Search PubMed⌕ Search

Biomedical subjects

W Rozenbaum

Publications and source records attributed to W Rozenbaum.

139 records · Page 8Linked to original sources
PubMed1979

[Society of Nephrology, Computer Technology Commission. Dialysis computer program. VI. - Survival and risk factors].

The sixth report of the "Diaphane Dialyse Informatique" Program concerns 2,518 adult patients (age 15 and over) treated by chronic hemodialysis or hemofiltration in 33 French dialysis centres between June 1972 and December 1978. 1) The number of centers participating to the program is progressively increasing. Overall duration of follow-up represents 4,192 patient-years, allowing precise evolutive studies of terminal renal failure treated by hemodialysis. 2) Mean age at start of treatment continues to increase. Among 709 patients who started treatment in 1977-1978, 8,8 p. 100 of men and 11 p. 100 of women were over 69 years old. 3) Patients with diabetic nephropathy represent 4,4 p. 100 of all patients dialyzed between 1972 and 1978 and 5,9 p. 100 of the patients starting treatment in 1977-1978. 4) The percentage of patients temporarily treated by peritoneal dialysis before hemodialysis decreases from 32,9 p. 100 in 1973-1974 to 15,9 p. 100 in 1977-1978. 5) In 1978, 65,3 p. 100 of patients are dialyzed 3 times a week with a mean weekly duration of 14,0 h for male and 12,9 for female. 73 p. 100 of the patients are dialyzed during the night. 6) Disposable parallel plate hemodialyzers (71,8 per cent of dialysis sessions in 1978) and hollow fiber hemodialyzers (11,6 per cent) progressively replace disposable coil dialyzers and non disposable Kiil dialyzers. 7) Transient hypotensive episodes during dialysis sessions remain the most frequent complications (21,7 per cent of sessions in 1978). Transient hypotensive episodes are more frequently observed with coils than with parallel plate hemodialyzers or with hollow fiber dialyzers. 8) Mean diastolic blood pressure (DBP) +/- SD is 101,9 +/- 21,7 mmHg at start of dialysis and 81,4 +/- 11,8 mmHg when dialysed. During the course of treatment 28,7 per cent of the patients receive long term antihypertensive treatment. In spite of dialysis and antihypertensive treatments 11 per cent of all patients followed up maintain DBP greater than or equal to 95 mmHg. 9) Viral hepatitis remain the most prominent infectious problem with 30 per cent of patients being chronic Hbs antigen carriers. 10) Annual death rate calculated in the 2,518 patients dialyzed between 1972 and 1978 (78/1000) is 12 times superior to the death rate of the French population, adjusted for sex and age to the dialysis population. 43,1 per cent of deaths are of cardiovascular origin. Risk factors for overall mortality are age, sex (male), existence of a vascular or diabetic nephropathy, twice weekly dialysis strategy, elevation of systolic or diastolic blood pressure during the course of dialysis treatment, hypocholesterolemia and to a lesser extent hypotriglyceridemia. On the contrary, hypercholesterolemia, hypertriglyceridemia and hyperuricemia do not appear as risk factors for overall mortality or cardiovascular mortality. These results plead for a perfect control of hypertension and to the extension of thrice weekly dialysis for the whole population of patients treated by maintenance hemodialysis.

Adolescent↗
PubMedDate not supplied

Effect of HAART on health status and hospital costs of severe HIV-infected patients: a modeling approach.

PURPOSE: The purpose of this study was to assess the impact of highly active antiretroviral therapy (HAART) on health status and hospital costs in severe HIV-infected patients who were followed in a French hospital. METHOD: The first 500 patients who received HAART, with CD4 + cell count below 250/mm(3), were considered. Evolution of the distribution of patients among different health states, including death, was modeled through a continuous time Markov model. Hospital financial charges and antiretroviral treatment costs were computed. Health states defined by both CD4 counts and viral load were used to show clinical changes in the patient population over a 14-month period after HAART initiation. The economic impact of HAART initiation was assessed using a simplified model based on CD4 counts only over two 14-month periods, before and after initiation. RESULTS: Between day 0 and month 14, the proportion of patients in the least severe state (CD4 + >100/mm(3) and viral load<500 copies/mL) increased from 1% to 50%, and the proportion with more than 100 CD4 + cells/mm(3) increased from 17% to 80%. Antiretroviral treatments amounted to Fr 2,141 per patient-month before HAART initiation and to Fr 3,093 after. Conversely, hospital charges fell from Fr 5,138 per patient-month to Fr 3,136. CONCLUSION: Our model gives a representation of the effect of HAART on (1) the improvement of patients' health status, (2) the increase of treatment costs, and (3) the reduction of hospital financial charge. Important savings in hospital charges can compensate for the extra cost associated with the initiation of HAART.

