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 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Awareness of the relative prevalence of diseases causing altered states of consciousness (ASC) in a particular geographic locality could greatly facilitate the approach to patient management. This prospective study has, therefore, evaluated 202 patients with ASC admitted to the medical wards of GCMS teaching hospital in a two year period, between January 1994 and December 1995. ASC was defined as a clinical state manifested by conditions ranging from confusion and disorientation in person, place and time to stupor and deep coma. History, physical examination, limited laboratory tests and course of the patient in the hospital were used to identify the aetiology. There were 122 (60.4%) males and 80 (39.6%) females with male to female ratio of 3:2. Most of the patients, 122 (60.4%), belong to the age group below 40 years and the median age was 33 years (range = 15.84). The median duration of hospital stay was six days (range = 1-90). The commonest cause was infections, 111 (55%) followed by metabolic disorders, 45 (22.3%), structural lesions, 30 (14.9%) and poisoning, seven (3.5%). The aetiology was not identified in nine (4.5%) of the patients. Cerebral malaria was the commonest infectious cause followed by chronic meningitis and/or encephalitis. In hospital mortality rate was 60.4%. Unknown diagnosis, structural neurologic and metabolic causes were associated with increased mortality rate, with p values of 0.002, 0.009 and 0.015, respectively. The same was true for presence of HIV infection, P = 0.02. Since infectious causes are the commonest causes in our series, of which most are treatable with a relatively favourable outcome, critical evaluation for infections and early intervention is recommended. In addition, diagnostic facilities, especially for structural central nervous system lesions has to be improved because successful treatment and prognosis depends on the identification of a specific aetiology.
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PMID:Aetiology and outcome of non-traumatic altered states of consciousness in north western Ethiopia. 914 79

We aim to assess the age-related differences in psychological stress and depression in patients with human immunodeficiency virus (HIV) infection. Prospective, longitudinal, observational study of patients with HIV followed at a university affiliated VA Medical Center. Fifty-six consecutive patients with HIV infection aged 19-68 were studied. Data on demographics, living arrangements, education, employment, income, social, religious, and community support, medical status, psychological stress, depression, and coping was assessed at baseline and every 6 months. Instruments for psychological testing included Beck Depression Inventory, Profile Mood Status (POMS) scale and ways of coping scale (inventory of coping with illness scale). Sixty-nine per cent (38/56) of the patients were older than 35 years of age. Older patients exhibited significantly greater emotional and psychological stress; the mean POMS score for older patients was 56.8 as compared to 21.5 for younger patients (P = 0.004). Older patients had significantly greater depression (P = 0.001), higher tension and anxiety (P = 0.005), greater anger and hostility (P = 0.03), greater confusion and bewilderment (P = 0.01), and more fatigue (P = 0.003) as compared with younger patients. Older patients were significantly more likely to have intravenous drug use as an HIV risk factor (P = 0.02), less likely to be employed (P = 0.005), and more likely to use non-traditional therapies (P = 0). Intravenous drug use was an independent predictor of psychological stress in older patients. Patients with HIV, older than 35 years of age, are significantly more likely to suffer from depression and psychological stress; intravenous drug use was an independent predictor of stress. Interventions for the treatment of depression should be especially sought in this subgroup of patients with HIV.
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PMID:Psychological stress and depression in older patients with intravenous drug use and human immunodeficiency virus infection: implications for intervention. 914 58

Perceived risk of infection, one factor influencing HIV-related behavior decisions, has been the focus of expanding research efforts. A body of research now exists examining factors related to risk perceptions and the relationship between risk perceptions and behavioral decision making. This article examines 60 quantitative studies of HIV-related risk perceptions, identifies methodological and theoretical limitations or gaps in current knowledge, and suggests ways future research might better assess the role of risk perceptions and facilitate the adoption and maintenance of HIV-related health protective behaviors. The authors argue that mixed findings in the quantitative literature are due to (1) cross-sectional study designs that constrain or confound the interpretation of findings, (2) construct confusion and measurement inconsistencies. (3) insufficient consideration of specific subgroup or behavioral differences, and (4) inattention to situational norms and other contextual factors that influence risk perceptions and behavior.
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PMID:Rethinking perceived risk and health behavior: a critical review of HIV prevention research. 915 76

Toxoplasma gondii is a frequent cause of subclinical latent human infection and an important opportunistic pathogen that may cause severe disease in immunocompromised patients. Patients with AIDS who have antibodies to T. gondii should be considered at high risk for development of clinical disease (toxoplasmosis). Reactivation of latent infection in the central nervous system is a common HIV/AIDS-related complication in these patients. Typical presenting symptoms are headache, confusion, fever, and focal neurologic deficits. Routine serologic tests cannot distinguish active from latent infection. Neuroradiologic studies may be highly suggestive of toxoplasmic encephalitis, but the definitive diagnosis can be made only by demonstration of toxoplasma in brain tissue. The unique pathogenesis of toxoplasmic encephalitis in patients with AIDS necessitates intensive primary therapy followed by life long suppressive therapy. Clinical and radiographic improvement is usually rapid with appropriate treatment.
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PMID:Recognition and management of toxoplasmosis. 931 66

Survivors of multiple AIDS-related losses face threat to their identity because of the extreme disruption to their personal, assumptive, and interpersonal worlds. This article briefly explains the experience of multiple-loss survivors and includes a case history of a survivor. An individual's sense of self is transformed through identification with the disease. In the gay community, a particularly strong identification with AIDS arose. One outcome of the meshing of an AIDS and homosexual identity is the tendency for gays to assume an identity in relation to HIV ("I am HIV positive/negative.") Personality alteration is not uncommon and may include an inability to trust, labile emotionality, and diffuse anger. Erik Erikson's developmental stage model is used to clarify the confusion survivors face in maintaining and forming identity. Many survivors are catapulted into an integrity versus despair task, reporting many similarities with the situation of their grandparents. The survivor's interpersonal connection to the world, especially their connection to a community, is severely shaken. The article does not ignore the potential for positive identity growth arising from this tragedy. Conclusions from this experience may have applicability in other areas of multiple, ongoing losses.
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PMID:Threats to identity in survivors of multiple AIDS-related losses. 932 6

