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PubMedDate not supplied

Care of women infected with the human immunodeficiency virus.

OBJECTIVE: --To review current knowledge regarding human immunodeficiency virus (HIV) infection in women and to derive from that data standards of care. DATA SOURCES: --Selective review of pertinent articles addressing cervical disease, pelvic inflammatory disease, sexually transmitted diseases, contraception, and pregnancy in HIV-infected women. A computer-assisted search was used to identify relevant articles on pharmacokinetics of drugs in women and oral contraceptive--drug interactions. DATA EXTRACTION: --Pertinent data were abstracted from case-control, cohort studies, clinical trials, and pharmacokinetic studies. DATA SYNTHESIS: --Few studies have been performed to define the clinical course of HIV infection in women. Gender-specific manifestations, such as cervical neoplasia, pelvic inflammatory disease, and vaginal moniliasis, appear to pursue a more aggressive course in HIV-infected women. Little is known about the pharmacokinetics of drugs for HIV and related infections. Oral contraceptives may alter the metabolism of some drugs used in HIV-infected women. An approach to the routine treatment of HIV-infected women is summarized. CONCLUSIONS: --Little is currently known regarding the natural course of HIV infection in women. Women infected with HIV should be followed up frequently with specific attention paid to the reproductive system. Additional studies should be conducted to determine the impact of HIV on gender-specific diseases.

Contraception↗
PubMedDate not supplied

[Familial Bloom's syndrome associated with neuroblastoma].

Bloom's syndrome (BS) is an autosomal recessive disease characterized by short stature, sensitivity to sunlight, and telangiectasic malar erythema. It is associated to chromosomal breakage, to primary combined immunodeficiency, and to a high incidence of neoplasias. The authors report the case of two siblings with BS and associated immunodeficiency. Both patients were male and 5 (A) and 4 (B) years old at the time of diagnosis. Chronic diarrhea, recurrent otitis media, purulent rhinitis, conjunctivitis and pyodermatitis were reported by patient A. Patient B was admitted with diagnosis of bilateral neuroblastoma and had the tumor resected. Later on, he presented with oral moniliasis, herpetic stomatitis, and skin abscesses. This patient did not have recurrent infections. Immunological evaluation showed normal serum levels of CH50, C3, and C4 for both patients. Serum IgG, IgA, IgM, and salivary IgA levels were: 455 mg/dl, 15mg/dl, 20mg/dl, 0.6mg/dl for A, and 400mg/dl, 15mg/dl, 20mg/dl, and 0.2mg/dl for B, respectively. Serum antipolio antibodies (1, 2, and 3) were normal, and low levels of isohemagglutinins were observed in both patients. T cells subset determination showed: patient A--OKT3 = 66%, OKT4 = 33%, OKT8 = 32%, and 4/8 ratio = 1.0; patient B--OKT3 = 70%, OKT4 = 32%, OKT8 = 34%, and 4/8 ratio = 1.0. In vitro cellular immune response to PHA was depressed only in patient B. Patients karyotype showed chromosomal breaks with sister chromatid exchanges. Neither patient had abnormal alphafetoprotein and carcinoembryonic antigen serum levels. The rarity of such associations justifies the presentation of the cases.

Bloom Syndrome↗
PubMed1990

Acute sore throat.

The second common problem to be presented in this series is the acute sore throat. The common causes are viral pharyngitis and tonsillitis due to streptococcus pyogenes. Another important cause that warrants attention is Epstein Barr virus (infectious mononucleosis) so that prescribing of penicillins is carefully considered. The sore throat may be the presentation of serious and hidden systemic diseases, such as blood dyscrasias, AIDS and diabetes (due to moniliasis).

Acute Disease↗
PubMedDate not supplied

[Hypogammaglobulinemia of variable expression, Addison's disease, Dubin-Johnson's disease].

A girl aged 12 with hypogammaglobulinaemia is described who developed Addison's disease with adrenal antibodies at the age of eight. This unusual finding is rarely seen in childhood except in the syndrome of juvenile familial polyendocrinopathy and mucocutaneous moniliasis. By chance the child also had Dubin-Johnson syndrome which could alter the metabolism of therapeutically administered drugs and steroids.

Addison Disease↗
PubMedDate not supplied

[Acquired immunodeficiency syndrome in older children].

The authors report 3 cases of AIDS in children 10 and 11 years of age. These cases fulfill the definition of AIDS such as established by C.D.C. (Centers for Disease Control, Atlanta, Georgia U.S.A.) As opportunistic infections, the first case had oral moniliasis, the second case presented with ganglionic form of Kaposi Sarcoma and the third case had cryptococcal meningitis. The mode of transmission in this age group is unknown. Only one child had repeated transfusion. The parents of these children are in good health and were not at risk for AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Long-term follow-up of hemophiliacs with lymphocytopenia or thrombocytopenia.

