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

In a prospective study, we investigated whether human immunodeficiency virus (HIV) infection alters the clinical presentation in patients with tuberculous pleuritis. One hundred twelve of 118 patients who presented with pleural effusion suffered from tuberculosis (TB); 65 patients (58%) were HIV seropositive. Evidence of disseminated TB was found more often in HIV-positive than in HIV-negative patients (30.8% vs 10.6%, p < 0.02). Dyspnea, fever, night sweat, fatigue, and diarrhea, severe tachypnea, hepatomegaly, splenomegaly, and lymphadenopathy were significantly more common in HIV-infected than in HIV-negative patients with TB. The same applied to a negative Mantoux reaction, lower hemoglobin, higher beta 2-microglobulin values, and in pleural fluid, lower albumin and higher gamma-globulin levels. Among HIV-infected patients, PPD skin test anergy was significantly associated with relative low albumin and gamma-globulin levels of pleural fluid. However, the radiographic features did not differ with respect to HIV status; they were predominantly those of primary pleuritis (78% in each group). We conclude that coexisting HIV infection affects clinical and laboratory features, but not the radiographic presentation of patients with TB pleuritis in Tanzania.
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PMID:Clinical features of HIV-seropositive and HIV-seronegative patients with tuberculous pleural effusion in Dar es Salaam, Tanzania. 795 5

In the Mwanza Region, Tanzania, an analysis of evaluable, available records from 370 patients from the peripheral hospital and 127 patients from the referral hospital who received a blood transfusion during January-June 1990 was conducted to identify unnecessary blood transfusions. Guidelines the researchers used to determine whether or not a blood transfusion was avoidable were based on the hemoglobin (Hb) level (e.g. children under 5 years old = or Hb 4 g/dl for criteria A and 5 g/dl for criteria B). The blood transfusion could have been avoided in 44% of operated patients based on both sets of criteria. Two of the 11 blood transfusions given to pregnant women with chronic anemia were avoidable. Among the under 5 years olds, 62% of blood transfusions were avoidable based on criteria A and 35% were avoidable based on criteria B. 31% and 15% of blood transfusions among 5-14 year olds were avoidable based on criteria A and B, respectively. As for adults, 63% of blood transfusions were avoidable based on criteria A and 27% were avoidable based on criteria B. Overall, 32% of blood transfusions were avoidable based on criteria B and 56% based on criteria A. Since limitations undoubtedly existed for this retrospective study, the researchers have begun a prospective study. They will use the research findings to develop and implement blood transfusion guidelines in the region to reduce unnecessary blood transfusions in order to reduce transfer-associated HIV transmission.
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PMID:Are some blood transfusions avoidable? A hospital record analysis in Mwanza Region, Tanzania. 811 64

Management of transfusion therapy in sickle cell disease patients with acute complications is often made difficult because of confusing indications, a variety of methods, disparate goals, and varying needs for maintenance transfusion. In priapism, acute chest syndrome, many major surgical procedures, toxemia of pregnancy, and cerebrovascular accidents, the target hemoglobin A level should be made as close to 100% as possible by mechanized red blood cell exchange. If mechanized exchange is unavailable, manual exchange should be instituted. Hemoglobin A should be maintained at greater than 60% to 70% by periodic simple transfusion until patients are fully recovered. Stroke patients should undergo maintenance transfusions for at least 3 years and perhaps 5 to 12 years. Physicians and patients should be aware of the transfusion-related risks of hepatitis and HIV infection. Alloimmunization and iron overload should be minimized in patients requiring frequent transfusions and chelation therapy should be utilized for iron overload.
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PMID:Transfusion therapy in sickle cell disease patients: methods and acute indications. 812 Apr 39

