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Biomedical subjects

T L Nielsen

Publications and source records attributed to T L Nielsen.

At least 37 records · Page 2Linked to original sources
PubMed1995

[AIDS in Denmark. 1. Opportunistic infections and malignant diseases. Danish Study Group for HIV infection].

To examine the distribution of AIDS-defining illnesses among Danish AIDS patients, data on 687 AIDS patients diagnosed in the period from 1980 to 1990 (93% of all reported cases in the period) were collected. The most frequent AIDS-defining illness was Pneumocystis carinii pneumonia followed by candida oesophagitis and Kaposis sarcoma. The proportion of homo/bisexual men presenting with Kaposis sarcoma as the initial AIDS-defining illness declined over time. Patients with extrapulmonary tuberculosis had higher CD4 cell counts than patients presenting with other illnesses. Cytomegalovirus chorioretinitis and atypical mycobacteriosis were seen more frequently after the time of the AIDS diagnosis, and a low CD4 cell count at time of the AIDS diagnosis was a significant predictor for the development of these opportunistic infections during follow-up. Danish AIDS patients present with a wide spectrum of HIV-related illnesses, reflecting their exposure to opportunistic microorganisms and the degree of immune deficiency. The pattern of HIV-related illnesses is changing over time, and therefore continuous surveillance is needed to optimize therapeutic and prophylactic regimens.

AIDS-Related Opportunistic Infections↗
PubMed1995

[AIDS in Denmark. 2. Survival after the diagnosis of AIDS. Danish Study Group for HIV infection].

The survival pattern was studied for 687 Danish AIDS patients (93% of notified cases in the study period) who were diagnosed with AIDS during the period from 1980 to 1990. The median survival was 17 months. Factors significantly associated with a shortened survival were transfusion-acquired HIV infection, age > 40 years, year of diagnosis before 1987, and the presence of either disseminated infection with Mycobacterium avium-complex, Cytomegalovirus chorioretinitis or malignant lymphoma at time of the AIDS diagnosis. There was also a significant association between survival and CD4 cell count at time of AIDS diagnosis. Patients who had CD4 cell counts above 200 x 10(6)/l had twice as long a survival as patients who had CD4 cell counts less than 50 x 10(6)/l. The prognosis of Danish AIDS patients remains poor. The most important determinant of survival time appears to be the degree of immune deficiency at time of diagnosis.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Interleukin-8 and eicosanoid production in the lung during moderate to severe Pneumocystis carinii pneumonia in AIDS: a role of interleukin-8 in the pathogenesis of P. carinii pneumonia.

Pneumocystis carinii pneumonia (PCP) may cause severe respiratory distress. This is believed to be partly caused by the accumulation of neutrophils in the lung. Interleukin-8 (IL-8) and leukotriene B4 (LTB4) are potent neutrophil chemo-attractants and activators. Eicosanoids [i.e. prostaglandins (PG) and leukotrienes (LT)] are pro-inflammatory mediators released from arachidonic acid by action of phospholipase A2 (PLA2) and have been implicated in the host response to micro-organisms. Bronchoalveolar lavage (BAL) was performed on patients with PCP as part of a randomized study of adjuvant corticosteroids vs. placebo, in addition to standard antimicrobial therapy. Re-bronchoscopy was offered at day 10. BAL fluid was available for 26 patients who had follow-up bronchoscopy performed. At diagnosis, IL-8 levels were elevated in patients with PCP, compared to healthy controls, and correlated with relative BAL neutrophilia and P(A-a)O2. LTB4 was also elevated in PCP, but failed to correlate with either BAL neutrophilia or P(A-a)O2. PLA2 activity in patients correlated with IL-8 levels and BAL neutrophilia, but not with P(A-a)O2. A trend towards a decrease in IL-8 levels in BAL fluid was detected in the corticosteroid-treated patients from days 0-10, whereas no change was detected in the placebo group. No change in levels of LTB4, LTC4, PGE2, PGF2a and PLA2 were detected cover time in either treatment group. This study establishes a correlation between IL-8, BAL neutrophilia and P(A-a)O2, and suggests a role of IL-8 as a mediator in the pathogenesis of PCP, whereas the role of eicosanoids seems less clear.

