RESUMEN
The objective of this study was to ascertain the elements that govern the intrafollicular delivery of large molecules to follicles of human scalp skin in vitro. The experiments were designed to assess the intrafollicular disposition of drug as a function of size, charge, and formulation. First, fluorescein covalently linked to antisense oligonucleotides and rhodamine-conjugated dextrans were topically applied to fresh human scalp skin in vitro. The drug position in the follicle was qualitatively determined by examining histologic sections of hair-bearing skin taken parallel to the skin surface at various depths and dissected hair follicles via fluorescent microscopy. Using radiolabeled antisense oligonucleotides we demonstrated that these cross sections can also be used to quantitatively localize the intrafollicular delivery of large molecules to follicles of human scalp skin in vitro. Experimental results showed that cationic lipid-based formulations enhanced delivery of oligonucleotides within the follicle. The qualitative analysis also illustrated that cationic lipid-based formulations directed the intrafollicular permeation along the junction of the internal and external root sheath. The charged, lower molecular weight (MW) dextrans permeated into all components of the hair follicle, including the hair shaft. The higher MW dextrans were confined to the follicular structures immediately surrounding the hair shaft. The demonstration of quantitation showed that approximately 0.5% of the applied dose was delivered to the hair bulbs and the deeper skin strata within 24 h of a single application. We conclude that topically applied agents of relatively large MW, in properly formulated delivery vehicles; have the potential to reach pharmacologically active concentrations at the hair bulb. It also should be noted that delivery takes place via the junction of the internal and external root sheath.
Asunto(s)
Sistemas de Liberación de Medicamentos , Folículo Piloso/metabolismo , Oligonucleótidos Antisentido/administración & dosificación , Piel/metabolismo , Dextranos/farmacocinética , Portadores de Fármacos , Composición de Medicamentos , Humanos , Inmunohistoquímica , Técnicas In Vitro , Liposomas , Peso Molecular , Oligonucleótidos Antisentido/farmacocinética , Espectrometría de FluorescenciaRESUMEN
To estimate the recent course of the human immunodeficiency virus type 1 (HIV) epidemic among men within birth cohorts, ethnic groups, and HIV-risk groups in Los Angeles County, backcalculation methods were combined with log-linear models and census data to reconstruct HIV incidence in subgroups from AIDS surveillance data. Results were compared with directly measured HIV seroprevalence in public sexually transmitted disease (STD) clinics in Los Angeles. Models of HIV incidence indicate that the initial epidemic pattern among men who have sex with men, including a decline in incidence since the mid-1980s, does not apply to all post-1960 birth cohorts. Later peaks were observed in younger birth cohorts and among injection drug users, especially among African-American men, with no evidence of a peak before the 1990s among men born after 1960. Our results indicate that HIV continued to spread near peak rates into the 1990s among younger birth cohorts, especially among young African-American men who have sex with men. Because of the lengthy incubation period from HIV infection to AIDS incidence, our results imply that the AIDS epidemic has not yet peaked in these cohorts and may continue to grow through the present decade in several subgroups. The large variation in HIV incidence and prevalence across birth cohorts and other subgroups needs to be addressed in future community intervention plans.
