Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 17 de 17
Filter
1.
Int J Tuberc Lung Dis ; 11(3): 331-7, 2007 Mar.
Article in English | MEDLINE | ID: mdl-17352101

ABSTRACT

SETTING: Charity Hospital New Orleans, Louisiana, USA. OBJECTIVE: To define the differences between the pre-HAART (highly active anti-retroviral treatment) and HAART eras in patients co-infected with Mycobacterium kansasii and the human immunodeficiency virus (HIV). DESIGN: A retrospective chart review revealed 82 patients with HIV and M. kansasii during the 6-year period from 1 July 1991 to 30 June 1997 (pre-HAART era), while the 6-year period from 1 July 1997 to 30 June 2003 (HAART era) revealed 55 cases. RESULTS: Among all patients with M. kansasii and HIV, 47 (34%) had an additional, concurrent mycobacterial infection and two had triple mycobacterial species isolation. More patients (17/82, 21%) had disseminated mycobacterial disease in the pre-HAART era than in the HAART era (3/55, 5%; P = 0.045). Pre-HAART patients treated without clarithromycin (CLM) survived a median of 2 months vs. 10 months for pre-HAART patients treated with CLM (P = 0.05). Those treated without CLM had a median survival of 2 months in the pre-HAART era (n = 19) vs. 10.5 months in the HAART era (n = 12, P < 0.02). CONCLUSION: CLM use in treatment of M. kansasii in HIV-co-infected patients is associated with significantly longer survival.


Subject(s)
AIDS-Related Opportunistic Infections/drug therapy , Anti-Bacterial Agents/therapeutic use , Antiretroviral Therapy, Highly Active , Antitubercular Agents/therapeutic use , Clarithromycin/therapeutic use , Mycobacterium Infections, Nontuberculous/drug therapy , Mycobacterium kansasii/drug effects , AIDS-Related Opportunistic Infections/epidemiology , Adult , CD4 Lymphocyte Count , Female , Humans , Louisiana/epidemiology , Male , Microbial Sensitivity Tests , Middle Aged , Mycobacterium Infections, Nontuberculous/epidemiology , Mycobacterium kansasii/isolation & purification , Retrospective Studies , Treatment Outcome
2.
Endoscopy ; 38(11): 1122-6, 2006 Nov.
Article in English | MEDLINE | ID: mdl-17111334

ABSTRACT

BACKGROUND AND STUDY AIMS: In the past, there were long delays in the diagnosis of patients with cancer of the stomach or esophagus. The objective of this study was to describe current delays in the diagnosis and treatment of gastric and esophageal adenocarcinoma and to compare the findings with those from an historical control population treated at the same institutions 10 years earlier. PATIENTS AND METHODS: Patients with biopsy-proven gastric cancer or esophageal adenocarcinoma who were treated at two academic medical centers in Germany between April and October 2003 were consecutively screened for eligibility to take part in the study. Medical charts for each patient were reviewed. Additional data were obtained via structured interviews. Main outcome measures were the total delay, and the delays related to patients themselves, to doctors, and to the hospital. Data were compared with those from a historic control group assessed in 1993. RESULTS: The median total delay for patients with gastric cancer (n = 104) was 3.5 months (range 0.3 - 29.6), and in patients with esophageal adenocarcinoma (n = 22) the total delay was significantly shorter (median 2.2 months, range 1.2 - 11.7; P < 0.05). Comparing these findings with those from an historic cohort of patients with gastric cancer (n = 100) revealed a significant decrease in the total delay (3.5 versus 8.0 months, P < 0.001). CONCLUSIONS: The current findings indicate that delays in the diagnosis and treatment of gastric cancer have become significantly shorter within the last 10 years as our understanding of and ability to treat this form of cancer have improved.


