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

This retrospective study evaluated complications associated with caesarean section in HIV-infected women. For each HIV-positive patient ( n=45) a control group of ten seronegative women ( n=450) was matched for age, number of foetuses, gestational age, indication for caesarean section, status of the membranes and kind of anaesthesia. All women delivered in the same hospital using a uniform protocol. We evaluated the duration of stay in hospital after operation, the need for antibiotics after caesarean section, the incidence of minor postoperative complications (mild anaemia, mild temperature or fever 24 h after surgery, wound haematoma or infection, urinary tract infection, endometritis) and major postoperative complications (severe anaemia, pneumonia, pleural effusion, peritonitis, sepsis, disseminated intravascular coagulation, thromboembolism). Most HIV-positive women (64.5%) had a complicated recovery after surgery. A higher incidence of major and minor postoperative complications were observed in the HIV-positive group than in the control group. There was a statistically significant greater incidence of mild anaemia, mild temperature or fever, urinary tract infection and pneumonia in the HIV-positive group. HIV-positive women with less than 500x10(6) CD4(+) lymphocytest/l had higher post-caesarean section morbidity than HIV-positive women with more than 500x10(6) CD4(+) lymphocytest/l. The median duration of hospital stay was significantly higher in the HIV-positive group (median 7 days) than in the HIV-negative group (median 4 days). The rate of HIV vertical transmission was 8.8%. Higher post-caesarean section morbidity was found in HIV-positive women than in controls. Unfortunately, the HIV-positive women (with low CD4 lymphocytes counts), whose infants theoretically will benefit most from caesarean delivery, are also the women who are most likely to experience post-operative complications.
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PMID:Post-operative complications after caesarean section in HIV-infected women. 1450 67

The pandemic of acquired immune deficiency syndrome (AIDS) is on the threshold of its third decade of existence. The World Health Organization-United Nations statistics show that human immunodeficiency virus (HIV)/AIDS pandemia is set to get much worse. Women of reproductive age are the fastest growing population with HIV. Common signs and symptoms have become more moderate or subclinical, and new clinical presentations have emerged. It is quite apparent that HIV-disease affects multiple organ systems. Advances have been made in elucidating the pathogenesis of HIV. In addition, the molecular technique of viral load determination and the CD + 4 T-lymphocyte count enable evaluation of the disease, its prognosis, and its response to therapy. There is limited specific information concerning the overall risk of anesthesia and surgery of HIV/AIDS patients. However, as far as can be determined, surgical interventions do not increase the postoperative risk for complications or death and should therefore not be withheld. There is also little evidence to suggest that HIV or antiretroviral drugs increase the rate of pregnancy complications or that pregnancy may alter the course of HIV infection. General anesthesia is considered safe, but drug interactions and their impact on various organ systems should be considered preoperatively. Regional anesthesia is often the technique of choice. Yet, one must take into consideration the presence of neuropathies, local infection, or blood clotting abnormalities. It should be emphasized that all practicing anesthesiologists should be familiar with the disease and should use prenatal anesthesia consultations and a team approach to assure optimal treatment for HIV patients.
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PMID:Human immunodeficiency virus: anesthetic and obstetric considerations. 1474 95

It has been reported that women of childbearing age constitute a large percentage of the new cases of HIV/AIDS infection. Consequently, it is not uncommon to find pregnant women who are HIV positive. Because of the increased prevalence of HIV infection in pregnant women, many anesthesiologists encounter these patients in their practices. Infection with HIV in pregnancy often raises questions about the safety of regional anesthesia in these patients. This controversy first began when it was suggested that the introduction of a spinal needle in an HIV-infected parturient would spread the disease into the CNS, leading to the development of neurological sequelae of this disease. Nevertheless, recent analysis of the problem has shown HIV infection should not contraindicate regional anesthesia.
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PMID:Anesthetic considerations for the HIV-infected pregnant patient. 1500 61