Immunologic abnormalities resembling those seen in patients with the acquired immunodeficiency syndrome (AIDS) are frequently observed in multitransfused but otherwise healthy individuals with hemophilia. To determine whether there was clinical or laboratory evidence to suggest an abnormality of immunoregulation in persons with hemophilia before the recognition of AIDS, we examined data collected by the Hemophilia Study Group from 1975 to 1979 on 1,551 patients with factor VIII deficiency. The prevalence of lymphocytopenia and thrombocytopenia in patients over 5 years of age on entry was found to be 9.3% (94/1,013) and 5.0% (26/518), respectively. These rates were significantly different from a normal population (P less than .00001 and less than .0003). No cases meeting the definition of AIDS were noted during the study. However, on follow-up in 1984 of a cohort of 79 patients with thrombocytopenia or lymphocytopenia on two or more occasions during the study, eight patients (10%) with AIDS-related abnormalities, including idiopathic thrombocytopenic purpura, non-Hodgkin's lymphoma, generalized lymphadenopathy, and oral moniliasis without obvious cause were identified. Of the 79 patients, liver disease accounted for five of the ten deaths (12.6% mortality) observed during a minimum follow-up of five years after detection of cytopenia. Only one death was attributed to bleeding in the absence of liver disease. We conclude that (a) the frequency of lymphocytopenia and thrombocytopenia was increased in multitransfused factor VIII-deficient hemophiliacs before the advent of AIDS, and (b) persistent lymphocytopenia and thrombocytopenia appear to be strongly associated with liver disease, which was the leading cause of death in a cohort of hemophiliacs followed five or more years.

Acute Kidney Injury↗
PubMed1980

A comparison of low dosage trimethoprim/sulfamethoxazole with oxytetracycline in acne vulgaris.

It has been well documented that acne vulgaris usually responds well to long-term systemic tetracycline therapy. However, not all patients respond satisfactorily due to drug intolerance, adverse side effects such as fixed drug eruptions, moniliasis, photosensitivity, and gastric irritation. A double-blind study comparing trimethoprim/sulfamethoxazole with oxytetracycline in the management of acne vulgaris has demonstrated that trimethoprim/sulfamethoxazole is an equally effective and as safe therapeutic agent as oxytetracycline. The results of this study are shown to confirm the works of other authors.

Acne Vulgaris↗
PubMed1980

Long-term follow-up of infants and children treated with beclomethasone aerosol by a special inhalation device.

A special inhalation device is described which enables young asthmatic children to inhale aerosols. Eighty children who were either too young or were otherwise handicapped to learn to inhale standard aerosols effectively took part in this study. The study period extended from three months to 41 months of treatment in patients ranging in age from 12 months to 15 years. Beclomethasone dipropionate aerosol (BDA) in doses up to 400 microgram/day were utilized. All children were observed to have an excellent response. There were no side effects such as moniliasis or growth failure. It was felt that age was no contraindication to the use of BDA and that better utilization of the aerosol was obtained by the use of the specal inhalation device.

Administration, Intranasal↗
PubMed1982

Vulvovaginitis in premenarcheal girls: clinical features and diagnostic evaluation.

Fifty-four premenarcheal patients (median age 5.8 years) with symptoms or signs of vulvovaginitis were studied, and the results of cultures of vaginal secretions were compared with those from an age-matched control group. Vaginal discharge was found on examination in 24 of 42 patients with a complaint of discharge, and in two of 12 patients without a complaint of discharge. Convincing evidence of bacterial or monilial infection was found in 14 of the 26 patients with discharge on examination, but in none of the 28 patients without discharge (P less than .001). In the latter group pinworm infestation was present in one patient. Moniliasis occurred exclusively in girls who were pubertal (P less than .001). Four patients were found to have gonorrhea. No patient appeared to have symptoms or signs caused by Bacteroides sp, Chlamydia trachomatis, viruses, or Trichomonas vaginalis. Noninfectious causes were identified in four patients with and 13 without discharge (P less than .025); the most common cause was poor hygiene, implicated in six patients. Bubble bath use was implicated in only one patient. In 22 patients, no specific cause could be identified. All patients with poor hygiene as the only cause, and most with no demonstrable etiology, recovered after being advised to institute improved perineal hygiene. Patients with vaginal discharge are likely to have specific infections, and therefore cultures should be taken, in particular for Neisseria gonorrhoeae. Genital pruritus in prepubertal girls has little or no etiologic specificity, but in pubertal girls with vaginal discharge it suggests the presence of monilial vaginitis.