Subject(s)
Adenocarcinoma/diagnosis , Adenocarcinoma/therapy , Esophageal Neoplasms/diagnosis , Esophageal Neoplasms/therapy , Stomach Neoplasms/diagnosis , Stomach Neoplasms/therapy , Adult , Aged , Aged, 80 and over , Cohort Studies , Delivery of Health Care/organization & administration , Female , Humans , Male , Middle Aged , Patient Acceptance of Health Care , Physician's Role , Socioeconomic Factors , Time Factors
3.
Water Res ; 36(2): 394-402, 2002 Jan.
Article in English | MEDLINE | ID: mdl-11827345

ABSTRACT

An aerobic membrane bioreactor treating municipal wastewater at complete biomass retention was studied in respect of microbiological parameters over a period of 380 days. The results were compared to those obtained from a conventional activated sludge wastewater treatment plant (WWTP) treating the same wastewater. Microscopically, significant changes in the structure of the flocs and of the ratio between free suspended and aggregated cells could be observed. The presence of filamentous bacteria varied from almost not present to very high numbers. With the exception of short periods after changes in operating conditions, protozoa and metazoa were rarely present in the sludge community. The rate of oxygen consumption and the cell detectability by fluorescence in situ hybridizatio (FISH) with rRNA-targeted oligonucleotide probes were used to assess the physiological state of the bacterial cells Oxygen consumption rates of sludge samples obtained from both the conventional and membrane filtration plant wer determined without and after addition of different energy and carbon sources. In contrast to the conventional activate sludge, a pronounced increase in respiration activity upon the addition of organic substrates could be observed in th membrane filtration sludge. In situ probing with the Bacteria-specific probe EUB338 visualized 40-50% of all DAPI stainable bacteria in the membrane bioreactor, compared to 80% cells detectable by FISH in the conventional activate sludge. These results suggest that bacteria present in the highly concentrated biomass of the membrane reactor use the energy supplied for their maintenance metabolism and were not in a physiological state characteristic for growth This assumption could explain the zero net biomass production observed in the reactor.


Subject(s)
Bacteria , Bioreactors , Membranes, Artificial , Waste Disposal, Fluid/methods , Water Purification/methods , Biomass , In Situ Hybridization, Fluorescence , Oxygen Consumption , Sewage
4.
Water Res ; 36(2): 413-20, 2002 Jan.
Article in English | MEDLINE | ID: mdl-11827347

ABSTRACT

Aerobic treatment of municipal waste water in a membrane bioreactor was studied for 535 d. Apart from sampling, sludge was retained completely by a submerged hollow fibre membrane with a pore-size of 0.2 microm. The pilot plant comprised an anoxic zone to enable denitrification. The maximum liquid hold-up of the plant was 3.9 m3. In this study the reactor performance and the stability of the process and the membrane capacity were investigated. A stable flux of 181 m(-2)h(-1) could be realised with a mean transmembrane pressure difference of 0.3bar with air-bubbling and backflushing the membrane and cleaning it in place every two months for one or two hours. For about 140d, a flux of 271 m(-2)h(-1) was achieved, but cleaning became necessary more often. The hydraulic retention time (HRT) varied between 10.4 and 15.6h. Accordingly the volumetric loading rate was between 1.1 and 1.7kg CODm(-3)d(-1). No inoculum was used. The mixed liquor suspended solids (MLSS) concentration gradually increased to 18-20g MLSSl(-1). The feed to microorganism (F/M) ratio varied according to the operation conditions but decreased against a value of 0.07 kg COD kg(-1) MLSSd(-1). Treatment performance was very stable and on a high level. The COD was reduced by 95%. Nitrification was complete and up to 82% of the total nitrogen could be denitrified.


Subject(s)
Bacteria, Aerobic/physiology , Bioreactors , Membranes, Artificial , Waste Disposal, Fluid/methods , Water Purification/methods , Nitrogen/metabolism , Oxygen/metabolism , Particle Size , Porosity , Sewage/microbiology , Water Movements
5.
Health Hum Rights ; 4(1): 60-81, 1999.
Article in English | MEDLINE | ID: mdl-10438555

ABSTRACT

Isolated Amazonian peoples such as the Urarina in Peru remain at risk of cultural and biological extinction from industrial exploitation and imported diseases. In the last seven years, many Urarina have died in epidemics of measles, cholera, pertussis, and malaria. The Peruvian government has encouraged oil exploration and logging in the Amazon without regard to Urarina rights, and the international treaty promoting indigenous rights that Peru ratified is not enforced. There are, however, two promising developments for indigenous survival. The first is the growing realization of biologists, ecologists, sociologists, and conservationists that conservation of biodiversity and global environmental protection are interconnected with indigenous rights. Secondly, the two declarations on the rights of indigenous peoples proposed by the Organization of American States and the United Nations are more specifically protective of indigenous rights than previous manifestos have been.