This study investigated maternal mortality at the Johannesburg Hospital, a 1100-bed academic hospital in South Africa. Patient records were assessed retrospectively over two time periods: 1995/1996 and 2000/2001. Causes of death were noted and compared with national data. The two time periods were compared to identify disease patterns and the role of anaesthesia in maternal mortality. The maternal mortality ratios were respectively 183 and 354 per 100000 live births respectively. Hypertension in pregnancy was the leading cause of mortality in 1995/1996, accounting for 10 out of the 20 deaths, but was the second most common cause in 2000/2001 (6 out of 35). HIV/AIDS-associated disease was the leading cause of mortality in 2000/2001 (42.7%, increasing from 20% in 1995/1996) with pneumonia the commonest cause of death. The statistics at this hospital were consistent with the national trend of an increasing association with HIV/AIDS. No deaths were found to be directly attributable to anaesthesia in either of the time periods. There is a need for clearer documentation of HIV status in pregnancy and antiretroviral intervention strategies must be considered.
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PMID:HIV/AIDS: impact on maternal mortality at the Johannesburg Hospital, South Africa, 1995-2001. 1532 78

A survey was done to determine the most common hospital accidents with biologically contaminated material among students at the Medical College of the Federal University of Minas Gerais. Six hundred and ninety-four students (between fifth and twelfth semesters of the college course) answered the questionnaire individually. Three-hundred and forty-nine accidents were reported. The accident rate was found to be 33.9% in the third semester of the course, and increased over time, reaching 52.3% in the last semester. Sixty-three percent of the accidents were needlestick or sharp object injuries; 18.3% mucous membrane exposure; 16.6% were on the skin, and 1.7% were simultaneously on the skin and mucous membrane exposure. The contaminating substances were: blood (88.3%), vaginal secretion (1.7%), and others (9.1%). The parts of the body most frequently affected were: hands (67%), eyes (18.9%), mouth (1.7%), and others (6.3%). The procedures being performed when the accidents occurred were: suture (34.1%), applying anesthesia (16.6%), assisting surgery (8.9%), disposing of needles (8.6%), assisting delivery (6.3%), and others (25.9%). Forty-nine percent of those involved reported the accident to the accident control department. Of these 29.2% did not receive adequate medical assistance. Eight percent of those involved used antiretroviral drugs and of these 86% discontinued the treatment on receiving the Elisa method applied to the patient (HIV-negative); 6.4% discontinued the treatment due to its side-effects; and 16% completed the treatment.
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PMID:Training-related accidents during teacher-student-assistance activities of medical students. 1536 58

This review summarizes the epidemiological evidence for occupationally acquired tuberculosis and considers the implications for the prevention of tuberculosis. The relevant epidemiological studies were identified on the basis of the Medline data bank, starting with the year 1966. The evaluation of occupational groups with an elevated tuberculosis risk is exclusively based on epidemiologic studies of good or acceptable quality, applying clearly defined criteria of methodological quality. In summary, the available epidemiological evidence suggests that the risk of tuberculosis is elevated in the following occupational groups: hospital employees in wards with tuberculosis patients; nurses in hospitals; nurses attending HIV-positive or drug-addicted patients; pathology and laboratory workers; respiratory therapists and physiotherapists; physicians in internal medicine, anaesthesia, surgery and psychiatry; non-medical hospital personnel in housekeeping and transport work; funeral home employees, and prison employees. However, the epidemiological evidence is limited for all these occupations, with the exception of the nurses, because of the lack of methodologically adequate studies that have got the statistical power to differentiate between specific work tasks. There is a need for large population-based studies with precise definition of exposure, which should include molecular epidemiologic methods in the investigation of occupational risk factors of tuberculosis.
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PMID:Review of epidemiological studies on the occupational risk of tuberculosis in low-incidence areas. 1608 90

A previously healthy 32-year-old man visited our clinic with a 5-week history of involuntary movement. Examination demonstrated continuous myoclonic jerks in the left elbow. Two days later, he developed generalized convulsion. Electroencephalography demonstrated small spikes over the right central region. Thus, we made a diagnosis of epilepsia partialis continua (EPC) with a secondary generalization. On admission, serum electrolytes, glucose and ceruloplasmin levels, and amino acid analysis were unremarkable. HIV serology was negative. Anticardiolipin, anti-MPO ANCA, and anti-Hu antibodies were negative. The cerebrospinal fluid (CSF) showed 151/microl lymphocytes and 23/microl polymorphs, 70 mg/dl of glucose, and 61 mg/dl of protein. Autoantibodies against the glutamate receptor subunits epsilon-2 and delta-2 were detected in the serum and CSF. Cranial MRI was unremarkable. Treatment with acyclovir and high-dose methylprednisolone failed to halt the jerks. Two weeks after admission, he developed status epilepticus, which necessitated general anesthesia. Intravenous immunoglobulin infusion gave no beneficial effects. Two months after the onset of the status epilepticus, his convulsions were controlled with zonisamide, clobazam, and carbamazepine. While he had no motor dysfunctions, he had loss of spontaneity and memory impairment. This report suggests that EPC might be the initial symptom of subacute encephalitis with a possible autoimmune mechanism.
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PMID:[Subacute encephalitis with anti-glutamate receptor antibodies presented with epilepsia partialis continua]. 1618 Jul 13

