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Query: UMLS:C0001175 (AIDS)
 120,706 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In 1987 the worldwide health program, the Safe Motherhood Initiative, was launched in Nairobi by international organizations to combat the alarming rate of maternal mortality resulting from pregnancy and delivery complications that takes 500,000 lives a year, 98% of them in developing countries. Yet the rate has scarcely diminished since ten. In underdeveloped countries maternal mortality is around 400 per 100,000 live births compared to 10-20 in Europe. The rate is the highest in high fertility regions such as Africa and Southeast Asia. The causes are blood loss, infection, hypertensive episodes during pregnancy, rupture of the uterus, and sepsis from botched induced abortion. In postpartum hemorrhage, especially in grand multiparous women, blood transfusion can be lifesaving. However, in a large part of Africa blood is often unusable because of infection with AIDS. In Jamaica and Bangladesh family planning campaigns particularly aimed at adolescents have yielded good results. In Zimbabwe campaigns target mostly men because of their authority. The utility of basic training of traditional birth attendants (TBAs) in delivery is highly questionable, and more thorough going training is being evaluated. Obstacles to reduction of maternal mortality within the Safe Motherhood program include shortage of funds, lack of coordination with local entities, inadequate antenatal care, illiteracy, and cultural barriers. Communication and training activities are essential, as demonstrated by the Matlab project in Bangladesh. The Matlab region had 200,000 people, 83% of women were illiterate, and maternal mortality reached 400 per 100,000 live births. 3 years after schooled midwives trained TBAs and integrated care for pregnant women, and transportation by boat to a newly built clinic was arranged, the maternal mortality rate declined to 140 from 380 per 100,000 live births in the intervention area (p = 0.02) compared to the control region. In the coming year the halving of maternal mortality is envisioned through prevention of anemia, tetanus, and extensive contraceptive use.
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PMID:[Safe Motherhood Initiative: the art of the feasible]. 146 8

Involvement of the central nervous system (CNS) is common in patients with advanced disease due to human immunodeficiency virus (HIV). Symptoms range from lethargy and apathy to coma, incoordination and ataxia to hemiparesis, loss of memory to severe dementia, and focal to major motor seizures. Involvement may be closely associated with HIV infection per se, as in the AIDS dementia complex, but is frequently caused by opportunistic pathogens such as Toxoplasma gondii and Cryptococcus neoformans or malignancies such as primary lymphoma of the CNS. The clinical presentations of attendant and direct CNS involvement are remarkably non-specific and overlapping, yet a correct diagnosis is critical to successful intervention. Toxoplasmic encephalitis is one of the most common and most treatable causes of AIDS-associated pathology of the CNS. A great deal has been learned in the last 10 years about its unique presentation in the HIV-infected patient with advanced disease. Drs. Benjamin J. Luft of the State University of New York at Stony Brook and Jack S. Remington of the Stanford University School of Medicine and Palo Alto Medical Foundation's Research Institute have studied T. gondii for many years and are two of the leading experts in the field. This commentary comprises an update of their initial review (J Infect Dis 1988;157:1-6) and a presentation of the current approaches to diagnosing and managing toxoplasmic encephalitis in HIV-infected patients.
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PMID:Toxoplasmic encephalitis in AIDS. 152 Jul 57

As mentioned previously, both MS and PML are demyelinating conditions of the CNS and pose diagnostic difficulties in their differentiation because of similarities in their clinical findings. However, certain features unique to each of these diseases are helpful in clinical diagnosis. MS, unlike PML, is a disease of unknown cause. Polygenetic influences in combination with exposure to an environmental agent and immune-mediated factors may be operative in the pathogenesis of MS. Age of onset peaks in the third to fourth decades with a predominance in women, as contrasted with PML, which peaks in the fifth to sixth decades in most non-AIDS-associated cases with a slight predominance in men. MS is more prevalent in areas farther from the equator: North America, Europe, Australia, and New Zealand. Common initial symptoms seen in MS include bilateral limb weakness (with the legs being affected twice as often as the arms), hyperreflexia, spasticity, optic neuritis, diplopia, incoordination, and paresthesias. (Paresthesias are typically found in the lower limbs in a symmetric pattern, but may follow no obvious anatomic distribution and often do not correspond to the distribution of sensory symptoms. Vibration and position sense are more frequently disturbed than pain and temperature.) Intellectual impairment and mental deterioration are uncommon early in MS, whereas they are a more frequent initial presentation in PML. In addition, the presence of speech impairment and monoparesis or hemiparesis with homonymous hemianopsia is more suggestive of PML. Brain stem involvement is infrequent.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Chronic encephalitis caused by leukoencephalopathy. 222 61