Subject(s)
Human Rights , Indians, South American , Social Change , Communicable Diseases/transmission , Environmental Pollution , Human Rights/legislation & jurisprudence , Humans , International Agencies , International Cooperation , Peru/epidemiology
6.
Emerg Infect Dis ; 5(2): 209-15, 1999.
Article in English | MEDLINE | ID: mdl-10221872

ABSTRACT

Epidemic malaria has rapidly emerged in Loreto Department, in the Peruvian Amazon region. Peru reports the second highest number of malaria cases in South America (after Brazil), most from Loreto. From 1992 to 1997, malaria increased 50-fold in Loreto but only fourfold in Peru. Plasmodium falciparum infection, which has increased at a faster rate than P. vivax infection in the last 3 years, became the dominant Plasmodium infection in the highest transmission areas in the 1997 rainy season. The vector Anopheles darlingi has also increased during this epidemic in Loreto. Moreover, chloroquine and pyrimethamine-sulfadoxine drug-resistant P. falciparum strains have emerged, which require development of efficacious focal drug treatment schemes.


Subject(s)
Malaria/epidemiology , Adolescent , Adult , Aged , Animals , Anopheles/parasitology , Child , Child, Preschool , Climate , Drug Resistance , Humans , Infant , Infant, Newborn , Malaria/drug therapy , Malaria/prevention & control , Middle Aged , Peru/epidemiology , Time Factors
8.
J Clin Microbiol ; 36(2): 362-6, 1998 Feb.
Article in English | MEDLINE | ID: mdl-9466742

ABSTRACT

A colorimetric, microplate-based Alamar Blue assay (MABA) method was used to determine the MICs of isoniazid (INH), rifampin, streptomycin (SM), and ethambutol (EMB) for 34 Peruvian Mycobacterium tuberculosis isolates (including both pansensitive and multidrug-resistant strains) and the H37Rv strain by using bacterial suspensions prepared directly from solid media. Results for all isolates were available within 8 days. Discordant results were observed on initial tests for 3 of 16 INH-susceptible isolates, 5 of 31 EMB-susceptible isolates, and 2 of 4 SM-resistant isolates (by the BACTEC 460 system). The overall agreements between the MICs obtained by MABA and the results obtained with the BACTEC 460 system were 87.9% for initial results and 93.6% after retesting 12 of 17 samples with discrepant results. Interpretation of MABA endpoints improved with technical experience. The MABA is a simple, rapid, low-cost, appropriate technology which does not require expensive instrumentation and which makes use of a nontoxic, temperature-stable reagent.


Subject(s)
Antibiotics, Antitubercular/pharmacology , Antitubercular Agents/pharmacology , Microbial Sensitivity Tests/methods , Mycobacterium tuberculosis/drug effects , Oxazines , Tuberculosis/drug therapy , Xanthenes , Bacteriological Techniques , Coloring Agents/metabolism , Culture Media/metabolism , Drug Resistance, Microbial , Drug Resistance, Multiple , Ethambutol/pharmacology , Humans , Isoniazid/pharmacology , Microbial Sensitivity Tests/economics , Peru/epidemiology , Rifampin/pharmacology , Sensitivity and Specificity , Streptomycin/pharmacology , Tuberculosis/epidemiology
9.
Ann Intern Med ; 125(8): 675-9, 1996 Oct 15.
Article in English | MEDLINE | ID: mdl-8849153