Squamous cell carcinoma is a rather infrequent neoplasm of the gastrointestinal tract. Nevertheless its frequency is increasing lately especially in high risk groups of the population infected from HIV or HPV viruses. Squamous cell carcinoma is a slowly and locally growing neoplasm which metastasizes in advanced stages. Its diagnosis must be accomplished by the least traumatic examinations possible. In our study we reviewed our five years experience that included 116 cases. In 89 of them cytological material from ulcerated positions of the anal region was examined. In the rest 27 cytological material was obtained by fine needle aspiration of subcutaneous or submucosal anal lesions. All 116 case reports were retrospectively evaluated. Cytological evaluation revealed 29 cases of normal anal epithelium, 13 granulomas, 12 cases of HPV infection, 28 anal squamous intraepithelial lesions (ASIL), 17 post radiation injuri-es of the anal mucosa and 17 carcinomas. The neoplasms were further subclassified in 12 well differentiated squamous cell carcinomas, 4 cloacogenic carcinomas and 1 leiomyosarcoma. Histological examination followed the initial cytological diagnosis in 75 cases. The correlation between cytological and histological reports did not reveal any false negative or any false positive result. The agreement between histological and cytological evaluation was absolute. Cytological examination is proved to be an easily accessible and totally reliable, low cost diagnostic method, not requiring any kind of anesthesia. It is well accepted by the patients and of paramount clinical utility for the initial diagnostic assessment, the long-term follow up after treatment of anal cancer patients. It is also valuable for the differential diagnosis among benign, premalignant and malignant anal lesions.
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PMID:The role of cytology in the diagnosis of benign and malignant anal lesions. 1713 83

In 2005, it was estimated that 2.3 million children below 15 years of age were living with human immunodeficiency virus (HIV)/AIDS and 570,000 children below 15 years died. Maternal-infant or vertical transmission is the most common mode of HIV infection in children. As transplacental passage of maternal anti-HIV antibodies, diagnosis of HIV infection in young infants relies on virologic assays. Infants older than 18 months of age can be diagnosed by serology alone. Pediatric HIV infections are classified according to Center for Disease Control and Prevention 1994 revised classification system. The understanding of viral pathogenesis, the development of highly active antiretroviral therapy, and the ability to quantitate viral burden have led to significant reduction in disease progression and morbidity in HIV-infected children. As survival improves, these children will require anesthesia care and pain treatment during the course of their illness. Considerations for the anesthesiologist include: possible involvement of multiple organ systems, adverse reactions and drug interactions of antiretroviral agents and adequate infection control to prevent HIV transmission in hospital and other infections to the immunocompromised patients. Finally, care should be taken not to violate confidentiality.
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PMID:Anesthesia in HIV-infected children. 1749 12

Many countries have health-care providers who are not trained as physicians but who take on many of the diagnostic and clinical functions of medical doctors. We identified non-physician clinicians (NPCs) in 25 of 47 countries in sub-Saharan Africa, although their roles varied widely between countries. In nine countries, numbers of NPCs equalled or exceeded numbers of physicians. In general NPCs were trained with less cost than were physicians, and for only 3-4 years after secondary school. All NPCs did basic diagnosis and medical treatment, but some were trained in specialty activities such as caesarean section, ophthalmology, and anaesthesia. Many NPCs were recruited from rural and poor areas, and worked in these same regions. Low training costs, reduced training duration, and success in rural placements suggest that NPCs could have substantial roles in the scale-up of health workforces in sub-Saharan African countries, including for the planned expansion of HIV/AIDS prevention and treatment programmes.
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PMID:Non-physician clinicians in 47 sub-Saharan African countries. 1846 40


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