[Prevention, first aid and treatment of eye injuries in the Ukraine during the last 60 years].
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Eye Injuries↗
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An aid to the oscillographic display of two short-lasting wave-forms separated by a known relatively long interval.
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Oscillometry↗
Ethics, mores and values--and AIDS.
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Acquired Immunodeficiency Syndrome↗
Two cases of long lasting bacteremia due to Mycobacterium avium complex despite new macrolides-containing regimens in patients with acquired immunodeficiency syndrome.
The prognosis of Mycobacterium avium complex (MAC) infection has been improved by new macrolides-containing regimens and the use of highly active antiretroviral therapy (HAART) in the treatment of acquired immunodeficiency syndrome (AIDS). We report on two AIDS cases with long lasting bacteremia due to MAC under this regimen. Both patients experienced problems due to side effects from the anti-MAC regimen and from an immune-reconstitution syndrome related to HAART. MAC infection persisted despite treatment, however, no anti-MAC drug-resistant isolates emerged throughout the clinical course in either case. These cases demonstrate that therapy for disseminated MAC infection is sometimes difficult even with HAART and macrolides-containing regimens.
Acquired Immunodeficiency Syndrome↗
The usage and costs of health services for HIV infection in Australia.
OBJECTIVE: To describe patterns of health-service usage and the resulting costs in 1992-1993 for Australian men. DESIGN: A prospective survey, stratified by phase of illness. SETTING: Hospital and community-based care. PATIENTS: A total of 128 homosexual men: 20 in phase 1 (CD4+ count > or = 500 x 10(6)/l), 31 in phase 2 (CD4+ count < 500 and > or = 200 x 10(6)/l), 30 in phase 3 (CD4+ count < 200 x 10(6)/l), and 47 in phase 4 (AIDS). MAIN OUTCOME MEASURES: Mean monthly service usage rates and costs. RESULTS: Health-service utilization increased and became more hospital-based as illness worsened; the main exception was use of antiretroviral drugs, which peaked in phases 2 and 3. Hospital admission was rare before diagnosis of AIDS. Hospital bed-days per patient per month averaged 3.3 for AIDS patients until the final 3 months of life increasing to 15.8 in the 3 months before death. Mean monthly costs (in 1992-1993 Australian dollars) were $331 [95% confidence interval (CI), 218-455] in phase 1, $667 (95% CI, 540-836) in phase 2, $1372 (95% CI, 1044-1776) in phase 3, and $4615 (95% CI, 3456-5985) for AIDS patients until the last 3 months of life and $13,308 (95% CI, 10,538-16,516) in the 3 months before death. Drugs comprised 57% of total costs in phase 1, but only 30% of costs for patients with AIDS, whereas hospital bed-days comprised 10% of phase 1 costs and 60% of AIDS costs. CONCLUSIONS: Health-care utilization and resulting costs increased with severity of illness, and were particularly high for AIDS patients in the 3 months before death. Service-utilization patterns and components of costs varied between each phase.
Acquired Immunodeficiency Syndrome↗
[AIDS and HIV infection in Poland in 1999].
After gradual increasing in the number of annually diagnosed AIDS cases in the last years these numbers remained relatively stable (nearly 120). The biggest number of newly discovered HIV infections (809) was reported in 1990. Next years these numbers ranged from 384 in 1993 to 637 in 1998. Majority of AIDS cases and HIV-infected persons in Poland were drug users, respectively 50% and 60%. Between 1985 and 1999 some important changes have been observed in Polish data collection system concerning for example: anonimity of reported HIV infections, data completeness and reporting of AIDS indicator diseases. Quality of collected epidemiological data will depend--among others things--on: easy access to HIV testing, data completeness and diagnosis of AIDS indicator diseases by definitive methods.
Acquired Immunodeficiency Syndrome↗
Variations in perceived pain associated with emotional distress and social identity in AIDS.
This article examines associations between self-perceptions of pain and associated pain distress to gender, ethnicity and religion, health care, health status, and emotional distress. Data were collected through interviews collected in participants' homes. Participants were 151 adults with diagnoses of advanced human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS). Time since diagnosis, health status, health care, ethnicity, gender, religion, and emotional distress were examined as mediators of pain symptoms, pain distress, and anticipatory pain. Almost all participants (83%) reported AIDS-related pain in the last 3 months. Unexpectedly, pain was negatively associated with time since diagnosis with AIDS. Pain symptoms and pain distress tended to vary by ethnicity, with Latinos expressing more symptoms and pain distress than African Americans. Anticipatory pain varied significantly by gender and religion, with women, Catholics, and Protestants anticipating pain more than men and non-Christians. Anxiety, depression, and general emotional distress were significantly associated with pain symptoms (r = 0.44, 0.33, 0.47) and pain distress (r = 0.34, 0.31, 0.34). Health status and health care were unrelated to pain symptoms, pain distress, or anticipatory pain. Pain is a common problem for people living with HIV/AIDS. Self-reported pain is associated with cultural factors and changes in illness status. Clinicians' attention to patients' emotional distress, depression, and anxiety may assist in interventions for pain management.