Cyclo(His-Pro) (CHP) is a gut-neuropeptide that influences both appetite and carbohydrate metabolism. This study was undertaken to determine whether concentrations of CHP correlated with various clinical markers of nutritional status and progression of HIV infection. Serum concentrations of CHP were analyzed in a clinical sample of 100 HIV-positive patients whose HIV clinical status ranged from asymptomatic to advanced disease with weight loss. We found a relationship between CHP concentrations and serum albumin and hemoglobin levels, markers of chronic nutrition and disease. However, no correlation was seen between CHP and cortisol concentrations, a marker of acute stress. To analyze the relationship of HIV clinical stage and CHP, patients were divided into three subgroups: asymptomatic, mildly symptomatic, and clear-cut AIDS. CHP concentrations were significantly correlated with HIV clinical stage. These data lead to the hypothesis that CHP is a marker of disease progression and that it potentially plays a role in modulating the nutrition of HIV-infected patients.
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PMID:Relationship between serum cyclo(His-Pro) concentrations and the nutritional status of HIV-infected patients. 813 57

In a retrospective study, the perioperative findings and complications of AIDS patients and asymptomatic HIV-positive patients were compared to those of HIV-negative patients. Characteristic operations in HIV-positive patients were those of extremities in general surgery, and dilatation and curettage in gynecology. There were significant differences among three groups concerning preoperative hemoglobin, GOT, electrolyte concentrations and heart rate. As the preoperative findings, hepatitis and dyspnea on exertion were remarkable in the HIV-positive patients. During anesthesia tachycardia was more frequent in the HIV-positive patients. Postoperatively high fever, anemia and tachycardia were significantly more frequent in the HIV-positive patients. The postoperative leucocyte count was less in the AIDS-patients than in other two groups. As a whole there are some peculiarities about the estimation of the risk and the planning of anesthesia in the HIV-positive patients.
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PMID:[Perioperative complications in HIV-positive patients]. 818 23

We determined incidence and future projections of dementia after AIDS onset in 492 homosexual men with AIDS in the Baltimore/Los Angeles sites of the Multicenter AIDS Cohort Study, 64 of whom developed dementia. We studied various risk factors for dementia, including demographic and clinical features, medical history, markers of immune status before AIDS, and zidovudine use. During the first 2 years after AIDS, HIV dementia developed at an annual rate of 7%. Overall, 15% of the cohort followed through death developed dementia. The median survival after dementia was 6.0 months. Using a proportional hazards model, risk factors for more rapid development of dementia were lower hemoglobin (relative hazard, 0.59 per additional 2 g/dl; p = 0.0005) and body mass index (relative hazard, 0.64 per additional 5 kg/m2; p = 0.05) 1 to 6 months before AIDS, more constitutional symptoms 7 to 12 months before AIDS (relative hazard, 1.68 per additional symptom, p = 0.005), and older age at AIDS onset (relative hazard, 1.60 per decade older; p = 0.009). In a multivariate model, pre-AIDS hemoglobin remained the most significant predictor of dementia. There were no significant risks defined from demographic characteristics, specific AIDS-defining illnesses, zidovudine use before AIDS, or CD4+ lymphocyte count before AIDS. We project that 12 months after the first AIDS diagnosis, 7.1% of survivors will have dementia. The observed association between anemia, low weight, constitutional symptoms, and dementia suggests a role for cytokines inducing both systemic and neurologic disease.
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PMID:Dementia in AIDS patients: incidence and risk factors. Multicenter AIDS Cohort Study. 823 37

Outlined is the protocol for field research in Malawi aimed at ascertaining whether infants born to anemic mothers in areas where malaria is prevalent are at increased risk of morbidity. Specifically, the research seeks to: 1) quantify the prevalence and pattern of anemia in infants living in areas where malaria is endemic; 2) investigate whether birth hemoglobin is associated with clinical risk in infancy; 3) measure the associations between fetal anemia, maternal iron status, and malaria in pregnancy; and 4) quantify the contribution of maternal anemia and iron status to fetal growth retardation. Anemia incidence and malaria prevalence will be assessed through a larger cohort study of infants enrolled at birth and followed for up to 18 months. Also planned is a case-control study that will compare infants born with and without fetal anemia. Odds ratios for maternal anemia, iron deficiency, and parasitemia will be computed for cases and controls to determine the relative contribution of each to fetal hemoglobin status. Finally, the risk of maternal parasitemia, iron deficiency, and anemia will be measured in low-birth-weight, growth-retarded infants and those with normal birth weights. The findings will be used to develop a strategy for anemia control among high risk mothers and infants. This is of particular concern in developing countries, where blood transfusions for anemia can lead to human immunodeficiency virus infection.
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PMID:A study of the consequences of malarial infection in pregnant women and their infants. 823 22

