Histoplasmosis diseminada subaguda con lesiones iniciales en cavidad oral en un paciente con sida: Reporte de un caso y revisión de la literatura / Subacute disseminated histoplasmosis in a patient with aids. Early oral lesions: A case report and review of the literature

La histoplasmosis es una micosis endémica producida por un hongo dimorfo: el Histoplasma capsulatum. La histoplasmosis es una de las enfermedades fúngicas de mayor prevalencia, en pacientes con enfermedad HIV/Sida avanzada y recuentos de linfocitos T CD4 + menores de 100 cel/uL. Las formas diseminadas agudas y subagudas de la enfermedad, resultan de la reactivación de una infección latente y son mucho más graves en sujetos con Sida, en comparación con otras inmunodeficiencias. En algunos casos, las lesiones orales pueden ser primera o la única manifestación de la enfermedad y pueden asentar en la lengua, el paladar y la mucosa bucal. Se presenta un paciente con infección por el virus de la inmunodeficiencia humana (VIH), que desarrolló una histoplasmosis diseminada subaguda con lesiones ulcerosas en la mucosa oral, como manifestación inicial de la enfermedad.

Histoplasmosis is an endemic mycosis caused by a dimorphic fungus, Histoplasma capsulatum. Histoplasmosis is a fungal disease most prevalent in patients with advance HIV/AIDS disease and CD4 +T cell counts less than 100 cells/uL. Acute and subacute disseminated forms of the disease result from reactivation of latent infection and are much more severe in patients with AIDS compared with other immunodeficiencies. In some cases, oral lesions appear to be the only primary manifestation of the disease and may compromise the tongue, palate or the oral mucosa. Here we present a patient with infection by the human immunodeficiency virus (HIV) who developed a subacute disseminated histoplasmosis with ulcerative lesions in the oral mucosa as the initial manifestation of the opportunistic disease.

Histoplasmosis diseminada subaguda con lesiones iniciales en cavidad oral en un paciente con sida: Reporte de un caso y revisión de la literatura / Subacute disseminated histoplasmosis in a patient with aids. Early oral lesions: A case report and review of the literature

La histoplasmosis es una micosis endémica producida por un hongo dimorfo: el Histoplasma capsulatum. La histoplasmosis es una de las enfermedades fúngicas de mayor prevalencia, en pacientes con enfermedad HIV/Sida avanzada y recuentos de linfocitos T CD4 + menores de 100 cel/uL. Las formas diseminadas agudas y subagudas de la enfermedad, resultan de la reactivación de una infección latente y son mucho más graves en sujetos con Sida, en comparación con otras inmunodeficiencias. En algunos casos, las lesiones orales pueden ser primera o la única manifestación de la enfermedad y pueden asentar en la lengua, el paladar y la mucosa bucal. Se presenta un paciente con infección por el virus de la inmunodeficiencia humana (VIH), que desarrolló una histoplasmosis diseminada subaguda con lesiones ulcerosas en la mucosa oral, como manifestación inicial de la enfermedad.(AU)

Histoplasmosis is an endemic mycosis caused by a dimorphic fungus, Histoplasma capsulatum. Histoplasmosis is a fungal disease most prevalent in patients with advance HIV/AIDS disease and CD4 +T cell counts less than 100 cells/uL. Acute and subacute disseminated forms of the disease result from reactivation of latent infection and are much more severe in patients with AIDS compared with other immunodeficiencies. In some cases, oral lesions appear to be the only primary manifestation of the disease and may compromise the tongue, palate or the oral mucosa. Here we present a patient with infection by the human immunodeficiency virus (HIV) who developed a subacute disseminated histoplasmosis with ulcerative lesions in the oral mucosa as the initial manifestation of the opportunistic disease.(AU)

Risk factors for the delivery of macrosomic infants at the University Hospital of the West Indies.