Acquired Immunodeficiency Syndrome↗
Ten-year trends in CD4 cell counts at HIV and AIDS diagnosis in a London HIV clinic.
OBJECTIVE: To examine temporal trends (1986-1996) in the CD4 cell count at first HIV-1 positive test and initial AIDS diagnosis, and the influence of selected patient characteristics and treatment factors on these trends. DESIGN: A retrospective clinic-based study. SETTING: Three hospital-based clinics in West London. PATIENTS: A group of 5921 adult HIV-1-seropositive persons and 2835 reported patients with AIDS over a 10-year period from 1 January 1986 to 1 October 1996. METHODS: The CD4 cell count at HIV diagnosis (CD4HIV) was defined as the nearest CD4 cell count to within 2 months of HIV diagnosis; and the CD4 cell count at AIDS diagnosis (CD4AIDS) as the last CD4 cell count in the two months prior to the development of AIDS. Simple and multiple linear regression analysis were used to examine the influence of selected covariates on CD4HIV and CD4AIDS. RESULTS: The percentage of patients with an available CD4HIV and CD4AIDS increased from less than 5% in 1987 to 53% and 40%, respectively, in 1990, and 79% and 48%, respectively, in 1996. Patients with a missing CD4HIV or CD4AIDS were younger and less likely to have received antiretroviral therapy or prophylaxis for Pneumocystis carinii pneumonia (PCP). There was no significant change in CD4HIV over a 10-year period (median 334 x 10(6) cells/l), but a lower CD4HIV was associated with older age at presentation and injecting drug use. There was a delay in the onset of clinical AIDS, with a fall in the median CD4AIDS value from 99 x 10(6) cells/l prior to 1987, to 58 x 10(6) cells/l in 1990, 68 x 10(6) cells/l in 1994 and 60 x 10(6) cells/l in 1996; this decline in onset was seen for PCP as well as for cytomegalovirus and atypical mycobacterial infections. At all time periods, a lower CD4AIDS was associated with combined use of antiretroviral therapy and PCP prophylaxis. After adjustment for use of antiretroviral therapy and PCP prophylaxis prior to AIDS diagnosis, year of diagnosis was no longer associated with CD4AIDS. There was a significant trend towards an improved survival following AIDS diagnosis from 20.1 months prior to 1988, to 20.3 months (1989-1990), 21.0 months (1991-1992) and 22.1 (1993-1994) (P < 0.0005). CONCLUSIONS: The observed decline in CD4AIDS value was related to the introduction of antiretroviral therapy in 1988, and PCP prophylaxis in 1989. Temporal changes in the CD4 cell count at HIV and AIDS diagnosis among different demographic groups can provide insights into the changing natural history of the HIV epidemic and access to medical care. We recommend monitoring of the CD4 cell count at new HIV and AIDS diagnosis and at initiation of antiretroviral therapy as additional measures in national HIV/AIDS surveillance.
Acquired Immunodeficiency Syndrome↗
[Healthcare: a growing role in international politics].
Since the end of the cold war the tone of international relations has clearly changed. Whereas relations were once defined strictly in terms of more or less armed confrontation, economic and social issues now play a growing role. Healthcare policies in Africa have long been influenced by the policies of countries sponsoring bilateral and even multilateral foreign aid programs. However the last ten years have witnessed an increasing interaction between international policy and healthcare policy. The two main reasons for this trend involve 1) access to drug treatment and the WTO and 2) the extension and impact of the AIDS epidemic. The problem of access to drug treatment for poor populations (fundamental right) has led to the emergence of an increasingly strong and effective civil society. Because of its social and economic effects as well as its geopolitical and security implications, AIDS has become a major factor in international relations. With regard to both these issues the place and role of the USA is demonstrative of the interaction between healthcare and international relations.
Acquired Immunodeficiency Syndrome↗
AIDS-related conditions: study of a representative sample of 1203 patients deceased in 1992 in France.
