RESUMEN
OBJECTIVES: To quantify the effect of HIV infection and HIV-suppressive therapy on interferon-alpha (IFN-alpha) production by human blood mononuclear cells; to compare, in parallel, effects on CD4+ T-cell numbers; and to ascertain the relationship of these interferon and CD4 parameters to resistance to opportunistic infections. DESIGN: Serial studies of 294 unselected patients with HIV infection during therapy, with outcomes analysis. METHODS: Determination of IFN generation by blood mononuclear cells via bioassay, and T-lymphocyte subset analysis via flow cytometry; serial studies of individual patients; linear regression and chi2 contingency table analysis. RESULTS: HIV burden is inversely related to interferon-alpha generation, much as it is to CD4+ T-cell counts. Both of these recover during HIV-suppressive therapy. Reconstitution of IFN-alpha generation to levels commensurate with protection against opportunistic infection occurs prior to similar restoration of CD4 counts. In the outcomes analyses, such immune reconstitution was associated with protection from recurrent or new opportunistic infection. Conversely, viral suppression without such immunologic recovery was not protective against opportunistic infection. CONCLUSIONS: Rapidly responding IFN-alpha generating cells appear to participate in resistance to opportunistic intracellular infection. Recovery of IFN-alpha generation may be an early marker of immune reconstitution in AIDS.
Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/inmunología , VIH-1/fisiología , Interferón-alfa/biosíntesis , Infecciones Oportunistas Relacionadas con el SIDA/inmunología , Infecciones Oportunistas Relacionadas con el SIDA/prevención & control , Recuento de Linfocito CD4 , Linfocitos T CD4-Positivos/inmunología , Células Dendríticas/inmunología , Femenino , Infecciones por VIH/virología , Humanos , Leucocitos Mononucleares/inmunología , Masculino , ARN Viral/sangre , Carga ViralRESUMEN
OBJECTIVES: Fecal occult blood screening is cost-effective, is easily administered to large groups of patients, and reduces mortality associated with colorectal cancer. Within our predominant African American and Latino inner city clinic populations, compliance with common screening procedures is suboptimal. A procedure with increased compliance is needed to adequately screen this population at high risk for colorectal cancer. The objective of this study was to compare the results of the 3-day at-home hemoccult test for occult blood to those of a hemoccult test performed from stool obtained at rectal examination in the office. METHODS: A total of 350 consecutive patients referred to the GI clinic of University Hospital or Jersey City Medical Center for colorectal cancer screening had both the 3-day at-home hemoccult test and an in-office hemoccult examination performed, followed by either sigmoidoscopy (for negative results) or by colonoscopy (for positive results). RESULTS: Patients were noncompliant with dietary restrictions, 3-day card return, follow-up appointments, and endoscopy with conventional screening methods. Decisions based on the in-office examination with direct scheduling of endoscopy significantly improved compliance with follow-up. There was no statistical difference between the two detection methods, suggesting that the in-office examination was the more effective screening test. CONCLUSIONS: Endoscopy based on an in-office hemoccult examination is an acceptable alternative to using the 3-day at-home stool collection to govern endoscopic choices. In a noncompliant inner city population, use of the in-office examination increased compliance with follow up, potentially allowing more patients exposure to screening.
Asunto(s)
Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/etnología , Grupos Minoritarios , Sangre Oculta , Negativa del Paciente al Tratamiento , Salud Urbana , Negro o Afroamericano , Anciano , Femenino , Hispánicos o Latinos , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , New Jersey/etnología , Visita a Consultorio Médico , Estándares de Referencia , Sensibilidad y EspecificidadRESUMEN
Since thiamin plays a role in glucose metabolism we wanted to know if blood thiamin influx from gravida to neonate was influenced by treatment of gravidas having gestational diabetes mellitus (GDM). In this study we found thiamin hypovitaminemia in 19% of the 77 pregnancies despite vitamin supplementation and treatment for GDM; neonates born to mothers with hypovitaminemia were also thiamin hypovitaminemic. All neonatal blood had significantly higher thiamin concentration than gravidas. Indeed, cord blood from neonates born to mothers treated with insulin for GDM had significantly higher thiamin concentration than other neonates in the study. A significant weight depression was noted in neonates born to treated GDM mothers. Healthy gravidas giving birth to macrosomia neonates, had significant thiamin hypovitaminosis, but only macrosomic neonates of treated diabetic mothers had significantly depressed blood thiamin concentrations. We noted that subclinical thiamin hypovitaminemia is prominent during pregnancy despite vitamin supplementation. Perhaps increased thiamin supplementation during pregnancy seems warranted to avoid metabolic stress in mother and fetus due to thiamin hypovitaminemia.