AIDS-Related Opportunistic Infections↗
PubMed1995

Efficacy and toxicity of two doses of trimethoprim-sulfamethoxazole as primary prophylaxis against Pneumocystis carinii pneumonia in patients with human immunodeficiency virus. Dutch AIDS Treatment Group.

The efficacy and toxicity of trimethoprim-sulfamethoxazole (TMP-SMZ) as primary prophylaxis against Pneumocystis carinii pneumonia (PCP) for patients with human immunodeficiency virus (HIV) infection was assessed by comparing the effects of two dosages (480 or 960 mg once a day) of the drug. The multicenter trial involved 260 HIV-infected patients with CD4 cell counts < 0.2 x 10(9)/L and no history of PCP. Patients were randomly assigned to the treatment groups. After a median follow-up of 376 days (range, 1-1219), none of the patients developed PCP. Most adverse reactions that required discontinuation were seen within the first month of TMP-SMZ use and were seen more frequently and earlier in the 960-mg group (hazard ratio, 1.4; 95% confidence interval, 0.95-2.02; P = .007). For patients with HIV infection, 480 mg of TMP-SMZ is as efficacious as but less toxic than 960 mg of the drug for primary prophylaxis against PCP.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Prognostic value of interleukin-8 in AIDS-associated Pneumocystis carinii pneumonia.

UNLABELLED: Interleukin-8 (IL-8) is a potent neutrophil chemoattractant and activator. Pneumocystis carinii pneumonia is associated with an accumulation of neutrophils in bronchoalveolar lavage (BAL) fluid. Thus, we hypothesized that IL-8 is involved in the pathogenesis of P. carinii pneumonia. BAL fluid and serum were prospectively collected in 76 consecutive HIV-infected patients with a primary episode of P. carinii pneumonia, as well as in 10 healthy control subjects. Patients were found to have elevated levels of IL-8 in BAL fluid compared with control subjects (p < 0.01). Nine patients died during the course of P. carinii pneumonia. Comparing survivors with nonsurvivors, the median IL-8 level in BAL fluid was 127 (0 to 3,900) versus 584 (127 to 6,100) pg/ml (p < 0.05). Furthermore, patients with levels of IL-8 in BAL fluid greater than 90 pg/ml (i.e., greater than control subjects) had significantly worse vital prognosis (log rank test, p < 0.05). Thirteen percent required mechanical ventilation (MV). Patients requiring MV had a median IL-8 level of 396 (25 to 6,100) versus 129 (0 to 3,900) pg/ml for patients not requiring MV (p < 0.05). IN CONCLUSION: i) IL-8 in BAL fluid correlates to the clinical severity of the pneumonia, and ii) is a predictor of mortality and severe respiratory compromise.

AIDS-Related Opportunistic Infections↗
PubMed1995

Does cytomegalovirus predict a poor prognosis in Pneumocystis carinii pneumonia treated with corticosteroids? A note for caution.

OBJECTIVE: To examine the importance of cytomegalovirus (CMV) in bronchoalveolar lavage (BAL) fluid of patients with HIV-associated Pneumocystis carinii pneumonia (PCP) treated with adjunctive corticosteroids (CS). DESIGN: Analysis of clinical data during a 5-year period. SETTING: Department of infectious diseases where clinical and paraclinical data on patients suspected of having PCP have been sampled prospectively. PATIENTS: 148 consecutive patients with a first episode of PCP in a 5-year period. MAIN OUTCOME MEASURE: Vital status 3 months after diagnosis of PCP. RESULTS: Patients with PCP treated with adjunctive CS who had CMV cultured from BAL fluid had a two times higher mortality within 3 months from bronchoscopy than others (p = 0.08). This difference could not be explained by differences in CD4 count, PO2 or PCO2 at time of bronchoscopy. CONCLUSION: With the accepted usage of adjunctive CS in severe PCP, the role of CMV as a pulmonary copathogen may have changed. Active CMV infection may be an important cause of failing treatment of severe PCP in those treated with adjunctive CS.