ABSTRACT

The term "race" has many definitions, ranging from a family unit to a species, but in common and medical usage, defining "race" has meant separating Homo sapiens into three to six groups. This division of Homo sapiens into race taxons started in the 18th century, when the sciences of genetics and evolutionary biology were not yet invented. These disciplines have since shown that human race taxonomy has no scientific basis. Race categories are social constructs, that is, concepts created from prevailing social perceptions without scientific evidence. Despite modern proof that race is arbitrary biological fiction, racial taxons are still used widely in medical teaching, practice, and research. Human diversity is inconsistently taught in medical schools and erratically presented in medical texts. Race taxons have been "medicalized"; that is, race groupings have been legitimized by their use in medical literature and practice as acceptable descriptive labels that are integral to the proper diagnosis and treatment of disease in humans. Assumptions about disease that are made because a race has been assigned can result in important negative consequences for individual patients and inaccurate genetic inferences for populations. In contrast, ethnicity is a concept that incorporates social, religious, linguistic, dietary, and other variables to identify individual persons and populations. Ethnicity may be able to impart clinical clues to diagnosis if the clinician taking the history is well informed and open minded. Ethnic boundaries are dynamic and imprecise, and a strict methodical approach to ethnicity that is equal to the approach required for the study of other variables is necessary if the concept of ethnicity is to be clinically useful.


Subject(s)
Medicine , Racial Groups , Semantics , Biomedical Research , Ethnicity , Humans
10.
J Med Vet Mycol ; 34(2): 133-7, 1996.
Article in English | MEDLINE | ID: mdl-8732359

ABSTRACT

Aspergillus spp. rarely cause mycetomata. We report a patient with diabetes and nephrotic syndrome with Aspergillus flavus mycetoma of the back, with the development of an epidural abscess, diskitis and vertebral osteomyelitis. The patient was successfully treated with decompressive laminectomy and a 14-month itraconazole regimen. Serial serum itraconazole levels and quantitative Aspergillus antigen levels were performed. This is the second reported and first extrapedal case of mycetoma caused by A. flavus.


Subject(s)
Abscess/drug therapy , Antifungal Agents/therapeutic use , Aspergillosis/drug therapy , Aspergillus flavus , Epidural Space , Itraconazole/therapeutic use , Mycetoma/drug therapy , Abscess/microbiology , Abscess/pathology , Abscess/surgery , Adult , Aspergillosis/microbiology , Aspergillosis/pathology , Back , Epidural Space/microbiology , Epidural Space/pathology , Epidural Space/surgery , Female , Humans , Laminectomy
11.
Clin Infect Dis ; 21(1): 77-85, 1995 Jul.
Article in English | MEDLINE | ID: mdl-7578764

ABSTRACT

We conducted a retrospective study to further elucidate the clinical presentations and prognosis of disease due to Mycobacterium kansasii in patients infected with human immunodeficiency virus (HIV). Forty-nine HIV-infected patients first had M. kansasii isolated at a mean CD4 cell count of 62/mm3 and at a mean interval of 17 months after the diagnosis of AIDS. Seventeen of the 49 patients had disseminated disease caused by M. kansasii. Twenty-nine patients had a positive acid-fast smear of sputum, and 35 were known to be cigarette smokers. At the time of initial isolation of M. kansasii, 13 patients had other concurrent pulmonary isolates and 15 had another mycobacterial species concurrently isolated (the Mycobacterium avium complex in 13 instances). Patients who received antimycobacterial treatment survived longer than those who did not. Only one of the 49 patients was definitively determined to be colonized with M. kansasii without disease; therefore, it appears that pulmonary isolates of M. kansasii in HIV-infected patients are almost always associated with disease. The increase in rates of M. kansasii disease among HIV-infected patients has paralleled the rise of AIDS in Louisiana. So far, this state has recorded more coinfections with M. kansasii and HIV than any other.


Subject(s)
AIDS-Related Opportunistic Infections/complications , HIV Infections/complications , HIV-1 , Mycobacterium Infections, Nontuberculous/complications , Nontuberculous Mycobacteria/isolation & purification , AIDS-Related Opportunistic Infections/diagnosis , AIDS-Related Opportunistic Infections/drug therapy , Adolescent , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , CD4 Lymphocyte Count , Female , HIV Infections/diagnosis , HIV Infections/drug therapy , Humans , Lung/microbiology , Lung Diseases/microbiology , Male , Middle Aged , Mycobacterium Infections, Nontuberculous/diagnosis , Mycobacterium Infections, Nontuberculous/drug therapy , Prognosis , Retrospective Studies , Sputum/microbiology
13.
South Med J ; 87(7): 715-9, 1994 Jul.
Article in English | MEDLINE | ID: mdl-8023204

