected persons. Existing data suggest physical manifestations, antiretroviral therapy, psychological well-being, social support systems, coping strategies, spiritual well-being, and psychiatric comorbidities are important predictors of QOL in this population. Health care professionals are encouraged to become familiar with the full spectrum of predictors of HRQOL, which may eventually contribute to the development of multiple entry points for interventions in promoting QOL in these patients. Identifying variables influencing QOL among diverse groups, particularly women, injection drug users, and adolescents, and designing effective interventions specific to the social and psychological well-being of HIV-infected individuals are areas for research.
AIDS-Related Opportunistic Infections↗
Sharps injuries in a pediatric teaching hospital: a shared responsibility.
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Accidents, Occupational↗