AIDS-Related Opportunistic Infections↗
PubMed1995

Randomized study of sulfamethoxazole-trimethoprim versus aerosolized pentamidine for secondary prophylaxis of Pneumocystis carinii pneumonia in patients with AIDS.

In a prospective, randomized open-label trial, the efficacy of sulfamethoxazole-trimethoprim (SMX-TMP) 400/80 mg b.i.d. was compared with the efficacy of aerosolized pentamidine (AP) 60 mg every 2nd week as secondary prophylaxis (SP) against recurrence of Pneumocystis carinii pneumonia (PCP) in AIDS patients. 94 patients participated in the study, 47 in each group. The patients were observed for a mean period of 17.2 months. PCP recurred in the AP group in 8 cases, while 1 relapse occurred in the SMX-TMP group. The one-year cumulative relapse rate was 9.0% (95% CI 0-19%) in the AP group compared with 2.4% (95% CI 0-8%) in the SMX-TMP group (p < 0.05). The odds ratio was 4.2 (95% CI 0.5-39.8) in favour of SMX-TMP. Furthermore, we found a tendency towards a protective effect against toxoplasmosis in the SMX-TMP group, though there was no difference in survival between the two groups. There was no statistical difference in frequency of crossover from one therapy form to the other. Based on these data we recommend SMX-TMP for secondary PCP prophylaxis.

AIDS-Related Opportunistic Infections↗
PubMed1995

The seroprevalence of hepatitis B and C in hospitalized Danish patients.

Health care workers are at risk of acquiring blood-borne infections. To assess the risk of exposure to hepatitis B or C in the case of occupational blood exposure, we determined the seroprevalence of these infections in 466 patients admitted to a Copenhagen university hospital. Serological markers for hepatitis B or C were detected in 56 patients (12.0%). The seroprevalence of HBsAg and anti-HCV was 0.9% and 1.5% respectively. HCV RNA, indicating ongoing hepatitis C, was found in five of seven anti-HCV-positive patients by polymerase chain reaction. The serological findings had not previously been diagnosed in 4 of 10 potentially infectious patients and only 6 of 10 patients belonged to high-risk groups. In conclusion, health care workers should be aware of the potential the occupational risk of hepatitis B and C even in a low-prevalence country like Denmark. Management of health care workers after blood exposure should include serological testing for both hepatitis B and C. Strict adherence to universal precautions is recommended and vaccination against hepatitis B should be encouraged.

Adolescent↗
PubMed1994

[Pneumocystis carinii pneumonia in HIV-infected patients examined by bronchoscopy during the period 1989-1991].

We analyzed prospectively collected data from 211 HIV-infected patients who underwent bronchoscopy because of pulmonary symptoms during the period 1989-1991. We found an improvement in survival for patients diagnosed with Pneumocystis carinii pneumonia (PCP) in 1991 as compared to 1989 and 1990 (log rank test: p = 0.07). A significant decline in PO2 and CD4 cell count was observed in patients with PCP in the same period (p < 0.05 and 0.005 respectively). We suggest that the decline in CD4 cell count and in PO2 may reflect a change in Pneumocystis carinii transmission, and that the improved survival may be a result of altered treatment strategy of PCP.

AIDS-Related Opportunistic Infections↗
PubMed1994

[AIDS and heart disease].

This article reviews cardiac manifestations of AIDS in terms of etiology, pathogenesis, pathoanatomic lesions and heart function. Hypothetically the prevalence of myocarditis and disperse fibrosis of the myocardium are correlated to increasing rates of dilated cardiomyopathy and cardiac insufficiency. Echocardiography has proved to be of value in detecting early abnormalities and should be recommended on broad indications, though aggressive therapy of cardiac abnormalities is of importance to ensure quality of life and surveillance for the patients.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Differential effect on serum neopterin and serum beta 2-microglobulin is induced by treatment in Pneumocystis carinii pneumonia.