We observed increased hemoglobin A2 (HbA2) levels in an asymptomatic human immunodeficiency virus-1 (HIV1) patient with no previous history of beta-thalassemia. He was treated only with zidovudine (AZT). In an attempt to understand this observation, a retrospective study was initiated to determine whether mean HbA2 levels are higher in AZT-treated patients than in subjects not receiving this drug and to assess if other hematologic alterations are associated with elevated HbA2. One hundred fifty-one HIV-positive cases were investigated; AZT was administered to 81 of them. The mean value of HbA2 was 0.032 (SD +/- 0.005) for the treated group vs. 0.027 (SD +/- 0.004) for the controls. This difference was highly significant (P < 0.001). Twenty-four patients (31%) in the treated group had elevated HbA2 levels vs. none in the controls. Bone marrow toxicity seemed to be more significant in patients with heightened HbA2 values, and HbA2 levels did not increase with CDC clinical stage. We conclude that AZT may be linked to high HbA2 levels in some patients.
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PMID:Increase of hemoglobin A2 in human immunodeficiency virus-1-infected patients treated with zidovudine. 834 56

Between September 1990 and July 1991, health workers and/or laboratory personnel at Siaya District Hospital in rural western Kenya (about 60 km northwest of Kisumu) gathered data on 799 patients who received 927 blood transfusions, including blood donation, grouping, and HIV screening. Most blood recipients were children (under 15 years old). Only 6% of all recipients were men. Just 30% of transfusions were performed the day of request. Blood donors recruited when it was most needed for survival. Their blood tended to be available 3 days after the request. The volunteer donated blood tended to be available for transfusion the day of request, however, because it had already been banked and screened. Patient-recruited donors were more likely to be HIV infected than volunteer donors (13.4% vs. 4.6%; relative risk = 2.91; p .001). 47% of the pediatric transfusions should not have taken place because 23% of these children did not suffer respiratory distress and their hemoglobin levels were greater than t gm/dl and because 27% received the transfusion 2 days after the day of request. 90% of all adult transfusions were inappropriate (i.e., transfusion of no more than 1 unit of blood or received the transfusion 2 days after the day of request). 30% of blood units that had been banked and screened at the time of request were not transfused until at least 2 days after request. These findings identified those areas which must be targeted to improve the appropriate and timely use of blood and reducing transfusion-induced HIV transmission: reduction of inappropriate transfusions, increased recruitment of volunteer donors, and improved laboratory services.
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PMID:Blood transfusion practices and blood-banking services in a Kenyan hospital. 835 59

The use of autologous blood is a well established and extremely popular technique to decrease the necessity for homologous transfusions and the attendant risks of hepatitis, HIV, and HTLV--I/II infections. The most beneficial timing for autologous reinfusion of predonated blood remains unknown. The present study was undertaken to determine the optimal timing of autologous blood reinfusion in elective spinal surgery. Fifty-seven patients were prospectively individually randomly allocated into early versus delayed reinfusion groups prior to undergoing elective spinal surgery by a single surgeon. Three surgical subgroups were entered into the study: anterior/posterior (A/P) spinal fusion patients, posterior thoracolumbar scoliosis fusion patients (PSF), and degenerative posterior lumbar fusion patients (LF). Randomization was successful in that three was no significant difference in male to female ratio, age, preoperative hemoglobin, or number of units predonated between the early and delayed reinfusion groups. Likewise, there was no significant difference in the details of the operative procedure when compared as a group for the early versus delayed reinfusion groups. A significant increase in the postoperative day #1, 2 and 3 hemoglobin was seen in the early reinfusion group, while there was no significant difference seen in the postoperative day #7 hemoglobin between the early versus delayed reinfusion group. There was no effect of surgical grouping on these significant comparisons. Earlier patient mobilization was also seen in the early reinfusion groups for the A/P and PSF groups. There was no difference in patients' subjective evaluation of satisfaction and discomfort between the early or delayed reinfusion groups as determined by blinded interview on days 1, 3, 5, and 7 postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Early versus late replacement of autotransfused blood in elective spinal surgery. A prospective randomized study. 836 75


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