[Anti-neutrophil cytoplasmic antibodies (ANCA) in patients with symptomatic and asymptomatic HIV infection]. / Anticuerpos anticitoplasma de neutrófilos (ANCA) en pacientes infectados por HIV sintomáticos y asintomáticos.

The cytopathic effect of HIV on CD4 T cells, as well as the active autoimmune mechanism occurring during infection, have been documented. Of the cytokines involved in the pathogenesis of AIDS, the main one produced by the monocyte-macrophage series is tumor necrosis factor alfa (TNF alpha). This cytokine induces antigens such as proteinase 3 (Pr 3) or mieloperoxidase (MPO). Anti-neutrophil cytoplasmic antibodies (ANCA) are directed against this type of PMN antigens. In the present paper, the role of anti-neutrophil cytoplasmic antibodies (ANCA) in HIV infected patients as responsible for autoimmune phenomena in relation to opportunistic infections, was studied. A total of 88 serum samples belonging to 49 asymptomatic and 39 symptomatic HIV infected patients were tested for ANCA by an indirect immunofluorescence (IIF) test over a neutrophil substrate. ANCA were detected in 53.8% of symptomatic patients as compared to 4.1% in asymptomatic cases (p < 0.0001). A 95.9% correlation was observed between ANCA-positive samples and pulmonary infection (n = 20). In those ANCA (+) samples 95.9% correlation was found with pulmonary infection (n = 20). Pulmonary infection due to Mycobacterium tuberculosis is a frequent finding in HIV infected patients from Northeastern Argentina. When the presence of ANCA in TB(+) HIV(+) and TB(+) HIV(-) patients was studied, it was seen that positive-ANCA significantly correlated with the first group (p < 0.001). The presence of ANCA was not related to viral infections, toxoplasmosis, neurological features of AIDS, vasculitis or malignant diseases. ANCA during pulmonary infection, mostly caused by TB, as well as PMN infiltration in pulmonary parenchyma, and the deregulated immune reaction elicited by HIV, may contribute to the onset of autoimmune phenomena. The presence of human T lymphocytes reactive to heat stress proteins (Hsp), an important target of immune response against certain intracellular auto-antigens such as MPO from PMN, added to the mechanism of molecular mimicry, could explain the association of ANCA and TB in patients with severe alterations of their immune response. According to these results, the limited presence of ANCA in asymptomatic patients HIV(+) and in HIV(-) with pulmonar TB, could indicate that the virus may not be responsible for the induction of these antibodies.

Pharmacist facilitation of a home IV therapy treatment program.

A pharmacist's knowledge and experience had strong impact on the success of a home intravenous (IV) infusion treatment program, as stated in the following case study. After reviewing the patient's medical history, clinical course, and drug therapy plan, the pharmacist made recommendations that simplified the home IV self-care program, without compromising the results. The article describes how the pharmacist's liaison between patient and physician resulted in successful treatment and avoided significant costs to the hospital and the State Medical Assistance Program (Pennsylvania Department of Public Welfare). As Diagnosis Related Groups (DRGs) become fully implemented, the pharmacist's services will become an even more important component of discharge planning.

Phlebitis associated with the intravenous use of cephalothin and cephapirin.

The frequency and severity of phlebitis associated with cephalothin and cephapirin was compared in a double-blind study in 82 surgical patients with 149 different infusion sites. After treatment with the coded drug products, the status of each patient's veins was evaluated daily by i.v. therapists. Cephapirin was associated with a slightly lower rate of phlebitis, but the difference was not significant. For both drugs, the duration of therapy did not appear to have an effect on the rate of phlebitis. Scalp vein needles were associated with a lower rate of phlebitis than plastic catheters, but the difference was not significant.