RESUMO
While previous studies have characterized the types of dermatological disease among people experiencing homelessness (PEH) in the outpatient setting, dermatological disease among hospitalized PEH has never been evaluated. Therefore, we performed a cross-sectional analysis of hospitalized patients who received dermatology consultations at two San Francisco hospitals between March 2018 and March 2020 and compared the odds of diagnostic categories between PEH and patients with stable housing. In both unadjusted and adjusted analyses, PEH had significantly higher odds of bacterial skin infections [adjusted odds ratio (aOR) = 2.29, 95% CI 1.46-3.61], ectoparasitic disease (aOR = 9.43, 95% CI 3.79-23.47), psoriasis or seborrhoeic dermatitis (aOR = 2.50, 95% CI 1.43-4.36) and venous stasis or lymphoedema (aOR = 2.54, 95% CI 1.23-5.27) and significantly lower odds of drug reactions (aOR = 0.34, 95% CI 0.18-0.67). Overall, these findings highlight the unique dermatological challenges among hospitalized PEH and suggest potential strategies to facilitate equitable dermatology care delivery.
Assuntos
Dermatopatias/diagnóstico , Adulto , Idoso , Estudos Transversais , Feminino , Pessoas Mal Alojadas , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , São FranciscoRESUMO
BACKGROUND: Pruritic papular eruption (PPE) of HIV is common in HIV-infected populations living in the tropics. Its aetiology has been attributed to insect bite reactions and it is reported to improve with antiretroviral therapy (ART). Its presence after at least 6 months of ART has been proposed as one of several markers of treatment failure. OBJECTIVES: To determine factors associated with PPE in HIV-infected persons receiving ART. METHODS: A case-control study nested within a 500-person cohort from a teaching hospital in Mbarara, Uganda. Forty-five cases and 90 controls were enrolled. Cases had received ART for ≥ 15 months and had an itchy papular rash for at least 1 month with microscopic correlation by skin biopsy. Each case was individually matched with two controls for age, sex and ART duration. RESULTS: Twenty-five of 45 cases (56%) had microscopic findings consistent with PPE. At skin examination and biopsy (study enrolment), a similar proportion of PPE cases and matched controls had plasma HIV RNA < 400 copies mL(-1) (96% vs. 85%, P = 0·31). The odds of having PPE increased fourfold with every log increase in viral load at ART initiation (P = 0·02) but not at study enrolment. CD4 counts at ART initiation and study enrolment, and CD4 gains and CD8(+) T-cell activation measured 6 and 12 months after ART commencement were not associated with PPE. Study participants who reported daily insect bites had greater odds of being cases [odds ratio (OR) 8·3, P < 0·001] or PPE cases (OR 8·6, P = 0·01). CONCLUSIONS: Pruritic papular eruption in HIV-infected persons receiving ART for ≥ 15 months was associated with greater HIV viraemia at ART commencement, independent of CD4 count. Skin biopsies are important to distinguish between PPE and other itchy papular eruptions.
Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Prurido/etiologia , Adulto , Mordeduras e Picadas/complicações , Contagem de Linfócito CD4 , Estudos de Casos e Controles , Feminino , Infecções por HIV/complicações , Humanos , Masculino , RNA Viral/metabolismo , Fatores de Risco , Fatores SocioeconômicosRESUMO
Caffeine was analyzed in human plasma and saliva by a simple, rapid, and sensitive radioimmunoassay procedure. Immunization of rabbits with an antigen prepared by coupling 7-(5-carboxypentyl)-1,3-dimethylxanthine to bovine serum albumin resulted in the formation of antibodies selective for caffeine as opposed to various mono- and dimethylxanthines, mono-, di-, and trimethyluric acids and a variety of common drugs. The radioligand used for competitive binding studies was 7-(2,3-3H2-propyl)-1,3-dimethylxanthine. The procedure permits direct analysis of caffeine in plasma or saliva without extraction. Comparison with a high pressure liquid chromatography method for the analysis of caffeine gave satisfactory results and showed no evidence for interference by metabolites. A caffeine half-life of 4.0 hours determined by the radioimmunoassay was in agreement with previous work. Comparison of human plasma and saliva levels by the radioimmunoassay procedure indicated approximately equal concentrations in the two fluids.
Assuntos
Cafeína/análise , Saliva/análise , Adulto , Animais , Formação de Anticorpos , Cafeína/sangue , Cromatografia Líquida de Alta Pressão , Humanos , Métodos , Coelhos/imunologia , Radioimunoensaio , Soroalbumina Bovina , Xantinas/imunologiaAssuntos
Cannabis/análise , Dronabinol/análise , Animais , Formação de Anticorpos , Especificidade de Anticorpos , Antígenos , Soluções Tampão , Bovinos , Reações Cruzadas , Dronabinol/sangue , Haptenos , Humanos , Ligantes , Masculino , Métodos , Proteínas , Coelhos/imunologia , Radioimunoensaio , Soroalbumina BovinaRESUMO
Antisera to theophylline (T) have been obtained by immunizing rabbits with a conjugate of 8-(3-carboxypropyl)-1,3-dimethylxanthine and bovine serum albumin. Comparison of 50% displacement values indicated good selectivity for T vs. a number of other xanthine derivatives. An analytical procedure using this antiserum can measure 200 pg of T and direct analysis of 0.1 mug/ml in plasma or 0.02 mug/ml in saliva is feasible.
Assuntos
Teofilina/análise , Animais , Formação de Anticorpos , Cafeína , Reações Cruzadas , Feminino , Soros Imunes , Masculino , Microquímica , Coelhos , Radioimunoensaio/métodos , Saliva/análise , Soroalbumina Bovina , Teobromina , Teofilina/sangue , Teofilina/imunologiaRESUMO
Saliva and plasma levels of phenytoin (DPH) and phenobarbital (PB) in a series of epileptic patients were compared by means of a radioimmunoassat (RIA) that required only 10 mul of saliva or plasma. There was an excellent linear relation (r = 0.98) between the logarithms of the concentrations of DPH in the two fluids. The ratio saliva/plasma was remarkably constant at 0.10 and was unaffected by varying levels of PB. The ratio was close to the fraction of DPH reported unbound in plasma at 37 degrees. PB plasma and saliva levels were also closely related (r = 0.98 for logarithm of plasma and saliva levels). This relation was nonlinear [plasma ocncentration = 4.43 X (salivary concentration)0.86], but could be approximated by the ratio plasma/saliva = 3.4. The simplicity of sample collection and the sensitivity of the RIA procedure suggest that clinical monitoring of these anticonvulsant levels may be carried out by RIA on saliva samples.