ABSTRACT

Reports of blastomycosis in individuals infected with the human immunodeficiency virus (HIV) are increasing. We report on 3 patients co-infected with blastomycosis and HIV (to add to the previously reported 21), and review important clinical aspects and outcomes in all cases. The percentage of patients co-infected with blastomycosis and HIV who had disseminated blastomycosis (63%) was similar to the blastomycosis patients in the general population (67%); however, as a group the patients with HIV were severely immunosuppressed and fared poorly. Severe immunodeficiency was indicated by CD4 counts < 200/mm3 in 85% of co-infected patients. Central nervous system (CNS) involvement occurred in 46% of this group, approximately 5 to 10 times more frequently than in individuals not infected with HIV previously reported at 5% to 10%. The mortality rate from blastomycosis for patients with both HIV infection and blastomycosis is 54%, about 5 times the mortality rate of blastomycosis patients in the general population, previously reported at < 10%. Disseminated blastomycosis in individuals with HIV may appear as deep cutaneous ulcers, as was the case in two of our patients. Although blastomycosis is not an AIDS-defining infection, it may be reasonable to consider HIV testing and measurement of CD4 counts in patients with blastomycosis. Such testing could help identify individuals who are HIV positive but asymptomatic who have blastomycosis, as well as provide useful information regarding a possible association between CD4 cell deficiency and various clinical manifestations of blastomycosis. Patients with HIV and blastomycosis should be examined carefully for any evidence of CNS involvement. Lifetime therapy with ketoconazole or itraconazole is likely to be of benefit to patients with HIV who have been treated successfully for blastomycosis.


Subject(s)
Blastomycosis/etiology , HIV Infections/complications , Adult , Blastomycosis/drug therapy , Blastomycosis/mortality , CD4 Antigens/analysis , CD4-CD8 Ratio , HIV Infections/immunology , HIV Seropositivity/complications , Humans , Itraconazole/therapeutic use , Ketoconazole/therapeutic use , Male , Middle Aged , Survival Rate
16.
Antimicrob Agents Chemother ; 37(9): 1997-9, 1993 Sep.
Article in English | MEDLINE | ID: mdl-8239620

ABSTRACT

The MICs of ofloxacin, sparfloxacin, clarithromycin, azithromycin, and fusidic acid for clinical isolates of Mycobacterium kansasii were determined by the radiometric (BACTEC) method. All drugs except azithromycin elicited MICs for 90% of the strains tested that were lower than previously reported achievable maximum concentrations in serum. Ofloxacin, sparfloxacin, and clarithromycin had the largest maximum concentration in serum/MIC for 90% of strains ratio of the drugs tested.


Subject(s)
Anti-Bacterial Agents/pharmacology , Nontuberculous Mycobacteria/drug effects , 4-Quinolones , Fusidic Acid/pharmacology , Humans , Macrolides , Microbial Sensitivity Tests , Mycobacterium Infections, Nontuberculous/microbiology
17.
Rofo ; 126(1): 43-4, 1977 Jan.
Article in German | MEDLINE | ID: mdl-137867

ABSTRACT

A 28 year old patient complained of sensory disturbances and pain in the right upper arm during pregnancy. During the 32nd week of her pregnancy, a large painful mass developed in the flexor muscles which, radiographically, showed some calcification. A diagnosis of a parosseous sarcoma was made; biopsy, however, indicated a diagnosis of non-traumatic myositis ossificans. Since the histological appearances of active myositis may be vary difficult to distinguish from a juxtacortical sarcoma, a right brachial angiogram and scintiscan were obtained. The angiographic and scintigraphic findings were erroneously considered to suggest malignancy. Following delivery, the tumour was removed. Futher histology confirmed the diagnosis of localised, non-traumatic myositis ossificans. The value of radiology, biopsy, angiography and scintigraphy are discussed with reference to our experience.


Subject(s)
Myositis Ossificans/diagnosis , Pregnancy Complications/diagnosis , Adult , Bone Neoplasms/diagnosis , Brachial Artery/diagnostic imaging , Diagnosis, Differential , Diagnostic Errors , Female , Humans , Humerus , Myositis Ossificans/pathology , Pregnancy , Radiography , Radionuclide Imaging , Shoulder/diagnostic imaging , Technetium
SELECTION OF CITATIONS
SEARCH DETAIL
...