HIV-related Pneumocystis carinii pneumonia in older patients hospitalized in the early HAART era.

OBJECTIVE: To determine whether older age continues to influence patterns of care and in-hospital mortality for hospitalized persons with HIV-related Pneumocystis carinii pneumonia (PCP), as determined in our prior study from the 1980s. DESIGN: Retrospective chart review. PATIENTS/SETTING: Patients (1,861) with HIV-related PCP at 78 hospitals in 8 cities from 1995 to 1997. MEASUREMENTS: Medical record notation of possible HIV infection; alveolar-arterial oxygen gradient; CD4 lymphocyte count; presence or absence of wasting; timely use of anti-PCP medications; in-hospital mortality. MAIN RESULTS: Compared to younger patients, patients > or =50 years of age were less likely to have HIV mentioned in their progress notes (70% vs 82%, P <.001), have mild or moderately severe PCP cases at admission (89% vs 96%, P <.002), receive anti-PCP medications within the first 2 days of hospitalization (86% vs 93%, P <.002), and survive hospitalization (82% vs 90%, P <.003). However, age was not a significant predictor of mortality after adjustment for severity of PCP and timeliness of therapy. CONCLUSIONS: While inpatient PCP mortality has improved by 50% in the past decade, 2-fold age-related mortality differences persist. As in the 1980s, these differences are associated with lower rates of recognition of HIV, increased severity of illness at admission, and delays in initiation of PCP-specific treatments among older individuals--factors suggestive of delayed recognition of HIV infection, pneumonia, and PCP, respectively. Continued vigilance for the possibility of HIV and HIV-related PCP among persons > or =50 years of age who present with new pulmonary symptoms should be encouraged.

Comparison of body composition, exercise and nutritional profiles of female and male body builders at competition.

Limited research information is available on the training programs and dietary practices of competitive male and female body builders. Information on body composition, training programs, and nutritional profiles of eleven competitive male and female body builders were obtained 48 hours prior to competition. Body composition was assessed by hydrostatic weighing. Skinfold data were obtained to assess the distribution of subcutaneous fat. Questionnaires concerning training programs and a three day food intake record were collected. The female body builders achieved a degree of leanness similar to the males. The relative training volumes for the women were greater than those of the men for all body regions. Gender differences were found in regional deposition of subcutaneous fat between males and females, with the males showing a more uniform distribution of subcutaneous fat. The nutritional profiles of male and female body builders were similar. The pre-competitive diets were low in kilocalories, and the relative energy intakes for men and women were 28.6 kcal/kg and 29.2 kcal/kg respectively. Both men and women consumed low fat and high protein foods. All of the vitamin/mineral intakes of the body builders exceeded the RDA's with the exceptions of calcium for men and women and iron for women only.