Asunto(s)
Negro o Afroamericano , Brotes de Enfermedades , Infecciones por VIH/etnología , VIH-1 , Adolescente , Adulto , Negro o Afroamericano/estadística & datos numéricos , Factores de Edad , Estudios de Cohortes , Demografía , Infecciones por VIH/epidemiología , Hispánicos o Latinos , Humanos , Incidencia , Modelos Lineales , Los Angeles/epidemiología , Masculino , Prevalencia , Factores de Riesgo , Población Blanca/estadística & datos numéricosRESUMEN
To determine factors associated with isosporiasis in persons with acquired immunodeficiency syndrome (AIDS) in Los Angeles County, data from the AIDS surveillance registry were analyzed for the eight-year period 1985-1992. Isosporiasis was reported in 127 (1.0%) of 16,351 persons with AIDS during the study period. Prevalence of infection was highest among foreign-born patients (3.2%), especially those from El Salvador (7.4%) and Mexico (5.4%), and in all persons of Hispanic ethnicity (2.9%). Persons with a history of Pneumocystis carinii pneumonia (PCP) were less likely than PCP-negative patients to have isosporiasis (0.2% and 1.4%, respectively, P < 0.01). A decrease in the prevalence of isosporiasis in patients negative for PCP was observed beginning in 1989 (P = 0.02). Prevalence decreased with age (P < 0.01, by chi-square test for trend). After controlling for multiple factors by logistic regression, isosporiasis was more likely to occur in foreign-born patients than in those born in the United States (adjusted odds ratio [OR] = 5.8, 95% confidence interval [CI] 3.4, 9.9, P < 0.001) and in Hispanics than in whites (non-Hispanics) (adjusted OR = 3.5, 95% CI 1.7, 7.2, P < 0.001). A prior history of PCP continued to be negatively associated with isosporiasis (adjusted OR = 0.2, 95% CI 0.1, 0.3, P < 0.001). Age and time remained independently associated with infection. These data suggest that isosporiasis among persons with AIDS in Los Angeles County may be related to travel exposure and/or recent immigration and that the use of trimethoprim-sulfamethoxazole (TMP-SMX) for PCP may effectively prevent primary infection or expression of latent isosporiasis. Physicians should have an increased index of suspicion for Isospora in AIDS patients with diarrhea who have immigrated from or traveled to Latin America, among Hispanics born in the United States, in young adults, and in those not receiving PCP prophylaxis. Food and water precautions should be advised and TMP-SMX prophylaxis considered for the prevention of Isospora infection for patients with human immunodeficiency virus infection who travel to Latin America and other developing countries.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Coccidiosis/epidemiología , Isospora , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Adolescente , Adulto , Anciano , Animales , Antimaláricos/uso terapéutico , Coccidiosis/tratamiento farmacológico , Etnicidad , Femenino , Humanos , Los Angeles/epidemiología , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Vigilancia de la Población , Prevalencia , Sistema de Registros , Factores de Riesgo , Combinación Trimetoprim y Sulfametoxazol/uso terapéuticoRESUMEN
OBJECTIVE: To retrospectively identify unrecognized human immunodeficiency virus type 1 (HIV-1) infection among a cohort of children transfused as neonates before donated blood was routinely screened for HIV-1 antibody. METHODS: Records at a large, private, metropolitan hospital were reviewed to identify children who were transfused as neonates between January 1980 and March 1985 and discharged alive from the hospital. Multiple data sources were used to locate these children. Parents or guardians were contacted, and their children were offered HIV-1 antibody testing and physical examination. RESULTS: Of the 775 children identified as having received transfusions during the project period, 644 (83%) were located, and 443 (69%) were evaluated for HIV-1 infection. Among those evaluated, 33 (7%) had antibody to HIV-1, including 14 whose infections had not been previously diagnosed. At the time of enrollment, 13 children infected with HIV-1 were asymptomatic an average of 63 months after transfusion. CONCLUSION: HIV-1 antibody testing should be considered for all children, regardless of clinical status, who were transfused before routine blood donor screening was implemented in March 1985, particularly in areas with a high incidence of acquired immunodeficiency syndrome during those years.