Forty-three human immunodeficiency virus-infected patients with Pneumocystis carinii pneumonia (PCP) were enrolled in a study of adjunctive corticosteroid treatment for 10 days versus placebo, in addition to antimicrobial treatment. Levels of neopterin and beta 2-microglobulin (beta 2M) were determined in consecutive serum samples. Initiation of antimicrobial treatment resulted in significantly increased neopterin levels, whereas beta 2M levels slightly decreased from pretreatment levels. In patients treated with corticosteroid, both neopterin and beta 2M decreased, by approximately 50% and approximately 30%, respectively, and returned to baseline after discontinuation of corticosteroid treatment. Antimicrobial treatment alone did not affect either neopterin or beta 2M in healthy controls. Results indicate that treatment has a differential effect on the immune response: increased macrophage activation leading to neopterin production and decreased production of beta 2M by lymphocytes. Further, addition of corticosteroids modified and decreased this immune activation and may explain the earlier demonstrated beneficial effect of corticosteroids in PCP treatment.

AIDS-Related Opportunistic Infections↗
PubMed1994

Admission to Danish hospitals after suspected ingestion of corrosives. A nationwide survey (1984-1988) comprising children aged 0-14 years.

A search was made in The National Board Hospital Register of all admissions to Danish hospitals caused by ingestion of corrosives or suspected ingestion of corrosives during 1984-1988 among children aged 0-14 years. Discharge information on each child was collected. The study comprised 224 children. Six children developed a stricture of the esophagus, and in 11 children, the epiglottis was affected. In nearly all cases, these serious complications were due to ingestion of lye or dishwash detergent. Among children without symptoms or signs at the initial examination, none developed a stricture of the esophagus or epiglottic oedema. We conclude that during a period of five years, serious etching after ingestion of corrosives was seen only after ingestion of lye (four cases), dishwash detergent (one case) and an unidentified caustic agent (one case). In all serious cases, symptoms or signs of etching of the skin, mouth or pharynx were observed at first examination.

Adolescent↗
PubMed1993

[Exposure to blood and risk of infection among health personnel].

Health care workers, especially surgeons, are frequently exposed to blood. Most blood exposures are not reported. Blood exposures involve risk of contracting serious infectious diseases like HIV, hepatitis B and hepatitis C. Fifty-four cases of occupational transmission of HIV-virus have been reported world wide. Occupational HIV-infection has not been reported in Denmark. Hepatitis B infection can be prevented by vaccination, but there is no effective drug or vaccine to prevent infection with hepatitis C and HIV-virus. Thus, the prevention of occupationally transmitted infections should concentrate on the prevention of blood exposures. Further studies on occupational blood exposure among Danish health care workers are needed.

Blood↗
PubMed1993

[Occupational blood exposure among personnel employed in a department of infectious diseases. 1. Frequency and reporting].

We investigated the frequency and reporting rate of occupational blood exposure among formerly and presently employed medical staff in a Department of Infectious Diseases (DID) from 1987-1991, the department has a high prevalence of HIV-positive patients. Subjects were asked to complete an anonymous questionnaire describing occupational percutaneous (PCE) and mucocutaneous (MCE) blood exposure experienced during their employment at the DID. One hundred and thirty-five out of 168 (80%) subjects responded. Forty-five subjects described 37 PCE and 15 MCE. Forty-four (85%) of the exposures involved HIV-positive blood and six (11.5%) involved blood from a patient with hepatitis B. Incidence rates of PCE and MCE per year (PY) were: A) Interns and residents: 0.51 PCE/PY and 0.17 MCE/PY. B): Senior residents and senior physicians 0.13 PCE/PY and 0.21 MCE/PY. C) Registered nurses 0.11 PCE/PY and 0.03 MCE/PY. D) Nursing assistants 0.09 PCE/PY and 0.11 MCE/PY. Sixty-five percent of PCE and 13% of MCE were reported to the security representative. The major reason for not reporting was that the subject found it unnecessary. We conclude that medical personnel, especially interns and residents, employed at clinics of infectious diseases have a real and serious risk of being exposed to infectious blood. The importance of reporting needs to be stressed.

Accidents, Occupational↗
PubMed1993

[Occupational exposure to blood among personnel employed in a department of infectious diseases. 2. Accidental mechanisms and protective devices].

