RESUMO
BACKGROUND: Pathogen-negative diarrhea is common in HIV infection and has been associated with clinical symptoms, histopathology, HIV expression, CD4+ lymphocyte depletion, cytokine mRNA expression, and apoptosis of lamina propria mononuclear cells. OBJECTIVES AND METHODS: To examine the short-term (7-day) effects of treatment with combination antiretroviral therapies upon gastrointestinal symptoms and rectal mucosa in 15 HIV-infected subjects. RESULTS: Treatment was associated with significant decreases in the perception of abdominal bloating and cramps. Similar declines in RNA burden and rises in CD4+ lymphocyte counts were found in blood and mucosa. Treatment was also associated with a fall in the number of lamina propria mononuclear cells undergoing apoptosis by in situ labeling, a change that correlated with the change in mucosal viral burden. CONCLUSIONS: Peripheral blood and mucosal compartments are equally responsive to effective antiretroviral therapies. The detection of significant changes within 7 days of starting antiviral therapy implies that intestinal dysfunction may be a direct result of local HIV infection.
Assuntos
Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/tratamento farmacológico , Mucosa Intestinal/virologia , Linfócitos/imunologia , RNA Viral/análise , Apoptose/imunologia , Contagem de Linfócito CD4 , Linfócitos T CD4-Positivos/imunologia , Linfócitos T CD8-Positivos/imunologia , Cólica/tratamento farmacológico , Quimioterapia Combinada , Feminino , Gastroenteropatias/tratamento farmacológico , Proteína do Núcleo p24 do HIV/análise , Proteína do Núcleo p24 do HIV/sangue , Infecções por HIV/fisiopatologia , Humanos , Mucosa Intestinal/imunologia , Mucosa Intestinal/fisiopatologia , Masculino , Estudos Prospectivos , RNA Viral/sangue , Carga ViralRESUMO
Nurse practitioners have been used in the USA for 30 years and have been shown to provide better and more cost-effective care than doctors in primary care settings. Consequently, they are a powerful vehicle for professional change in the current cost-cutting health-care reforms. This article examines the American experience.
Assuntos
Descrição de Cargo , Profissionais de Enfermagem/organização & administração , Autonomia Profissional , Análise Custo-Benefício , Currículo , Humanos , Profissionais de Enfermagem/educação , Estados UnidosRESUMO
There is a complex relationship between malnutrition and immune function. Patients with chronic immunological disorders often become malnourished as a result of disease complications. On the other hand, macronutrient deficiencies are associated with the development of immunological deficiencies which are reversible on nutritional repletion. Deficiencies of macronutrients lead to diminished function of T and B lymphocytes in all patients, irrespective of HIV status. Lymphopenia is a characteristic finding in malnourished patients and includes loss of helper lymphocytes (CD4). This paper provides an overview of the gastrointestinal problems in AIDS and concludes that, because of the complex nature of the human immunodeficiency virus (HIV), a multidisciplinary team approach is essential, with the nurse playing a major role.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Neoplasias Gastrointestinais/complicações , Infecções por HIV/complicações , Candidíase/complicações , Diarreia/etiologia , Humanos , Distúrbios Nutricionais/complicaçõesRESUMO
This small survey, undertaken in one district health authority, sought the opinions of registered and enrolled nurses, regarding a single nurse taking total responsibility for the administration of medicines. Just over half of the trained nurses (58 percent) considered they should be able to administer medicines to patients on their own and were willing to do so. The remainder (42 percent) were opposed and concerned about the potential dangers of not having drugs double checked.
Assuntos
Recursos Humanos de Enfermagem , Preparações Farmacêuticas/administração & dosagem , Humanos , Inquéritos e QuestionáriosRESUMO
When a temporal delay is interposed between the contextual elements (wings) and the focal element (central axis) of the Müller-Lyer figures, the usual assimilation illusion changes to an illusion of contrast; that is, judged axis length is contrasted away from rather than assimilated toward the context provided by parallel extents between wings. Presentation time for the preceding contextual wings on the order of 1 sec or more was needed to produce contrast effects in judgments of the following focal axis (Experiment 3) and, given sufficient presentation time, these contrast effects were largely unaffected by the length of the temporal delay between contextual and focal elements, appearing equally strong for delays between 0 and 2 sec (Experiments 1 and 2). These results are consistent with a representational basis for these contrast effects that is high-level and long-lived. The Müller-Lyer contrast illusion may reflect the inadvertent error arising from basing judgments about particular objects on information about attribute differences among objects. Such judgmental errors may be the natural consequence of constrained computations that make explicit information required for certain common tasks, but at the expense of obscuring information required for less common tasks.