Bacteria↗
PubMedDate not supplied

FK 506/fluconazole interaction enhances FK 506 nephrotoxicity.

In a diabetic liver transplant recipient, immunosuppressed with FK 506, a severe digestive moniliasis required treatment with the antifungal imidazole derivative fluconazole. This was followed by a brisk rise in serum creatinine levels, which returned promptly to baseline when this combination was stopped. Serial measurements of FK 506 concentrations in plasma showed excessive areas under the 24 h time-concentration curve and trough levels during the concomitant intake of imidazole antifungals and FK 506. Eighteen months later, this patient presents with normal renal function. Antifungal imidazole derivatives inhibit the P 450 cytochrome enzyme system and may thus decrease the catabolism of FK 506. Meticulous monitoring of FK 506 trough levels and dosage adaptation are compulsory when concomitant treatment with such a drug is unavoidable. The same is true for cyclosporine in auto-immune diabetic patients receiving cyclosporine A.

Circadian Rhythm↗
PubMed1993

Short-segment intestinal interposition of the distal esophagus.

Esophageal replacement remains a challenge. Colon and jejunum provide alternative conduits to replace the lower esophagus when stomach is not suitable. Between 1971 and 1991, 41 patients underwent short-segment interposition of the esophagus with jejunum or colon. Indications were failed antireflux procedures (n = 21), nondilatable stricture (n = 9), achalasia (n = 2), moniliasis (n = 2), Barrett's esophagus with carcinoma in situ (n = 2), hemorrhagic esophagitis after esophagogastrectomy (n = 1), motility disorder (n = 1), instrumental perforation (n = 1), carcinoma (n = 1), and leiomyosarcoma (n = 1). Thirty-one patients (75.6%) had prior surgical procedures. Interposition with colon was performed in 22 patients and with jejunum in 19. Major complications occurred in 45% after colon interposition (10/22) and hospital mortality was 4.5% (1/22). Major complications after jejunal interposition occurred in 31% (6/19) and hospital mortality was 10.5% (2/19). A contained anastomotic leak occurred in 1 patient, perforation of a colon segment in 1, and jejunal graft necrosis in a third. Late functional results in 34 patients with a mean follow-up of 87 months were excellent or good in 26, fair in 5, and poor in 1. Colon interposition failed to improve symptoms in 2 patients with gastrointestinal motility disorders. Six patients underwent manometry and barium food provocation study. Two colon segments and 3 jejunal interpositions were hypoperistaltic or aperistaltic according to manometry. There was 1 case of aperistaltic jejunum with a distended afferent loop. When stomach is not available, successful palliation of swallowing can be accomplished with either jejunum or colon. Surgeons involved in the management of esophageal disease should be familiar with the technical details of both procedures.

Adult↗
PubMed1993

Endoscopic lesions in chronic renal failure.

To determine the frequency and type of upper gastrointestinal lesions in patients with chronic renal failure (CRF), upper G.I. endoscopy was done in 101 cases. Of the various mucosal lesions, inflammatory changes were seen maximally (40), followed by erosions (16) and ulcers (7). Other changes included atrophic gastro-duodenal folds (17), pale mucosa (11) and moniliasis (6) which was only seen in patients with end stage CRF. Lesions were more frequent in those who were in advanced stage of CRF (81%) and those undergoing dialysis (79%), reflecting a positive correlation of upper G.I. lesions with the severity of CRF.

Adolescent↗
PubMed1993

Prevalence of sexually transmitted diseases among female drug abusers in Malaysia.

The prevalence of sexually transmitted diseases (STD) among female drug abusers was determined by screening 130 new inmates of a rehabilitation centre. The majority of the subjects (77.7%) were self-confessed sex workers. A high prevalence of syphilis (50.8%), hepatitis B (52.2%), moniliasis (23.8%) and trichomoniasis (19.2%) were noted. Gonorrhoea vaginitis was seen in 8.5%, which was low compared to previous studies. Six subjects were seropositive for human immunodeficiency virus (HIV), with 5 of them admitting to needle sharing and working as prostitutes. More than half of them harboured 2 or more STD. A rich reservoir of STD was seen among the drug abusers. With more evidence now available concerning the ease of HIV transmission associated with ulcerative STD, a stage could be set for greater heterosexual HIV transmission. As part of the rehabilitation process, female drug abusers need a thorough screening for STD followed by aggressive treatment regimens.

Adolescent↗