We investigated exposure mechanisms of mucocutaneous (MCE) and percutaneous (PCE) blood exposures and compliance with universal precautions among all formerly and presently employed medical staff from 1987 to 1991 in a Danish Department of Infectious Diseases. All subjects were asked to complete an anonymous questionnaire. One hundred and thirty-five out of 168 (80%) subjects responded. Thirty-seven PCE and 15 MCE were described. More than 50% of PCE happened during procedures without specific reasons or were caused by unexpected patient movement, while only one PCE was caused by recapping. Thirty-five percent of PCE happened during drawing of venous blood samples. Compliance with usage of gloves was high (70-100%), depending on the procedure, and 72% of the subjects claimed to have sufficient knowledge of the risk of blood exposures and how to prevent it. Still, 11 (73%) out of 15 MCE might have been prevented by appropriate use of protective barriers. To reduce the frequency of blood exposure further the development of safer instruments and continuous education in safer techniques and usage of protective barriers are of major importance.

Accidents, Occupational↗
PubMed1993

[Corticosteroid treatment of patients with AIDS and severe Pneumocystis carinii pneumonia. A European multicenter study. Danish-Dutch AIDS Study Group].

Fifty-nine HIV-1 infected patients with a microscopically proven first episode of moderate to severe Pneumocystis carinii pneumonia (PCP) were enrolled into a randomized European multicenter study. The effect of adjunctive corticosteroid (CS) therapy was assessed on: 1) survival to discharge, 2) need for mechanical ventilation (MV) and 3) survival at day 90. CS was given within 24 hours of standard therapy as intravenous methylprednisolone 2 mg/kg bodyweight daily for ten days. All patients received cotrimoxazole as standard treatment. Inclusion criteria were a PaO2 < 9.0 kPa (67.5 mmHg) and/or a PaCO2 < 4.0 kPa (30.0 mmHg). During the acute episode of PCP nine (31%) of the 29 control patients died versus three (10%) of the 30 CS patients; p = 0.01. Mechanical ventilation was necessary in 15 patients; 12 (41%) in the control group and three (10%) in the KS group; p = 0.01. The 90-day survival was 69% in patients receiving cotrimoxazole alone versus 87% in patients receiving adjunctive KS; p = 0.07. Based on these data we conclude that adjunctive CS therapy for moderate to severe PCP in AIDS-patients reduces the acute mortality and the need for mechanical ventilation.

AIDS-Related Opportunistic Infections↗
PubMed1993

Serum type III procollagen peptide in patients with Pneumocystis carinii infection. The Copenhagen-Amsterdam PCP-Prednisolone Study Group.

Inflammation may play a central role in the pathogenesis of HIV-related Pneumocystis carinii pneumonia (PCP). Serum levels of the amino-terminal propeptide of Type III procollagen (PIIINP) reflect inflammatory activity in granulation tissue and in chronic rheumatic and liver disorders. To investigate changes in PIIINP serum levels during an episode of HIV-related PCP, consecutive serum samples were taken from 48 HIV-infected patients with PCP in a randomized, placebo-controlled study of the effect of adjunctive methylprednisolone therapy (26 in corticosteroid [CS] group and 22 in control group). All patients were treated with co-trimoxazole. In the control group, PIIINP serum levels at day of initiation of therapy (Day 0) were significantly higher in patients requiring mechanical ventilation and/or dying during the course of the pneumonia, and serum levels of PIIINP higher than 5 ng/ml were associated with a higher mortality than levels below 5 ng/ml. The level of PIIINP increased from Day 0 to Day 5. There was a significant correlation between changes in PIIINP levels and changes in the alveolar-arterial oxygen gradient from Day 0 to Day 5. In the CS group, the PIIINP levels decreased while steroid was administered. At Days 21 to 28 there were no difference in the levels of PIIINP between the two groups. PIIINP serum levels may predict the clinical outcome of PCP. The antimicrobial therapy may exacerbate the inflammatory reaction in HIV-related PCP, leading to respiratory failure. CS prevents this increased inflammatory activity.

AIDS-Related Opportunistic Infections↗