This study presents the main clinical findings on 200 AIDS patients at Kilimanjaro Christian Medical Centre in the northern zone of Tanzania, with detailed neurological findings on 135 out of 200 cases and 53 controls. Results show that 21 out of 200 (10.5%) had an obvious focal neurological disorder, including cranial nerve palsies, hemiparesis and paraparesis. Ninety-seven out of 135 (72%) had less obviously detectable neurological disorders, versus 36% of controls (P less than 0.005). Most frequent were AIDS dementia complex (54%), retinopathy (23%), areflexia (21%), pyramidal tract signs (19%) and tremor and incoordination (19%). Frontal lobe release signs (FLRS) were found in 103 out of 135 (76%) patients, versus 36% of controls (P less than 0.005). Advanced and terminal AIDS cases were more likely to have neurological disorders than early AIDS patients. A further study on 87 non-AIDS patients with acute unexplained neurological disorders showed 10 out of 87 to be HIV seropositive. Three case studies are presented. This study suggests that neurological disorders are among the main clinical features of AIDS and HIV disease in Africa.
AIDS 1989 May
PMID:Neurological disorders in AIDS and HIV disease in the northern zone of Tanzania. 250 33

HIV/AIDS in Pakistan is slowly gaining recognition as a public health issue of great importance. However, the responses to the disease have been marred by lack of coordination and commitment. We examine, in this paper, the situation in the Sindh province of Pakistan, which is recognized as having the sole fully functioning AIDS prevention and control programme in the country. In discussing the results of the Sindh programme's activities we highlight progress made as well as gaps in data and surveillance. We also recommend strategies for implementation at the provincial and national levels. In addition this example of a sub-national government programme provides a case study for similar programmes in the region.
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PMID:Sub-national response in HIV/AIDS: a case study in AIDS prevention and control from Sindh province, Pakistan. 1082 47

The AIDS Vaccine Advocacy Group issued a report on May 15 claiming that both the pharmaceutical industry and the United States government have made little progress towards the development of an HIV vaccine. President Clinton set a goal of 2007 for a vaccine, but the Advocacy Group states that a viable vaccine will not be available by then, due to a lack of coordination and leadership. While Federal funding has increased for vaccine research, the pharmaceutical industry has scaled back or eliminated many HIV vaccine research programs. The Advocacy Group has proposed that policy makers take a more direct role to encourage vaccine research, develop financial incentives for vaccine research, begin planning for global access to an HIV vaccine, and prevent discrimination against volunteers in vaccine clinical trials.
AIDS Policy Law 1998 May 29
PMID:Advocacy group sees little progress toward an HIV vaccine. 1136 44

This is a critique of a study by Howlett, Nkya, Mmuni, Missalek, published in AIDS (1989), which reports on clinical findings in 200 AIDS patients at the Kilimanjaro Christian Medical Center in Tanzania between 1985-88. For 135 of these patients, the study concentrates on the clinical neurological symptoms of AIDS. General symptoms included weakness (98%); wasting (92%); fever (79%); diarrhea (75%); maculo-papulor rash (71%); and candidiasis (57%). Neurological symptoms included AIDS dementia complex (54%); retinal abnormalities (23%); areflexia (21%); pyramidal tract signs (19%) and tremor and incoordination (19%). This study is the most detailed published examination to date of the clinical neurological symptoms associated with AIDS in African patients. In spite of the weaknesses of the study the paucity of laboratory investigations and the lack of autopsy information and the frequency of different infections affecting the nervous system in African AIDS patients, the study will be referenced in all future works on the neurology of AIDS in Africa. (Author's modified).
WHO AIDS Tech Bull 1989 Oct
PMID:Neurological disorders in AIDS and HIV disease in the northern zone of Tanzania. 1228 84

