ABSTRACT
Infection by Aspergillus species causes a wide spectrum of pulmonary disease in humans. In two patients with semi-invasive Aspergillus-induced lung disease, significantly reduced levels of interferon-gamma secretion by peripheral blood mononuclear cells were found after in vitro stimulation with the T-cell mitogen phytohaemagglutinin. Despite anti-fungal therapy, both patients exhibited progressive disease, and adjunctive interferon-gamma therapy was associated with significant clinical improvement. The data suggest that impaired production of interferon-gamma can be seen in patients with chronic pulmonary aspergillosis. Adjunctive cytokine therapy with interferon-gamma may be useful in patients with progressive disease despite adequate anti-fungal therapy.
Subject(s)
Aspergillosis/drug therapy , Interferon-gamma/therapeutic use , Lung Diseases, Fungal/drug therapy , Adult , Antifungal Agents/therapeutic use , Aspergillosis/immunology , Aspergillus fumigatus/drug effects , Bronchoalveolar Lavage Fluid/microbiology , Chronic Disease , Disease Progression , Dose-Response Relationship, Drug , Drug Administration Schedule , Drug Therapy, Combination , Female , Humans , Injections, Subcutaneous , Interferon-gamma/blood , Lung Diseases, Fungal/immunology , Middle AgedABSTRACT
The aim was to study the quality of care at a diabetic clinic of a large hospital in Sri Lanka; a sample of 200 patients was randomly selected. A questionnaire was designed to assess patient knowledge of diabetic management and service provision. Clinic attendance records were also used. Measures of outcome were taken to be (i) the patient's level of understanding of their condition, (ii) the availability of diagnostic tests, (iii) the provision of regular screening and (iv) the length of consultation time. The average attendance at each four-hour clinic was 174 patients. With three doctors available, average consultation time was four minutes per patient. Procedures undertaken included measuring blood glucose levels, testing for proteinuria and screening for hyperlipidaemia, hypertension and eye disease. The average score for knowledge regarding management and complications, obtained from analysis of the questionnaire, was 5.3 out of a maximum of 9.0 points. The study showed that the quality of care of diabetic patients did not meet the standards that should be expected. Two of the principal problems were lack of good organisation and poor planning of resource utilisation. An increase in funding would, of course, assist in implementing the improvements suggested.