This study describes the experience of a generic hospice admitting people with advanced HIV disease over a 4-year period. Data were collected retrospectively for all patients with HIV disease admitted. The aim of the study was to review the number of referrals, the reason for referral, subsequent symptom control and multidisciplinary team involvement together with the outcome for these patients. Twenty-six patients were admitted for the first time. Two patients were female, 24 were male; median age was 36 years (range 25-58 years). Hospitals referred more patients than general practitioners (18 (70%) and 5 (20%) respectively), but most were from non-HIV specialist areas within hospitals (11 (42%)). The commonest reason for referral was locality, particularly in terms of ease of access. The most prevalent symptoms on admission were weakness, immobility and weight loss (77%, 73% and 62% respectively). These were not improved during admission. There was significant improvement in the control of other symptoms including pain, gastrointestinal disturbance, confusion and dyspnoea. Use of the full multidisciplinary team was high. Median length of stay was 19 days (range 1-77 days). Seventeen patients (65%) died on their first admission. This study confirms the high prevalence of symptomatology among patients with HIV disease. Many generic hospices can offer skilled multidisciplinary symptom control and psychosocial care, complementing other HIV specialist services. It is important that patients with HIV disease and specialist health care professionals working in the HIV field are made aware of what generic hospices are able to offer so that patients can make informed choices about their care.
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PMID:Caring for patients with HIV disease: the experience of a generic hospice. 940 1

Haitian women in Miami, Florida, responded to recruitment for testing of HIV antibody serostatus in ways that demonstrated the value of ethnographic methods for studying reactions to this kind of test, especially pre- and posttest counseling sessions. A total of 155 women between 14 and 61 years old, recruited in Miami in 1992 and 1993, participated. Response to testing identified three primary obstacles to the women's understanding of content presented in pre- and posttest counseling sessions: (1) their confusion about the meaning of positive versus negative, (2) the investigators' difficulty in communicating the concept of antibody, and (3) vagueness of the concept of window period between exposure and presentation of antibody. Retesting of a subset of Haitian participants helped to define sexual risk among these women in terms of having partners who had other partners and perception of supernatural risk.
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PMID:HIV testing among Haitian women: lessons in the recognition of risk. 940 87

Cerebral tuberculosis (TB) was diagnosed in 6 (4%) of 156 HIV-infected patients with TB seen at our institution over 6 years. We describe here the clinical and radiologic features of these cases and of 15 others reported in the literature. Of the 21 patients, 59% were intravenous drug users. Presenting symptoms were fever (76%), confusion (52%), seizures (38%), and headache (38%). Fourteen patients (66%) had previous or active extracerebral TB at presentation. Cranial CT scan showed ring-(62%) or nodular-(24%) enhancing lesions or mixed forms (14%). Among the 12 patients who underwent a brain biopsy, bacteriologic evidence of TB was found in 9. Four patients (19%) died during hospitalization. Among the 17 others who received antituberculous therapy, only 1 developed neurologic sequelae. Five patients also received steroid therapy to control cerebral edema or paradoxical growth of the cerebral mass lesions. TB should be considered as a cause of cerebral mass lesions in HIV-infected patients, especially if tuberculous infection is suspected at other sites.
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PMID:Cerebral tuberculosis in patients with the acquired immunodeficiency syndrome (AIDS). Report of 6 cases and review. 941 28

This study was carried out in 60 AIDS patients who presented toxoplasma encephalitis in Martinique (French West Indies). Diagnosis was based on a combination of fever, neurologic signs, and characteristic CT-scan images in patients with positive HIV serology. There were 46 males and 14 females with a mean age of 40 years. The mode of transmission was heterosexual in most cases (68.3%). The incidence of drug-related transmission was low (6.7%). Neurotoxoplasmosis was the most frequent presenting symptom of AIDS (53.3%) followed by esophageal candidosis (20%) and pneumocystosis (10%). Clinical symptoms were headache (56.5%), fever (48.3%), hemiparesia (36.6%), and confusion (36.6%). CT-scan showed most lesions to be multiple (70%), hypodense (89%), and subject to contrast uptake (93%). Mean lymphocyte level was 1128/mm3 with 88 CD4/mm3 and a CD4-to-CD8 ratio of 0.14. Conventional treatment using a combination of pyrimethamine and sulfadiazine led to skin rash and neutropenia and had to be discontinued in 30% of cases. Clinical symptoms and mean survival (327 days) were the same as comparable findings from Europe and North America.
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PMID:[Cerebral toxoplasmosis and AIDS in Martinique]. 951 53

Confusion in the elderly patient is usually a symptom of delirium or dementia, but it may also occur in major depression and psychoses. Until another cause is identified, the confused patient should be assumed to have delirium, which is often reversible with treatment of the underlying disorder. Causes of delirium include metabolic disorders, infections and medications. Thyroid dysfunction, vitamin deficiencies and normal-pressure hydrocephalus are some potentially reversible causes of dementia. Major irreversible causes include Alzheimer's disease, central nervous system damage and human immunodeficiency virus infection. All but the rarest causes of confusion can usually be identified based on the complete history, medication review, physical examination, mental status evaluation and laboratory evaluation with longitudinal reevaluation.
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PMID:Diagnostic approach to the confused elderly patient. 953 17


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