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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To date a total of more than 50 million individuals worldwide have been infected with HIV and more than 20 million have died from the disease. Two thirds of the known carriers of HIV 36 million worldwide, live in Africa. In Israel, as of December 31, 2000, there are a total of 2,843 reported carriers and 165 persons alive with AIDS. On the basis of future projections of increasing incidence of HIV/AIDS in obstetric patients undergoing anesthesia and surgery, obstetricians and anesthesiologists should be aware of the disease and its impact on anesthetic techniques and possible interactions between anesthetic drugs and HIV therapeutic agents. Surgical staff members should be knowledgeable and updated concerning safety precautions during surgical and anesthetic procedures.
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PMID:[The management of HIV patients during surgery and in the delivery ward: anesthetic considerations]. 1185 Nov 10

This article discusses the major areas of concern in Georgia regarding reproductive health. Unsafe practices of abortion have been trusted by Georgian women as a method of fertility regulation due to the shortage and unavailability of contraceptives. Pregnancy and delivery complications constitute 95% of maternal deaths due to insufficient hospital equipment, intensive care units, anesthesia services and personnel professionalism. In the advent of the UN Population Fund (UNFPA) in 1997, abortion rate had decreased from 41.1/1000 women in 1992 to 24/1000 in 1995. Also, UNFPA distributed contraceptives through clinics. Issues on the family planning, reproductive health, sexually transmitted infection, HIV/AIDS have been addressed or is presently being addressed to by the organization. The purpose of the organization is to develop a knowledge, attitudes, and practices (KAP) survey, develop and implement a national reproductive health program, assist the Ministry of Health in the implementation of management information system and extend access to reproductive health and family planning services. The project had been to proposed to extend until 1999 with prospective aims on the implementation of KAP, development of a national reproductive health program, further study of the management information system, and the pursuance of family planning and reproductive health services.
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PMID:Spotlight on Georgia. 1222 14

Breast feeding plays an important role in suppressing ovulation. The lactational amenorrhea method (LAM) of family planning takes advantage of this natural decline of fertility during exclusive breast feeding, when the woman is protected from pregnancy. An Australian study found that the contraceptive action of LAM alone lasts up to a year in some cases. However, for LAM to be effective after the first 6 months postpartum, 15 or more feedings a day are required, and supplements must be limited to 10% of total intake. It is advisable that those breast feeding less frequently use a contraceptive because of the return of ovulation before the onset of menses. A US study showed that two-thirds of women ovulated before signs of bleeding. On the other hand, even a menstruating, nursing mother is 30% less likely to conceive compared to a nonnursing mother. Contraceptive selection includes non hormonal methods. The condom also provides some protection against sexually transmitted diseases (STDs). The cervical cap, sponge, and diaphragm can be used 6 weeks postpartum, although failure rates of 28% have been reported for the sponge and the cervical cap in parous women. Spermicides may be used immediately after parturition. IUDs are highly effective, but insertion is FDA-approved after uterine involution is complete. Periodic abstinence methods require special training. Tubal sterilization anesthesia affects the infant, somewhat diminishing the sucking response. Among hormonal methods, progestin-only oral mini-pills and combination pills are highly effective when used with breast feeding, without adverse effects on infant health according to a long-term follow-up of Swedish children. Depot medroxyprogesterone acetate does not suppress milk production, nor do subdermal implants affect the health of infants. The risk of HIV transmission via breast milk is unknown, thus breast feeding should be discouraged only if an adequate supply of formula is available.
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PMID:Contraception during breastfeeding. 1228 4

Female Circumcision (FC) is "the total or partial cutting away of the female external genital organs." There are 3 types of FC: 1) Sunna where the foreskin of the clitoris is removed; 2) excision which involved removal of a part or all of the clitoris with a part or all of the labia minora; and 3) infibulation or pharaonic circumcision (the most severe type) which includes excision and removal of the labia majora only leaving a small hole to allow the exit of urine and menstrual fluid. FC carries the high risk of HIV infection because it is often practiced without anesthesia and with either a razor blade or a knife. The damages go beyond the physical--they include long-term side effects on women's physical and psychological health. The international battle against FC includes a series of legislative and political acts: 1) In 1946 the British Colonial government made one of the earliest efforts of its kind by making pharaonic circumcision in Sudan a felony and punishable by imprisonment; 2) In 1959 Egypt passed a law making circumcision illegal; 3) In 1977 the Special Committee of Non- Governmental Organizations on Human Rights of the United Nations in collaboration with WHO and UNICEF organized a sub-committee to investigate the status of women in 20 African countries and published a report; 4) In 1979 WHO held a conference in Sudan entitled "The Traditional Practices Affecting the Health of Women and Children" whose outcomes were published in a report; 5) In 1980 WHO forbade the practice of FC; 6) In 1984 a Pan-African seminar was held in Dakar, Senegal that established the Inter-African Committee Against Harmful Practices Affecting Women and Children (IAC); 7) In 1985 the UN Nairobi Conference on The Women's Decade passed resolutions against FC; 8) In 1988 the 39th Assembly of the WHO/Africa Region passed a resolution calling for the abolition of female sexual mutilation. Presidents of several African countries have condemned FC including Benin, Burkina Faso, Kenya, Senegal, Djibouti, Guinea Bissau and Mali.
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PMID:Female circumcision: desperately seeking a space for women. 1231 83