Adult↗
PubMedDate not supplied

Clinical and laboratory findings of disseminated Mycobacterium avium complex infection (DMAC) in a pair matched case-control study.

A pair matched case/control study was conducted from January 1991 to 30 June 1992 in order to define clinical and laboratory findings associated with DMAC infection in AIDS patients. Since DMAC infection is usually associated with advanced immunodeficiency, and therefore also with other opportunistic illnesses, in addition to the number of CD4+ lymphocytes, cases and controls were matched using the following criteria: date of AIDS diagnosis and antiretroviral therapy, number and severity of associated opportunistic infections and, whenever possible, type of Pneumocystis carinii prophylaxis, age and gender, in this order of relevance. Cases (defined as patients presenting at least one positive culture for MAC at a normally sterile site) and controls presented CD4+ lymphocyte counts below 50 cel/mm3. A significantly higher prevalence of general, digestive and respiratory signs, increased LDH levels, low hemoglobin levels and CD4+ cell counts were recorded for cases when compared to controls. Increases in gammaGT and alkaline phosphatase levels seen in cases were also recorded for controls. In conclusion, the strategy we used for selecting controls allowed us to detect laboratory findings associated to DMAC infection not found in other advanced immunosupressed AIDS patients without DMAC.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

[A cost-effectiveness analysis of changes in therapeutic strategies in the treatment of HIV since 1996].

The objective was to assess the cost-effectiveness ratio of HAART in the treatment of HIV infection. Two random samples were extracted from the database of the Rothschild Public Hospital, and patients were matched for age, sex and T4 cell counts: a first sample selected in 1996/97 of HAART treated patients (CAS group) and a second sample selected in 1994/95 of non-HAART treated patients (CONTROL group). Immune recovery and use of resources data were extracted and analyzed over two years for 196 included patients. Mean T4 cell count after two years was higher among CAS patients (344/mm3 vs. 234/mm3; p < 0.0001). CAS patients recorded a supplementary cost of antiretroviral treatments (+171%; p < 0.0001) balanced by savings in other drugs expenses (-62%; p = 0.0560) and in hospitalizations (-25%; NS). Overall, CAS patients presented a 15% (NS) lower medical cost than CONTROL patients.

Anti-HIV Agents↗
PubMedDate not supplied

[Human cryptosporidiosis: a propos of 4 cases].

Cryptosporidiae are ubiquitous protozoan belonging to the coccidiae family which parasite many wild and domestic animals bowels. Man gets infested by ingestion oocysts. The parasite complete cycle takes place on the surface of intestinal epithelial cells microvillosities. Human cases that we described occurred among patients presenting (or not) with acquired or congenital immunity depression. Diarrhea is the main symptom. Diagnosis is based on parasitological stool examination and pathological study of intestinal biopsies. At the present time no specific treatment is known and only the immunity deficit correction can possibly cure cryptosporidiosis.

Adult↗
PubMedDate not supplied

[The concept of therapeutic management: exemplary implementation of antiretroviral treatments].

Since the discover of AIDS in 1981 and the causal human immunodeficiency virus in 1983, therapeutic strategies have gone through many phases. When the ACTG 175 and Delta trials demonstrated the clinical improvement offered by regiments combining 2 nucleosides over monotherapy, combination therapy was being prescribed for less than 20% of all primary infections. Less than one year later, this rate suddenly rose to 90%. At the same time, the clinical benefit in terms of reduced morbidity and mortality was demonstrated for triple therapy and by the end of 1997, 65% of all treated HIV+ patients were taking the triple combination therapy, 34% were on bitherapy and only 1% on single drug regimens. This fantastically rapid evolution of management strategies appears even more exceptional when one realizes that these changes in prescription attitudes took place before expert groups were able to establish accepted guidelines. The number of patients under treatment also rose sharply from 57% in early 1994 to 87% in late 1997, while the number of active hospital files rose by 30%. These rapid changes in patient management schemes has had a major effect on HIV-related morbidity and mortality. In 1997, the number of deaths fell by 41% and the number of new AIDS cases by nearly 50%. The number of hospitalizations has also declined by 50% over the last 2 years. This is probably the first time in the history in medicine that preliminary clinical studies have led to direct patient benefit in so short a time. This achievement has been accomplished by the combined efforts of health care workers, patient associations, public authorities and the pharmaceutical industry. This global view must not however hide the fact that most all the prescriptions used today are based on the results of clinical trials in a small number of patients over short study periods. Long-term efficacy and tolerance remain unknown. One must also keep in mind one other figure which has not varied over this period. The percentage of new AIDS cases in patients no ith no prior treatment because they are unaware of the infection or because they do not want treatment remains unchanged at 40%.

Anti-HIV Agents↗