Asunto(s)
Infecciones por VIH/diagnóstico , VIH-1 , Reacción a la Transfusión , Estudios de Cohortes , Anticuerpos Anti-VIH/sangre , Infecciones por VIH/transmisión , VIH-1/inmunología , Humanos , Recién Nacido , Estudios RetrospectivosRESUMEN
Persons infected with human immunodeficiency virus (HIV) are at greater risk of infection with Listeria monocytogenes (LM) than the general population. We quantify the risk of listeriosis in persons with acquired immune deficiency syndrome (AIDS) and HIV infection in Los Angeles County (LAC) and report the LM serotype distribution among HIV-infected patients with listeriosis. Active surveillance for listeriosis was performed in LAC during most of the period from 1985 through 1992. Thirty-four (10%) of 351 nonperinatal cases of listeriosis reported in LAC from 1985 through 1992 were in HIV-infected persons, 25 of whom met the 1987 AIDS case definition. The incidence of listeriosis was 95.8 and 8.8 cases per 100,000 person-years among persons with AIDS and all HIV-infected persons, respectively, but only 1.0 case per 100,000 person-years in the total population. Excluding cases from a 1985 listeriosis epidemic associated with consumption of contaminated Mexican-style cheese, 11 (65%) of 17 HIV-infected persons with available isolates were infected with LM serotype 1/2b, whereas only 64 (31%) of 208 other persons with listeriosis and available isolates were infected with LM serotype 1/2b (odds ratio = 4.1; 95% confidence interval = 1.3-14.1). LM serogroup 1/2b may have been more common among HIV-infected persons in LAC than among other persons with listeriosis because of differences in diet or sexual practices, or to chance alone. Persons with HIV-infection, especially those with AIDS, should be educated in avoiding foods at high risk of listerial contamination, such as soft cheeses, foods sold from delicatessen counters, and undercooked chicken.
Asunto(s)
Infecciones por VIH/complicaciones , Listeria monocytogenes/clasificación , Listeriosis/complicaciones , Listeriosis/epidemiología , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Homosexualidad Masculina , Humanos , Incidencia , Lactante , Recién Nacido , Listeriosis/microbiología , Los Angeles/epidemiología , Masculino , Persona de Mediana Edad , Embarazo , Factores de Riesgo , Serotipificación , Factores Sexuales , Abuso de Sustancias por Vía Intravenosa/complicacionesRESUMEN
The hair follicle, hair shaft, and sebaceous gland collectively form what is recognized as the pilosebaceous unit. This complex, three-dimensional structure within the skin possesses a unique biochemistry, metabolism and immunology. Recent studies have focused on the hair follicle as a potential pathway for both localized and systemic drug delivery. Greater understanding of the structure and function of the hair follicle may facilitate rational design of drug formulations to target follicular delivery. Targeted drug delivery may enhance current therapeutic approaches to treating diseases of follicular origin. Presented here is a review of follicular drug delivery and a discussion of the feasibility of the pilosebaceous unit as a target site.
Asunto(s)
Administración Tópica , Cabello/fisiología , Glándulas Sebáceas/fisiología , Absorción Cutánea/fisiología , Animales , Humanos , Glándulas Sebáceas/metabolismoRESUMEN
To assess unfiltered drinking water as a source of cryptosporidium infection in patients with the acquired immunodeficiency syndrome (AIDS) the prevalence of cryptosporidiosis among persons with AIDS in Los Angeles County was assessed by water service area. One water distributor, serving approximately 60% of the county's residents (area B), has consistently employed filtration. The other company, which serves the remainder of the county (area A), did not institute filtration until mid-December 1986. This difference provided a 'natural experiment' in which to assess the effect of municipal water filtration on the level of cryptosporidiosis among persons with AIDS. The prevalence of cryptosporidiosis among AIDS patients was compared for the two water service areas for the time period (1983-6) preceding the implementation of filtration in area A. From 1983 to 1986 the age-standardized prevalence of cryptosporidiosis among AIDS patients was 32% lower in area A (4.2%), which received unfiltered water, than in area B (6.2%). Following addition of filtration in area A, the prevalence of cryptosporidiosis among AIDS patients decreased by 20%; however, a decline, of 47%, was also observed in area B. The similar baseline levels of cryptosporidiosis and the corresponding post-filtration decline in both areas suggest that filtration had no effect on levels of cryptosporidiosis among persons with AIDS. Thus it does not appear that municipal drinking water is an important risk factor for cryptosporidiosis in AIDS patients residing in Los Angeles County.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Criptosporidiosis/complicaciones , Criptosporidiosis/epidemiología , Abastecimiento de Agua , Infecciones Oportunistas Relacionadas con el SIDA/etiología , Adulto , California/epidemiología , Criptosporidiosis/etiología , Femenino , Humanos , Masculino , Prevalencia , Microbiología del Agua , Purificación del Agua/métodosRESUMEN