OBJECTIVE: The aim of this study is to determine the risk factors for the delivery of macrosomic infants at the University Hospital of the West Indies over a 3-year period. DESIGN AND METHODS: A retrospective, descriptive, case-controlled study was performed. Data were extracted from the maternal medical records of 316 macrosomic infants (weighing ≥ 4,000 g) and 316 controls (weighing from 2,500-3,999 g) delivered at the University Hospital of the West Indies. Descriptive analyses were performed comparing maternal characteristics between the two groups. Risk factors were determined using multiple logistic regression models. RESULTS: The incidence of macrosomia for the study period was 4.3%. Women who delivered a macrosomic infant were older, taller, and heavier with a greater body mass index at the start of the pregnancy and gained more weight during pregnancy than their counterparts in the control group (p < 0.05). Maternal obesity, height > 164 cm, abnormalities of glucose control, weight gain > 15 kg, gestational age > 40 weeks, and male gender of the infant were found to increase the risk of delivering a macrosomic infant by over 2-fold (p < 0.05). The greatest risk factor was that of having had a previous macrosomic infant which increased the risk of delivering a macrosomic infant by as much as 6-fold (adjusted odds ratio, 6.0; 95% confidence interval, 1.9-18.7). CONCLUSION: The maternal risk factors for fetal macrosomia identified in this study mirror those of previous studies.

A randomized, double-blind study of triple nucleoside therapy of abacavir, lamivudine, and zidovudine versus lamivudine and zidovudine in previously treated human immunodeficiency virus type 1-infected children. The CNAA3006 Study Team.

OBJECTIVES: Abacavir (ABC) is a potent inhibitor of human immunodeficiency virus type 1 (HIV-1) reverse transcriptase. We compared the efficacy, safety, and tolerability of combination therapy with ABC, lamivudine (3TC), and zidovudine (ZDV) versus 3TC and ZDV in antiretroviral experienced HIV-1-infected children over 48 weeks. METHODS: Two hundred five HIV-1-infected children who had received previous antiretroviral therapy and had CD4(+) cell counts >/=100 cells/mm(3) were stratified by age and by previous treatment. Participants were randomly assigned to receive ABC (8 mg/kg twice daily [BID]) plus 3TC (4 mg/kg BID) and ZDV (180 mg/m(2) BID; ABC/3TC/ZDV group) or ABC placebo plus 3TC (4 mg/kg BID) and ZDV (180 mg/m(2); 3TC/ZDV group). Participants who met a protocol-defined switch criteria (plasma HIV-1 RNA >0.5 log(10) copies/mL above baseline at week 8 or >10 000 copies/mL after week 16) had the option to switch to open-label ABC plus any antiretroviral combination or continue randomized therapy or withdraw from the study. RESULTS: The Kaplan-Meier estimates (95% confidence interval) of the proportion of participants who maintained HIV-1 RNA levels 10 000 copies/mL, a significantly higher proportion of participants in the ABC/3TC/ZDV group had HIV-1 RNA

Dynamical assessment of the accretionary record in the shell of the mussel Semimytilus algosus from a rocky shore in Chile.

Patterns of tidal microgrowth bands present in acetate peels of shell sections of the Chilean mussel Semimytilus algosus from three tidal levels on a wave-exposed shore were analyzed for the presence of recurring periodicities using numerical tools derived from signal nonlinear analysis. Both chaotic and coherent structure were found within the microgrowth pattern record, with mussels from the middle and lower tidal zones displaying a coherent structure to the patterns, whilst those from the upper tidal level displayed a chaotic banding pattern with a strong tidal component. It is suggested that because mussels in the upper tidal zone are subject to a wider suite of environmental conditions they are influenced by the spring-neap lunar tidal cycle to a greater extent than those growing in the mid to low tidal zone and display deterministic chaotic growth. This allows the mussels to grow continuously in the highly variable conditions that prevail in the upper tidal zone without continuous interruptions to shell deposition.

Acculturation and breastfeeding on the United States-Mexico border.

Previous studies have demonstrated a strong association between breastfeeding incidence and ethnic background, indicating the presence of strong cultural influences on infant-feeding patterns within ethnic groups. This study analyzed the relationship of acculturation into the United States, one aspect of ethnicity, to the initiation of breastfeeding among a sample of 213 women recruited approximately 2 months prenatally in the United States-Mexico border city of Brownsville, Texas. An in-depth, structured interview was conducted at that time (n = 213), at the time of birth (n = 207), and 2 to 3 weeks postnatally (n = 206). In addition, male partners of the mothers were interviewed prenatally when available (n = 119). Acculturation scores and demographic characteristics were tested relative to breastfeeding initiation. The degree of acculturation, age, and marital status were associated significantly with breastfeeding initiation (with breastfeeding continued at 2 to 3 weeks postnatally), but occupational status, education, and income were not. Breastfeeding incidence was highest among older, married, or low-acculturated, Anglo mothers. These data suggest that women being assimilated into the United States are inhibited in the initiation of breastfeeding. These findings suggest that to be successful, intervention programs to increase breastfeeding incidence must consider the cultural adaptation of different groups as they meld with the larger population.