Until recently, the only sustained AIDS activity in India has been alarmist media attention complemented by occasional messages calling for comfort and dignity. Public perception of the AIDS epidemic in India has been effectively shaped by mass media. Press reports have, however, bolstered awareness of the problem among literate elements of urban populations. In the absence of sustained guidance in the campaign against AIDS, responsibility has fallen to voluntary health activists who have become catalysts for community awareness and participation. This voluntary initiative, in effect, seems to be the only immediate avenue for constructive public action, and signals the gradual development of an AIDS network in India. Proceedings from a seminar in Ahmedabad are discussed, and include plans for an information and education program targeting sex workers, health and communication programs for 150 commercial blood donors and their agents, surveillance and awareness programs for safer blood and blood products, and dialogue with the business community and trade unions. Despite the lack of coordination among volunteers and activists, every major city in India now has an AIDS group. A controversial bill on AIDS has ben circulating through government ministries and committees since mid-1989, a national AIDS committee exists with the Secretary of Health as its director, and a 3-year medium-term national plan exists for the reduction of AIDS and HIV infection and morbidity. UNICEF programs target mothers and children for AIDS awareness, and blood testing facilities are expected to be expanded. The article considers the present chaos effectively productive in forcing the Indian population to face up to previously taboo issued of sexuality, sex education, and sexually transmitted disease.
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PMID:AIDS in India: constructive chaos? 1228 25

In 1989, there were 10 English-speaking African countries, plus Mozambique, with on-going population education programs within the school system. 7 other countries had programs in the planning stages. School programs were preceded after out-of-school and informal programs of the 1970s. Countries have designed population education in their own terms. The generalized goals of population education for the region were to expand awareness of population-related issues and problems; to develop skills, values, and attitudes which will enable people to make rational and timely decisions; and to behave in meaningful and socially desirable ways and improve the quality of human life. Population education has been accepted in most education curriculum in African countries, but fertility regulation in an action program is limited to a few countries. Although attention has been directed to mortality, teen pregnancy, drug use, and AIDS, there has been little discussion of the status of women, child labor, and female circumcision. Family-life education and population have been linked because of the acceptability of the term and the reality that the family is the basic unit of society. Anglophone African strategies have encompassed a central location for the population program within government, a pilot phase, an integration into other subjects, a life-long approach, and community participation; each of the aforementioned topics is discussed. Constraints in program design and implementation were identified as the lack of political support; the absence of a firm and consistent policy; the perceived conflict between population education and cultural values; the limited, sporadic financial support; the shortage of resources; poor attention to the importance of horizontal and vertical information transmission; and lack of coordination between agencies with population education programs. Future needs are for program expansion and a focus on groups at-risk, prominent policy support at the decision-making level, and teacher-training. Curriculum must be renewed periodically with a focus on its appropriateness for adolescents. Adolescent sexuality, contraception, and the spread of AIDS must be addressed, both formally and informally for those who are illiterate. Sustainability requires institutionalizing population education within the ministry of education with a stable budget and staff.
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PMID:Initiatives and resistances in English-speaking African countries. 1228 10

There is great concern over the prevalence of the acquired immunodeficiency syndrome (AIDS) in Sub-Saharan Africa (SSA), especially because of the existence of the HIV-1 and HIV-2 viruses. For example, in Senegal 9.8% of all prostitutes are infected with the HIV-2 virus as against 1.3% infected with the HIV-1 virus, and 0.7% infected by the 2 viruses. This situation has created many logistical problems for SSA as quoted from Dr. Ngaly's presentation at the International AIDS Conference in Montreal: 1) epidemiological problems; 2) socio-cultural problems; 3) illiteracy among most rural populations; 4) political factors; 5) ethical and legal problems; 6) the lack of new technologies; and 7) the inability to treat HIV positive patients. Added to these obstacles is the lack of coordination between national AIDS programs and the lack of institutional structures between African researchers and those in charge of the national AIDS programs. Lastly, in SSA there is the lack of an AIDS regional policy. In SSA, unlike North America and Europe where there are 4 high-risk groups for AIDS, everyone who is sexually active (with more than 1 partner) is at risk. However, epidemiological data concludes that genital ulcerations are co-factors of the HIV infection. Preventive strategies needed that are region specific for SSA include: 1) a more active role in mobilizing governments by the World Health Organization (WHO) requiring more coordination by clinicians, researchers and administrators of AIDS programs; 2) the need for national strategies aimed at 3 groups: the HIV-infected, the positive but asymptomatic, and the healthy population; and 3) the need to reach rural populations just as religious missionaries have done in the past. The discovery of an AIDS vaccine could solve many of these problems, but the ethical problem remains of how the vaccine could be tested in SSA without a regional policy.
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PMID:[Strategies and prevention of the increase of AIDS in Africa]. 1234 27


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