The effect of formulation on cimetidine delivery to the pilosebaceous unit and other skin phases was studied. In vitro and in vivo deposition determinations as well as a pharmacodynamic antiandrogenic sebaceous gland bioassays were made. A complex variety of factors influence how the formulation affects both the degree of drug deposition and its pharmacological activity in the pilosebaceous unit. When cimetidine was applied in formulations at pH values where it was predominately unionized, the thermodynamic driving force proved the dominant factor in influencing the extent of drug deposition into the pilosebaceous unit. Although more cimetidine was deposited into the pilosebaceous unit in vivo from the phospholipid-based liposomal formulation when cimetidine was ionized, this formulation was also the only one devoid of significant antiandrogenic action. Of great importance, it is clear from the studies that deposition from complex formulations, such as liposomes, where bilayer/drug interactions can persist in the skin, may give a false impression of the activity of a drug within a tissue. Moreover, data for cimetidine in 50% alcohol solution show that one can maintain local effects while reducing systemic activity by simply manipulating drug concentration in the application.
Asunto(s)
Cimetidina/farmacocinética , Glándulas Sebáceas/metabolismo , Antagonistas de Andrógenos/farmacología , Animales , Cimetidina/administración & dosificación , Cimetidina/farmacología , Cricetinae , Portadores de Fármacos , Oído Externo/metabolismo , Técnicas In Vitro , Liposomas , Masculino , Mesocricetus , Progesterona/farmacología , Glándulas Sebáceas/efectos de los fármacos , Soluciones , Espironolactona/farmacologíaRESUMEN
To determine the occurrence and factors associated with Cryptosporidium among persons with acquired immunodeficiency syndrome (AIDS) in Los Angeles County, data were analyzed from the AIDS surveillance registry for the 10-year period 1983-1992. Among 16,953 persons with AIDS, a total of 638 (3.8%) cryptosporidiosis cases were reported during the study period. The prevalence of cryptosporidiosis was higher in persons whose suspected human immunodeficiency virus (HIV) exposure category was through sexual contact (3.9%) than among persons in other HIV exposure categories (2.6%; P < 0.01) and in immigrants from Mexico (5.2%) than in American born patients (3.8%; P < 0.01). Blacks (2.7%) were less likely than whites (4.1%) and Latinos (4.2%) to be reported with cryptosporidiosis (P < 0.001). A temporal trend was observed from 1983 to 1986 when the prevalence decreased from 6.7% to 3.6% (P < 0.001, by chi-square test for trend). After controlling for confounding variables by stratified analysis, persons whose HIV exposure was sexual (adjusted odds ratio [OR] = 1.7, 95% confidence interval [CI] 1.3, 2.4, P < 0.01) and immigrants from Mexico (adjusted OR = 1.6, 95% CI 1.2, 2.1, P < 0.01) were more likely to have cryptosporidiosis. The negative association with black race remained significant (adjusted OR = 0.7, 95% CI 0.57, 0.96, P = 0.02). The prevalence of cryptosporidiosis decreased with age in gay and bisexual males (Mantel-Haenszel test for trend, P < 0.01) but not among female and heterosexual male cases.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Criptosporidiosis/epidemiología , Síndrome de Inmunodeficiencia Adquirida/transmisión , Adolescente , Adulto , Negro o Afroamericano , Factores de Edad , Bisexualidad , Distribución de Chi-Cuadrado , Niño , Preescolar , Intervalos de Confianza , Criptosporidiosis/complicaciones , Criptosporidiosis/transmisión , Femenino , Hispánicos o Latinos , Homosexualidad Masculina , Humanos , Los Angeles/epidemiología , Masculino , México/etnología , Persona de Mediana Edad , Oportunidad Relativa , Prevalencia , Sistema de Registros , Factores Sexuales , Conducta Sexual , Población BlancaRESUMEN
This review will highlight work done in our laboratories evaluating topical liposomal delivery in a wide variety of animal models and human skin using both in vivo and in vitro techniques. The mechanism by which liposomes facilitate deposition of drugs into the skin and some potential applications of topically applied liposomes will be discussed. Particular emphasis will be placed on the development of analytical techniques that allow the quantification of drug levels in the various skin strata and in pilosebaceous structures. Appropriate models of skin representing the two cases, as well as those wherein both routes are available for skin deposition, were examined using a wide variety of liposomal preparations containing radiolabeled and fluorescent molecules as marker compounds.