BACKGROUND: Little representative information exists on the frequency of human immunodeficiency virus (HIV)-related diseases among the overall AIDS population. The objective of this research is to assess the nature, frequency and characteristics of these diseases among AIDS patients during their last year of life and to analyse these frequencies according to the mode of transmission and other socio-demographic and medical characteristics. METHODS: To obtain comprehensive data, we conducted an investigation based on retrospective collection of clinical information on a representative sample (1203 deaths) of all AIDS deaths that occurred in France during 1992. RESULTS: The frequency of the diseases was markedly higher than the one described in the AIDS surveillance registers and varied between homosexuals and intravenous drug users (IVDU). After controlling for other variables (age, CD4 counts, survival times) by means of logistic regression, homosexuality remained a significant explaining factor for Kaposi's sarcoma, cytomegalovirus infections, herpes simplex and cryptosporidiosis. In contrast, HIV encephalopathy, hepatitis, mental disorders, invasive candidiasis and cachexia were more frequent in male IVDU. Few differences were observed by sex. CONCLUSIONS: Several factors may explain the differences: variation in exposure to infectious agents, general health status, use of medical care and direct influence of the mode of HIV transmission. These data are of particular value for medical services in planning the magnitude of health care needs among the AIDS population overall, for clinicians and researchers for advancing the understanding of the natural history of AIDS and in the definition of prophylactic strategies against opportunistic infections.
AIDS Dementia Complex↗
Assessing the impact of humanitarian assistance in the health sector.
There have been significant improvements in the design and management of humanitarian aid responses in the last decade. In particular, a significant body of knowledge has been accumulated about public health interventions in emergencies, following calls for developing the evidence base of humanitarian health interventions. Several factors have prompted this, such as the increased volume of humanitarian assistance with subsequent higher levels of scrutiny on aid spending, and greater pressure for improving humanitarian aid quality and performance. However, documentation of the ability of humanitarian interventions to alleviate suffering and curb mortality remains limited. This paper argues that epidemiological studies can potentially be a useful tool for measuring the impact of health interventions in humanitarian crises. Survey methods or surveillance systems are mainly used for early warning or needs assessment and their potential for assessing the impact of aid programmes is underutilised.
Journal Article↗
Opportunistic infections caused by protozoan parasites.
Parasitic protozoa have played a major role in the discovery of the HIV epidemic. It was the occurrence of clustered cases of Pneumocystis pneumonia which caught the attention of the epidemiologists indicating that something unusual was going on. Very recently remarkable progress was made in understanding the epidemiology. Knowledge is evolving that Pneumocystis is host-specific to an extent which seems to justify species rank for the cause of death in AIDS patients for many years. Toxoplasma gondii infections were also recognized very early in AIDS patients. Cerebral toxoplasmosis has now replaced Pneumocystis pneumonia as a fatal infection in many cases. AIDS patients with CD4 cells below 200/microl have a high risk to develop this complication. Cryptosporidium parvum was recognized as the cause of diarrhea in AIDS patients and also in immunocompetent humans where it only leads to a diarrheal episode lasting a few days. In AIDS patients the persisting diarrhea leading to loss of fluid and electrolytes can be life-threatening. Another group of parasites previously unknown to infect humans are the microsporidia, which are wide-spread parasites in nature. Increasing numbers of such infections are observed but many questions regarding pathogenesis and epidemiology are still unclear.
AIDS-Related Opportunistic Infections↗
Problems associated with providing dental care to patients with HIV-infected and AIDS patients.
Numerous articles published during the last decade have discussed the significance of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) toward the practice of dentistry. However, only since 1987 have studies been undertaken on the attitudes and behavior of dentists toward HIV-positive patients. A detailed analysis of 15 such reports suggests that concerns regarding the perceived stigma of treating such patients, together with a fear that HIV is transmitted through dental treatment are major reasons why dentists are reluctant to care for HIV-positive and AIDS patients. Successful resolution of these concerns is time consuming and expensive but necessary if dentists are to satisfy their professional obligations to patients with HIV infection and AIDS.
Acquired Immunodeficiency Syndrome↗
Involuntary movements and AIDS: report of seven cases and review of the literature.
We studied 1086 AIDS patients in the last six years. Of these 389 (35.82%) had neurological manifestation and 7 (1.8%) male patients had abnormal involuntary movements (parkinsonism in 3, hemichorea-hemiballism in 2, spinal myoclonus in 1 and rubral tremor in another). All patients were men, 5 white and 2 black. Four were homosexual, 2 drug-users and 1 bisexual. The mean age was 33.14 years. The time between AIDS diagnosis and the onset of movement disorders was 23.8 months in 5 patients and in 2 it was the first symptom. The parkinsonian patients did not show any opportunistic infection in connection with the neurological symptoms but in the remaining four cases this relationship was suggested. The data showed that not only the opportunistic infection but also the AIDS virus may play an important role on the development of involuntary movements.
Acquired Immunodeficiency Syndrome↗
Computer assistance for intraoperative navigation in ENT surgery.