Asunto(s)
Diabetes Gestacional/sangre , Macrosomía Fetal/sangre , Recién Nacido/sangre , Deficiencia de Tiamina/etiología , Tiamina/sangre , Adulto , Diabetes Gestacional/complicaciones , Diabetes Gestacional/tratamiento farmacológico , Suplementos Dietéticos , Femenino , Sangre Fetal/química , Macrosomía Fetal/etiología , Glucosa/metabolismo , Número de Embarazos , Humanos , Trabajo de Parto , Estado Nutricional , Embarazo , Deficiencia de Tiamina/sangre , Deficiencia de Tiamina/prevención & controlRESUMEN
The incidence of esophageal adenocarcinoma has increased significantly during the past 25 years in the United States and Europe. This increase has occurred predominantly among white men. To determine the effect of ethnicity and selected clinical features on the type of esophageal cancer in an urban, minority population, we retrospectively reviewed esophageal cancer at our institution. All patients with esophageal cancer from 1980 to 1995 were identified using the tumor registry data base and patient medical records at UMDNJ-University Hospital. Inclusion criteria were self-reported ethnicity and a confirmed pathologic diagnosis of either esophageal adenocarcinoma (ADENO) or squamous cell carcinoma (SCCA). Data abstracted from the record included age and year of diagnosis, weeks of survival, and risk factors, such as Barrett's esophagus and tobacco and alcohol abuse. Of 150 cases of esophageal cancer, 139 (93%) were SCCA and 11 (7%) were ADENO; the male:female ratio was 11:4. African and Latino Americans comprised 87% and white Americans 13% of the group. The incidence of ADENO increased during the study period: 1980-1984, 1 case; 1985-1989, 3 cases; and 1990-1995, 7 cases (P = .022); whereas the incidence of SCCA remained constant during the same intervals: 51, 52, and 36 cases, respectively (P > .05). By ethnicity, ADENO occurred more frequently among whites (7/19, 37%) than among African and Latino Americans (4/131, 3%); SCCA was more common among African and Latino Americans (127/131, 97%) than among whites (12/19, 63%) (P < .001). Other risk factors did not influence the type of esophageal cancer. The study concluded that the incidence of ADENO increased, primarily among white men, from 1980 to 1995 at UMDNJ-University Hospital. In contrast, the incidence of SCCA remained constant and was the primary type of esophageal cancer in African and Latino Americans. This study supports previous reports that ethnicity influences the histology of esophageal cancer.
Asunto(s)
Adenocarcinoma/epidemiología , Carcinoma de Células Escamosas/epidemiología , Neoplasias Esofágicas/epidemiología , Negro o Afroamericano/estadística & datos numéricos , Anciano , Femenino , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , New Jersey/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Población UrbanaRESUMEN
Blood transfusions are common in patients with end-stage liver disease (ESLD), and their effects on sensitization, rejection, and liver graft survival are not well known. These effects were examined in 121 recipients of primary liver grafts, surviving > or = 30 days. Ninety-six (79%) patients received transfusions before transplantation. Transfusion recipients had significantly fewer severe or recurrent rejection episodes (18%), compared with patients who did not receive transfusions (42%, P=0.006), if the first transfusion was > or = 90 days before the transplant. Patients with alcoholic ESLD (n=49) had significantly fewer severe rejection episodes when compared with the nonalcoholic (n=72) patients (12% vs. 35%, P=0.004). The transfusion benefit was, however, more apparent and significant in the nonalcoholic (26% vs. 56% in nontransfused, P=0.02) than among the alcoholic recipients (6% vs. 25%, P=0.1). This finding is, most likely, due to a combination of a higher rate of severe rejection and the statistical power of the larger number of recipients in the nonalcoholic group. This finding is further corroborated by a multivariate analysis in which blood transfusions retained their benefit (P<0.05) independent of recipient's age and diagnosis. Graft and patient survival were not significantly different in the transfused versus nontransfused groups. Transfusion recipients had a higher panel antibody (11.4+/-23.4 vs. 2.7+/-8.1, P<0.02) but no increased risk of a positive crossmatch. In liver recipients, blood transfusions diminish the risk of rejection independent of recipient's age and the cause of ESLD.
Asunto(s)
Transfusión Sanguínea , Trasplante de Hígado , Adulto , Enfermedad Crónica , Ciclosporina/uso terapéutico , Femenino , Rechazo de Injerto/prevención & control , Humanos , Inmunosupresores/uso terapéutico , Periodo Intraoperatorio , Hepatopatías Alcohólicas/cirugía , Fallo Hepático/cirugía , Trasplante de Hígado/inmunología , Masculino , Persona de Mediana Edad , Tacrolimus/uso terapéutico , Factores de TiempoRESUMEN
Twenty-six percent of pediatric patients had discrepant major diagnoses revealed at autopsy. A printed form used to document permission for autopsies improved the autopsy rate. No variables were found to predict the success rate for obtaining autopsies.
Asunto(s)
Autopsia , Hospitales Pediátricos , Niño , Hospitales de Enseñanza , HumanosRESUMEN
The mass screening of plants in the search for new drugs is vastly expensive and inefficient. It would be cheaper and perhaps more productive to re-examine plant remedies described in ancient and mediaeval texts.