Asunto(s)
Cosméticos/administración & dosificación , Liposomas/administración & dosificación , Preparaciones Farmacéuticas/administración & dosificación , Animales , Cosméticos/química , Portadores de Fármacos , Humanos , Liposomas/química , Preparaciones Farmacéuticas/químicaRESUMEN
OBJECTIVES: This study describes causes of death in persons with acquired immunodeficiency syndrome (AIDS) and assesses the completeness of reporting of human immunodeficiency virus (HIV) infection or AIDS on death certificates of persons with AIDS. METHODS: AIDS case reports were linked with death certificates in 11 local/state health departments; underlying and associated causes of death were available for 32,513 persons with AIDS who died. RESULTS: HIV/AIDS was designated as the underlying cause of death for 46% of persons with AIDS who died between 1983 and 1986 and 81% of persons with AIDS who died since 1987 (the year specific coding procedures were implemented for HIV/AIDS). Most other underlying causes of death were conditions within the AIDS case definition (notably Pneumocystis carinii pneumonia), pneumonia, infections outside the AIDS case definition, and drug abuse. Unintentional injuries, suicide, and homicide were less common. HIV/AIDS was listed as underlying or associated on 88% of death certificates from 1987 to 1989; reporting varied primarily by HIV exposure category and time between diagnosis and death. CONCLUSIONS: Physicians and other health care professionals should realize their critical role in accurately documenting HIV-related mortality on death certificates. Such data can ultimately influence the allocation of health care resources for HIV-infected individuals.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/mortalidad , Síndrome de Inmunodeficiencia Adquirida/diagnóstico , Causas de Muerte , Certificado de Defunción , Femenino , Humanos , Masculino , Grupos Raciales , Factores de RiesgoRESUMEN
To evaluate the accuracy of computerized medical-record coding for human immunodeficiency virus (HIV), medical charts were reviewed in six sites. In 7601 hospital and 867 Medicaid records with a listed diagnosis of HIV, the predictive value for HIV was 91% or higher. HIV was identified in 34% of 1155 Medicaid records listing immune disorder or illness in the acquired immunodeficiency syndrome (AIDS) surveillance definition (without an HIV code). In hospital and Medicaid records, AIDS was identified both in records listing AIDS and records listing HIV without AIDS. HIV codes on hospital and Medicaid records were highly predictive for HIV; undercoding of HIV occurred in Medicaid records.