The author, a dentist in the West Indies, describes his use of posters and leaflets to educate his patients about HIV/AIDS. Although these materials are placed in both the waiting and treatment rooms, this alone does not guarantee they are read. The dentist introduces discussion about AIDS into his exchanges with patients, when feasible. For example, while waiting for local anesthesia to take effect, the author may ask his patients for reactions to the AIDS materials or determine if they are aware of how HIV is transmitted. Male patients are frequently observed to pick up materials on AIDS and pregnancy to take home for their wives. Infection control practices are demonstrated to those who are concerned about contracting HIV through dental procedures.
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PMID:Discussions with a dentist. 1232 39

Cancrum oris (noma) is a gangrenous infection that develops in the mouth and spreads rapidly to other parts of the face. The disease occurs mostly in conditions of poverty, poor hygiene and malnutrition. In sub-Saharan Africa the frequency in several countries is estimated to be 1-7 cases per 1,000 population, and as many as 12 cases per 1,000 in the most affected communities. About 90% of these children die without receiving any care, yet the disease can, and should, be prevented. With increasing numbers of children who are malnourished and who have compromised immune systems (compounded by the HIV pandemic) the prevalence of conditions such as noma is likely to increase. Among the earliest features of noma are excessive salivation, marked fetor oris, facial oedema and a greyish-black discolouration of the skin in the affected area. This devastating gangrenous lesion may involve the cheek, the chin, the infra-orbital margin, palate, nose, antrum and virtually any part of the face. This report describes a 4-year-old HIV-positive African girl, who was abandoned, discharged from the Plastics Unit and now lives in a child care sanctuary. Little is known about her history prior to her arrival at the home a few weeks previously. The clinical examination revealed a delay in growth and physical development equivalent to that of a 2-year-old child. The left cheek had a perforating ulcer in a healing phase. The perforation, about 1 cm in diameter, was surrounded by oedematous tissues showing a mild to moderate erythema. The peripheral oedema extended to the lower palpebral, the upper labial, left labial commissural, mandibular and pre-parotid regions. Submental, submandibular and cervical lymph nodes were mildly painful upon palpation. The child was not pyretic. The intra-oral examination revealed the features of acute necrotising gingivitis (ANG). ANG was generalised and showed classic interdental crater-like ulcers covered with whitish debris. Halitosis was pronounced. Examination of the second quadrant revealed a large ulcer extending from the distal aspect of the deciduous canine to the distal aspect of the second deciduous molar. The adjacent palatal mucosa was severely oedematous. The alveolar bone supporting the first and the second molars was completely exposed to the fundus of the vestibulum. It was not possible to obtain intraoral photographs or radiographs. Chlorhexidine gluconate (0.2% solution) and metronidazole tablets, 200 mg twice daily for 15 days were prescribed. The child was seen every alternate day for 10 days and her condition improved rapidly. Halitosis had subsided. She was then referred to the Johannesburg Hospital for further treatment under general anaesthesia. The proposed treatment plan was as follows: removal of dental accretions and polishing of all teeth, extraction of the left maxillary teeth supported by non-vital bone, resection of the necrotic bone in the left maxilla and reconstructive surgery in the left cheek.
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PMID:Noma (cancrum oris): case report in a 4-year-old HIV-positive South African child. 1260 42