Asunto(s)
Medicina Tradicional , Plantas MedicinalesRESUMEN
OBJECTIVES: In the past, the predominantly Black population of Newark, NJ, had little access to programs promoting or providing Pap tests. The ratio of in situ to invasive cases of cervical carcinoma was markedly reduced in all age categories, indicating inadequate screening for this cancer in this population. Funding became available to provide and publicize Pap smears but ceased after 5.5 years. We examined the effect of these changes in funding. METHODS: Data came from all Newark hospitals and practitioners and from the state cancer registry. There are now data on incidence of in situ and invasive cervical cancer in Newark from 1970 through 1988, including years before, during, and after program funding. RESULTS: The ratio of in situ to invasive cervical cancer increased and decreased in a striking parallel with the provision and subsequent cessation of funding. CONCLUSIONS: Cessation of funding of education and screening programs can result in resumption of an unfavorable in situ/invasive cervical carcinoma ratio in a poor population.
Asunto(s)
Carcinoma/etnología , Carcinoma/prevención & control , Educación en Salud , Accesibilidad a los Servicios de Salud/economía , Tamizaje Masivo , Neoplasias del Cuello Uterino/etnología , Neoplasias del Cuello Uterino/prevención & control , Adolescente , Adulto , Negro o Afroamericano , Anciano , Anciano de 80 o más Años , Carcinoma/epidemiología , Carcinoma in Situ/epidemiología , Carcinoma in Situ/etnología , Carcinoma in Situ/prevención & control , Niño , Costos y Análisis de Costo , Femenino , Educación en Salud/economía , Accesibilidad a los Servicios de Salud/tendencias , Humanos , Incidencia , Modelos Lineales , Tamizaje Masivo/economía , Persona de Mediana Edad , Invasividad Neoplásica , New Jersey/epidemiología , Prueba de Papanicolaou , Neoplasias del Cuello Uterino/epidemiología , Frotis Vaginal/economía , Población BlancaRESUMEN
The variety of circumstances under which ultrasound examinations are performed makes fetal iliac bone measurement an important indicator of gestational age. We studied 322 well-dated pregnancies from 13 to 40 weeks' gestation with sonogram measurements of the fetal iliac bone in order to examine the relationship between gestational age and bone length. The results indicate a linear relationship, as described by the equation iliac length = -0.376 + (0.0887) (gestational age). The fit of the data to a straight line was quite close (R2 = .877, P = .0001). The data were used to obtain a nomogram for growth of the fetal iliac bone.
Asunto(s)
Determinación de la Edad por el Esqueleto , Edad Gestacional , Ilion/anatomía & histología , Ultrasonografía Prenatal/métodos , Estudios de Evaluación como Asunto , Femenino , Humanos , Embarazo , Sensibilidad y Especificidad , Caracteres Sexuales , Ultrasonografía Prenatal/normasRESUMEN
The objective of this study was to determine the effects of a year of Zn supplementation on Zn concentrations in circulating cells and on cellular immune functions in the elderly. Subjects, aged 60-89, were given a placebo, 15 mg Zn, or 100 mg Zn daily for 12 months. All subjects also received a multivitamin/mineral supplement that contained no additional Zn. Blood samples were drawn and immune functions assessed prior to and at 3, 6, 12, and 16 months after beginning Zn supplementation. Subject diets were also assessed at each visit. Dietary folate, pyridoxine, alpha-tocopherol, copper, zinc, and magnesium were consistently below recommended intakes. Although plasma Zn increased significantly in the 100 mg Zn treatment group, concentrations of Zn in erythrocytes, mononuclear cells, polymorphonuclear leukocytes, and platelets were not significantly increased by zinc supplementation. Natural killer cell activity was transiently enhanced by the 100 mg/day dose of Zn. There was a progressive improvement in delayed dermal hypersensitivity (DDH) and in lymphocyte proliferative responses to two mitogens; this may have been due to one or more components of the multivitamin/mineral supplement administered to all study subjects. The enhancement of DDH was significantly greater in the placebo group than in either zinc treatment group. Thus, zinc had a beneficial effect on one measure of cellular immune function while simultaneously having an adverse effect on another measure of cellular immunity.
Asunto(s)
Dieta , Inmunidad Celular/efectos de los fármacos , Zinc/farmacología , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Células Asesinas Naturales/efectos de los fármacos , Células Asesinas Naturales/inmunología , Masculino , Persona de Mediana Edad , Zinc/administración & dosificación , Zinc/sangreRESUMEN
We have studied the in vitro effects of human growth hormone on cell surface markers and mitogenic responses of peripheral blood lymphocytes (PBL) of normal and growth hormone-deficient children before, during and after treatment with growth hormone. Growth hormone resulted in a decrease in B cell expression but it did not affect expression of T cell subsets. Growth hormone depressed the proliferation of PBL of normal and untreated growth hormone-deficient children. The proliferative responses to phytohemagglutinin (PHA) versus PHA with growth hormone were not statistically different, though the responses of most normal and on treatment children were diminished by the addition of growth hormone. PBL derived from growth hormone-deficient children during treatment with human growth hormone exhibited significantly greater spontaneous proliferation then the PBL of normal children. Growth hormone further significantly enhanced their proliferation. PHA and PHA with growth hormone resulted in significantly greater proliferation of these patients' PBL when compared to those of normal children. We demonstrated that human growth hormone had substantial in vitro effects on immune functions. These effects, some of which depend on the treatment status of the children, may need to be considered in the clinical use of human growth hormone.