Breast-feeding initiation in a triethnic population.

The influence of sociodemographic factors on the initiation of breast-feeding was evaluated in a triethnic population from Galveston, Tex. Breast-feeding rates were 44.3% among Anglo-Americans, 13.5% among blacks, and 26.6% among Mexican-Americans. Mexican ethnicity, education levels among Anglo-Americans, and marital status were associated with the initiation of breast-feeding. Odds ratios for breast-feeding were 1.94 (95% confidence interval, 1.10 to 3.43) times higher in Mexican-American compared with black women, and 1.94 (95% confidence interval, 1.34 to 2.83) times higher in married than unmarried women. Anglo-American ethnicity and education, as main effects, were not significantly associated with breast-feeding, but their interaction was. Among Anglo-American women (in comparison with black women), the odds ratios of breast-feeding increased with education level, ranging from 1.84 for those with less than an eighth grade education to 7.46 for those with some college. In contrast to recent findings suggesting that education was more important than ethnicity in predicting breast-feeding, the odds of breast-feeding among Anglo-American compared with black women depended on the level of maternal education, but the odds of breast-feeding for Mexican-American vs black women did not depend on education.

Attitudes toward breastfeeding.

To understand why some lower socioeconomic status mothers delivering at a state university hospital breastfeed, while others do not, 26 attitude items were administered in a survey of 358 mothers. A factor analysis of these items yielded four interpretable factors: benefits to infant, social inconvenience, personal inconvenience, and physical inconvenience-medical benefits to child. These factors were significantly related to breastfeeding within each level of ethnicity and marital status. The results imply that emphasizing the benefits for the infant, and providing strategies for minimizing personal inconveniences, should promote breastfeeding in these populations.

Social support, social influence, ethnicity and the breastfeeding decision.

A survey was conducted of all mothers delivering infants at a university medical center hospital in the month of July, 1981. The survey was conducted within 48 hours of delivery and addressed factors related to the breastfeeding decision. The mother's response to the question concerning choice of infant feeding was verified against the feeding records. One set of questions concerned the perceived general supportiveness toward breastfeeding of six individuals significant to the mother. Another set of questions identified who was most influential in the mother's breast or bottle feeding decision. The pattern of significant bivariate relationships between a person's supportiveness and breastfeeding varied across ethnic and maritial status groups. Single and multiple logistic analyses were conducted within ethnic groups to identify from whom support was most important for initiating breastfeeding. Among Black-Americans, support from a close friend was most important. Among Mexican-Americans, support from the mother's mother was most important. Among Anglo-Americans, support from the male partner was important. A broad variety of ensuing research issues are raised. An implication is that social support may be an important interventive variable, but the potentially supportive individual to be reached by an interventive program varies by ethnic group.

Neurobehavioral effects of neonatal hypermagnesemia.

To investigate the effects on the newborn infant of maternal magnesium therapy for treatment of pre-eclampsia, we studied 36 hypermagnesemic infants born to pre-eclamptic mothers treated with MgSO4, 18 neonates born to untreated pre-eclamptic mothers, and 25 infants born to normal mothers. Impairment of neuromuscular transmission, as well as neurobehavioral differences when compared to controls, were found in hypermagnesemic infants. Awareness of the changes produced in the neonate by magnesium is important for accurate clinical assessment of the infant's condition, as well as for anticipating the postnatal interaction of magnesium with other drugs administered during labor and delivery.

Primary pulmonary hypoplasia in the neonate.

Infants with primary pulmonary hypoplasia with respiratory distress immediately after birth, but usually elude early diagnosis. They have no other abnormalities, but frequently develop signs and symptoms of the PFC syndrome. Roentgenographically, they show small, clear lungs and are prone to develop complicating pneumothoraces. The clinical, roentgenographic, and pathologic features of eight infants with primary pulmonary hypoplasia are presented.

Intepretation of lung function tests in the sickle-cell haemoglobinopathies

Prediction equations have been evolved for the assessment of vital capacity, total lung capacity, and the single breath carbon monoxide transfer factor in haemoglobin SS and haemoglobin SC disease. These relationships take account of the growth disorder and anaemia in the sickle-cell states. The results suggest that, in the clinically stable state, and effects of alveolar capillary sickling and haemoconcentration and any altered reactivity of haemoglobins S and C with the test gas are of no significance for clinical respiratory physiology. Sex differences in lung function appear independent of haemoglobin type. (AU)