A 40-year-old male with hemophilia A was scheduled for right total knee arthroplasty. He was HIV positive probably due to receiving infected blood products previously. We performed the pharmacokinetic study of factor VIII in advance, which showed the increased factor VIII activity 1.6% by an injection of one unit. kg-1 of factor VIII and the half-life of about 16 hours. To keep the factor VIII activity over 100% in the perioperative period, 3000 units of recombinant factor VIII was injected one hour before the induction of anesthesia followed by continuous infusion at 125 units per hour. The factor VIII activity before the induction was 110.6%. The operation was successful and there was no sign of bleeding tendency. The factor VIII activity after the operation, however, was unexpectedly low (73.1%), and it was necessary to increase the infusion rate to 150 units per hour. The factor VIII activity was kept over 80% until POD 7 with the continuous infusion and over 60% until POD 21 with intermittent administration. Factor VIII was discontinued on POD 21 without any sign of bleeding tendency after the postoperative rehabilitation. Although this patient was HIV positive, his immune system was well controlled with HAART and there was no difficulty in the anesthetic management. To prevent accidental infection to the medical staff, we again recognized the importance of standard precautions.
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PMID:[Anesthetic management of a hemophilia A patient with HIV infection: a case report]. 1264 80

The objective of the study was to elucidate thermal based ablation techniques for local tumor control. Seven lesions of renal cell carcinoma (2 renal, 1 adrenal, 2 muscle, 1 hepatic, 1 bone) were treated under local (n=2) or general (n=6) anaesthesia with percutaneous cryoablation (CRA): CryoHit device or radiofrequency (RF) ablation (RFA): RF 3000). Treatment was palliative in 4 patients with progression after systemic therapies, and with curative intention in one organ confined tumor (patient with active HCV and HIV infection). Mean power for RFA was 165 watts. Duration of treatments was 10-91 min. No bleeding or urinary leakage was observed; no drainage or indwelling catheters necessary. Pain relief was sufficiently achieved by tramadol and novaminesulfon. Inpatient period on average was 4.25 days. CRA led to complete tumor destruction (CTD) of an adrenal mass (time to progression, 15+ months) and partial tumor destruction (PTD) of a lumbar lesion (19 months); RFA resulted in CTD of 3 lesions (liver, 9+ months; kidney, 1+, 13+ months) and PTD in 2 lesions (muscle and bone, 3 months). In conclusion, it was found that CRA and RFA are safe and effective methods to destroy metastatic RCC. Such minimal invasive techniques are favorable for palliative treatment (low performance status, surgical preconditions) and in conjunction with immunochemotherapy; A decreased risk of bleeding, the shorter duration of hospitalization and a faster recovery of the patient encourage minimal invasive percutaneous thermal based therapies due to life-quality and economic aspects. Treatment of primary renal cell carcinoma is currently under investigation.
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PMID:Regional thermoablation of local or metastatic renal cell carcinoma. 1268 54

Studies describing posttraumatic stress disorder (PTSD) as a result of physical illness and its treatment were reviewed. PTSD was described in studies investigating myocardial infarction (MI), cardiac surgery, haemorrhage and stroke, childbirth, miscarriage, abortion and gynaecological procedures, intensive care treatment, human immunodeficiency virus (HIV) infection, awareness under anaesthesia, and in a group of miscellaneous conditions. Cancer medicine was not included as it had been the subject of a recent review in this journal. Studies were reviewed in terms of the prevalence rates for PTSD, intrusive and avoidance symptoms, predictive and associated factors and the consequences of PTSD on healthcare utilization and outcome. There was considerable variability both in the study methodology and design and in the results. The highest prevalence rates were identified in patients treated in intensive care units (ICUs) and those with HIV infection. Irrespective of the physical illness, posttraumatic symptomatology is more common than PTSD caseness. Existing characteristics of the patient may well predispose individuals to the development of PTSD as do other factors such as poor social support and negative interactions with healthcare staff. Generally, the severity of the illness itself is not predictive of PTSD. Issues relating to sampling, attrition, diagnosis, the course of symptoms, aetiological pathways, and the consequences of the disorder are discussed. The presence of PTSD most probably influences the patient's use of healthcare resources and may affect their clinical outcome.
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PMID:Posttraumatic stress disorder following medical illness and treatment. 1272 79

Over the last 20 years, the acquired immune deficiency syndrome (AIDS) has grown from a small case series of Pneumocystis carinii infection in four homosexual men to one of the major health problems facing the world today. In the next 5 years, human immunodeficiency virus (HIV) infection is expected to kill more than 2.2 million people. In the United States, women of childbearing age constitute a large percentage of new cases of AIDS. Because of the increased prevalence of HIV in pregnant women, many anesthesiologists encounter these patients in their practice. The safety of regional neuraxial spread has been a concern in the past, nevertheless, recent analysis of the problem has shown that HIV infection in pregnancy does not contraindicate administration of regional anesthesia.
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PMID:Human immunodeficiency virus in the parturient. 1277 Jun 62


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