Asunto(s)
Infecciones por VIH/diagnóstico , Hospitalización , Medicaid , Sistemas de Registros Médicos Computarizados , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Síndrome de Inmunodeficiencia Adquirida/diagnóstico , Infecciones por VIH/complicaciones , Humanos , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , Estados UnidosRESUMEN
OBJECTIVES: The purpose of this study was to evaluate the completeness of acquired immunodeficiency syndrome (AIDS) case reporting. METHODS: Statewide or hospital-specific 1988 medical records were linked with AIDS surveillance in six sites. Medical records were reviewed for persons who had diagnoses suggesting human immunodeficiency virus (HIV) infection or AIDS but were not reported to AIDS surveillance by September 1989. RESULTS: Among 4500 hospitalized persons diagnosed with AIDS through 1988 in the six sites, completeness of reporting was 92% (95% CI = 89%, 96%; range across sites = 89% to 97%). Completeness of reporting was high in males (92%), females (95%), Whites (95%), Blacks (90%), Hispanics (92%), men reporting sexual contact with men (92%), persons reporting injecting-drug use (91%), and persons exposed to HIV through heterosexual contact (99%). In Medicaid enrollees (two states), completeness of reporting was 99% (95% CI = 95%, 99%) in inpatients and 90% (95% CI = 79%, 90%) in outpatients. Of previously reported persons with AIDS, 82% were reported within 5 months of diagnosis. CONCLUSIONS: Completeness of AIDS reporting was high, overall and in each major demographic and HIV exposure group. These results demonstrate that current surveillance data in these six sites provide timely and accurate information regarding persons with AIDS.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/epidemiología , Vigilancia de la Población , Humanos , Estados Unidos/epidemiologíaRESUMEN
Evidence suggesting liposomal delivery into the pilosebaceous unit of the male Syrian hamster ear membrane was found using two fluorescent techniques, quantitative fluorescence microscopy (QFM), and a scraping method where the various tissue strata of treated skin are analyzed using fluorescence spectrophotometry. Whole ears were mounted on Franz diffusion cells and treated for 24 h with 40 microliters of the following test formulations, each containing approximately 100 micrograms/ml carboxyfluorescein (CF): i) multilamellar phosphatidylcholine: cholesterol: phosphatidylserine liposomes; ii) HEPES buffer (pH, 7.4); iii) 5% propylene glycol; iv) 10% ethanol; v) 0.05% sodium lauryl sulfate; and vi) a suspension of the same lipids used to form the liposomes that were not processed so as to produce a bilayer configuration. Topical application of the liposomally based formulation resulted in a significantly higher accumulation of CF in the pilosebaceous units than the application of any of the other non-liposomal formulations. There was excellent correlation between the two analytical methods used to determine CF deposition into the sebaceous glands.
Asunto(s)
Administración Tópica , Sistemas de Liberación de Medicamentos , Animales , Cricetinae , Oído , Fluoresceínas/administración & dosificación , Cabello , Liposomas , Mesocricetus , Microscopía Fluorescente , Modelos Biológicos , Glándulas SebáceasRESUMEN
American Indian/Alaska Natives (AI/ANs) appear to be underrepresented in AIDS surveillance statistics. We estimated the accuracy of racial classification and reporting completeness of AIDS among AI/ANs in Los Angeles County by surveying community-based organizations (CBOs) that provide services to persons with AIDS and then comparing the survey to AIDS surveillance data. The surveyed CBOs reviewed 6,500 records and found 60 Native American (the classification used by CBOs for AI/ANs) clients with AIDS compared with six AI/AN AIDS cases reported to the Los Angeles County AIDS surveillance registry. Racial classification was evaluated for 37 (62%) of the 60 Native American CBO clients. Only 11 (30%) of the 37 were verified as AI/ANs. The remaining 26 (70%) misunderstood the racial nomenclature and were reclassified by the CBOs as other races. Of 10 verified AI/AN clients for whom names were available, eight (80%) had been reported to the AIDS registry. However, seven (88%) of these eight were erroneously reported as other races. Racial misclassification accounts for much of the underrepresentation of AI/ANs in the Los Angeles County AIDS surveillance registry.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/etnología , Indígenas Norteamericanos , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/mortalidad , Adolescente , Adulto , Alaska/etnología , Certificado de Defunción , Humanos , Los Angeles/epidemiología , Masculino , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
The neuropsychological development of 15 human immunodeficiency virus type 1 (HIV-1) seropositive children infected through neonatal blood transfusion was compared with that of a control group of 33 HIV-1 seronegative children who had also received blood transfusions as neonates. Human immunodeficiency virus type 1 infection was identified on the basis of a callback blood testing. Two thirds of the HIV-1-infected children were asymptomatic at time of enrollment in the study of development. The children were administered two psychological batteries approximately 8 months apart. The results indicated that the two serostatus groups did not differ in overall intelligence, even as long as 8 years after HIV-1 infection. Significant group differences, though slight, were found on school achievement and on tasks that require motor speed, visual scanning, and cognitive flexibility. Continued longitudinal study of this cohort will be important in characterizing the evolution of neuropsychological deficits.