The intraoperative need for exact orientation during interventions in the paranasal sinuses and the augmented need for navigational aids in lateral skull base surgery have lead to the development of computer-aided tools during the last fifteen years. These tools, which provide the position of a tool or a pointer in the patient's preoperative radiologic imaging, have quickly gained a wide acceptance for revision surgeries and the surgical treatment of complex pathologies in Ear-, Nose- and Throat (ENT-) surgery. Currently, the use of such systems is spreading from academic centers to smaller hospitals and will become a standard tool in the near future. We review the present state of computer-aided surgery (CAS) systems, based on our experience as clinical and research centers with a long experience in the field, provide some technological background information and, based on selected cases, show the merits of this technology. The systems we have been working with cover a wide variety of intraoperative navigational systems in ENT surgery (Easy Guide, MedScan II, MKM, SNN, STN, SurgiGATE ORL, Treon, VectorVision, Viewing Wand, [without claiming completeness]), and virtually the whole area of ENT surgeries: macroscopic, (video-)endoscopic and microscopic procedures. The 3D tracking technologies involved cover mechanical, optical (active and passive), magnetic and robotic principles. The visualization tools used are computer monitors, video monitors, head-up-displays and the microscope's oculars, thus spanning the area from pointer-systems to real navigators and a surgical telepresence demonstrator, implementing the majority of available patient-to-image referencing strategies. Clinically, the systems can be operated with an acceptable accuracy of around 1 mm, whereas in laboratory settings and in cadaver studies application accuracy may be pushed to its limits: the physical resolution of the radiologic imaging used for navigation.
Journal Article↗
Caffeine, coffee and ephedrine: impact on exercise performance and metabolism.
This paper addresses areas where there is controversy regarding caffeine as an ergogenic aid and also identifies topics that have not been adequately addressed. It is clear that caffeine, in moderate amounts, can be used orally as an ergogenic aid in aerobic activity lasting for more than 1 min. It increases endurance and speed, but not maximal VO2 and related parameters. While there are fewer well-controlled studies for resistance exercise, the literature would suggest similar improvements: increased endurance at submaximal tension and power generated in repeated contractions and no change in maximal ability to produce force. It is likely that theophylline (a related methylxanthine) has similar actions and it has been suggested that the combination of caffeine and sympathomimetics may be a more potent erogenic aid. The voids in our understanding of caffeine include the dose (what amount is optimal, what vehicle is used to deliver the drug as well as method, pattern, and mode of administration), the potential side effects (particularly in competitive settings), health implications (insulin resistance and if combined with ephedrine, cardiovascular risks) and mechanisms of action. It appears unlikely that increased fat oxidation and glycogen sparing is the prime ergogenic mechanism.
Caffeine↗
The manifestation of AIDS in Africa: an epidemiological overview.
The HIV epidemic in Africa has changed over the last decade and the incidence of AIDS, which was very low at the beginning of nineties, is now dramatically increasing. In this paper, we analyze the current situation of AIDS epidemiology on the continent, based on data generated by the antenatal care surveillance systems. As described here, the spread and prevalence of HIV differ in each African country, with South Africa now facing the worst situation. In addition, we have focused our attention on the modes and risks of viral transmission, highlighting the spread of HIV in particular subpopulations, which, for different reasons, prove to be more affected by the epidemic, such as sex workers and children. Genotype evolution and distribution in the various geographical areas are also considered. From this brief overview, it appears clear that poverty, the lack of technologies and inadequate resources, due mostly to social and economic instability, are widening the already existent gap between Africa and industrialized countries.
Acquired Immunodeficiency Syndrome↗
Sensitivity of an AIDS case-finding algorithm: who are we missing?
OBJECTIVE: The objective of this study was to determine the sensitivity of an AIDS case-finding algorithm. METHOD: This study applied the AIDS case-finding algorithm to paid Medicaid claims linked to New Jersey AIDS surveillance data and assesses its sensitivity across subgroups of patients. FINDINGS: Of the 7183 cases with confirmed AIDS, based on the state's registry information, 95% (n = 6818) were correctly detected using all Medicaid claims, including pharmacy. For patients in a community-based waiver program, covered by Medicare, diagnosed with a severe mental illness, or continuously enrolled in Medicaid, with regular contact with the medical system, the algorithm identified almost all patients. To further evaluate algorithm performance, it was used with 2 groups of interest to researchers. For AIDS patients in the last 6 months of life, 88% were correctly detected without use of pharmacy claims and 95% when pharmacy claims were included. For pregnant women, data from the 6 months before the latest delivery date identify 27% of pregnant women without pharmacy claims and 41% when pharmacy claims were included. Using claims made after the latest delivery date, 81% of pregnant women were detected without pharmacy claims and 93% when pharmacy claims were included CONCLUSION: Results demonstrate that a multilevel screen can be used with Medicaid claims to effectively to detect most patients with AIDS. Detection is lower for some subgroups, and the absence of pharmacy claims can compromise detection.
Acquired Immunodeficiency Syndrome↗