Asunto(s)
Seropositividad para VIH/psicología , VIH-1 , Reacción a la Transfusión , Síndrome de Inmunodeficiencia Adquirida/psicología , Síndrome de Inmunodeficiencia Adquirida/transmisión , Adaptación Psicológica , Preescolar , Seropositividad para VIH/transmisión , Humanos , Lactante , Recién Nacido , Pruebas de Inteligencia , Pruebas Neuropsicológicas/métodos , NeuropsicologíaRESUMEN
It is reported on a severe craniocerebral trauma in a child with a rarely occurring spontaneously induced serum hypoosmolality which led to brain edema combined with intracranial increase of pressure and bulbar brain syndrome. By means of bedside brain ventricle catheterization for liquor drainage following drill-hole trepanation, the complication could be controlled. Later the recovery was completed under supervision of the outpatient department. Pathophysiological metabolic peculiarities, especially osmolality, are discussed. The necessity of special and repeated controls of the metabolic characteristics osmolality, sodium and potassium in serum and urine as well as the water and sodium balance within 24 hours is emphasized.
Asunto(s)
Edema Encefálico/etiología , Lesiones Encefálicas/complicaciones , Bulbo Raquídeo/patología , Lesiones Encefálicas/sangre , Lesiones Encefálicas/patología , Preescolar , Humanos , Concentración OsmolarRESUMEN
The incidence and characteristics of campylobacteriosis among patients with acquired immune deficiency syndrome (AIDS) in Los Angeles County were assessed by matching the Campylobacter and AIDS surveillance reporting registries for the years 1983-1987. Campylobacter infection was reported in 29 (0.7%) of 4,433 AIDS cases. The average annual incidence of Campylobacter among AIDS cases (519/100,000) exceeded the crude population rate by 39-fold and exceeded the rate among males aged 15-55 years by 35-fold. Campylobacter infection was more common in female AIDS patients than male patients (p = 0.065). A distinct seasonal variation was noted with peaks occurring in July and November. The median survival time for AIDS patients with Campylobacter (14 months) was lower than that for AIDS patients without Campylobacter (21 months); however, we were not able to assess potential confounders such as subsequent opportunistic infections or antiviral therapy and prophylactic regiment to validate this finding. Campylobacter cases with AIDS had higher rates of bacteremia and hospitalization than Campylobacter cases without AIDS. Attempts should be made to elucidate the sources of Campylobacter and other enteric infections among AIDS patients.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Infecciones por Campylobacter/complicaciones , Síndrome de Inmunodeficiencia Adquirida/mortalidad , Adolescente , Adulto , Infecciones por Campylobacter/epidemiología , Infecciones por Campylobacter/mortalidad , Femenino , Humanos , Incidencia , Los Angeles/epidemiología , Masculino , Persona de Mediana Edad , Estaciones del Año , Sepsis/complicaciones , Sepsis/epidemiología , Tasa de SupervivenciaRESUMEN
The effective utilization of the laboratory diagnostics in the intensive care medicine requires a close co-operation between physician and laboratory diagnostician beginning from discriminated requests and the faultless specimen collection until the computerised evaluation and interpretation. Out of the numerous necessary parameters of investigation special attention is directed to the assessment of the electrolyte and water balance, the transcapillary exchange and the oxygen consumption. In the following years the laboratory diagnostics has to meet important demands which result from pathobiochemical research conclusions with critically ill patients.