RESUMEN
Gastric syphilis in the setting of HIV is rare in the literature with only one other case reported. Herein, we present a case of a 40-year-old HIV-infected man with gastric syphilis. Evaluation revealed a rapid plasma reagin (RPR) of 1:2056, and cerebrospinal fluid with evidence of neurosyphilis. An esophagogastroduodenoscopy (EGD) was performed revealing nodular masses, which resolved after appropriate therapy with penicillin.
Asunto(s)
Infecciones por VIH/complicaciones , Gastropatías/diagnóstico , Sífilis/diagnóstico , Adulto , Diagnóstico Diferencial , Endoscopía del Sistema Digestivo , Humanos , Masculino , Gastropatías/complicaciones , Gastropatías/patología , Sífilis/complicaciones , Sífilis/patologíaAsunto(s)
Erupciones por Medicamentos/diagnóstico , Neomicina/efectos adversos , Piel/lesiones , Administración Tópica , Adulto , Antiinflamatorios/administración & dosificación , Clobetasol/administración & dosificación , Clobetasol/análogos & derivados , Diagnóstico Diferencial , Femenino , Glucocorticoides , Humanos , Neomicina/administración & dosificación , Heridas y Lesiones/complicacionesRESUMEN
The ability of IL-2 to induce expansion of the CD4(+) T lymphocyte pool has made it the most studied cytokine in the treatment of HIV infection. The majority of trials have used an empirical regimen of 5-day IL-2 cycles given every 8 weeks--a regimen based upon early pharmacodynamic studies and patient preference. To better define optimal duration and frequency of cycles, a randomized trial was conducted in which patients who received this "standard" regimen were compared to patients who received cycles of variable duration (based on individual patterns of cell cycle progression) and to patients who received cycles of variable frequency (based on individual CD4(+) T lymphocyte responses to previous cycles). Twenty-two patients with HIV-1 infection and CD4(+) T lymphocyte counts > 200 cells/mm(3) were randomized to one of three treatment groups for 32 weeks of study. Eight participants received four 5-day IL-2 cycles (controls) every 8 weeks; 7 participants received four cycles of longer duration (mean 7.7-days); and 7 participants received an increased frequency of 5-day cycles (every 4.1 weeks on average). All three groups experienced significant increases in mean CD4(+) T lymphocytes. However, there were no statistically significant differences in CD4(+) T lymphocyte increases between the group that received longer cycles (median increase 239 cells/mm(3), P = 0.78) or between the group that received more frequent cycles (median increase 511 cells/mm(3), P = 0.54) and the control group (median 284 cells/mm(3)). HIV-1 viral loads decreased during the study period in all three groups. Our inability to demonstrate a significant advantage of increased frequency or duration of IL-2 administration provides corroborating experimental evidence for the use of an IL-2 regimen consisting of 5-day cycles administered no more frequently than every 8 weeks in future clinical trials aimed at expanding the CD4(+) T lymphocyte pool.
Asunto(s)
Linfocitos T CD4-Positivos/efectos de los fármacos , Infecciones por VIH/terapia , Interleucina-2/uso terapéutico , Adulto , Linfocitos T CD4-Positivos/fisiología , Femenino , Infecciones por VIH/virología , VIH-1/aislamiento & purificación , Humanos , Interleucina-2/efectos adversos , Interleucina-2/sangre , Masculino , Persona de Mediana Edad , Receptores de Interleucina-2/sangre , Factores de TiempoRESUMEN
Severe hypothermia is a medical emergency and requires active and occasionally rapid core rewarming to prevent cardiac arrhythmias and death. In the accident and emergency department rewarming is often limited to warmed intravenous fluids, heated blankets, gastric and bladder lavage. Extracorporeal methods, which rewarm core blood directly, for example haemodialysis and cardiopulmonary bypass, require expertise and equipment not always found in a district general hospital. Venovenous haemofiltration is now commonly found in district general hospitals around the country and can be used safely for core rewarming. A case is reported of a severely hypothermic elderly patient successfully rewarmed using venovenous haemofiltration, in an accident and emergency department, when other conventional methods had failed.
Asunto(s)
Hemofiltración , Hipotermia/terapia , Recalentamiento/métodos , Anciano , Servicio de Urgencia en Hospital , Resultado Fatal , Femenino , HumanosRESUMEN
Lemierre's syndrome is characterized by an oropharyngeal infection followed by internal jugular vein septic thrombophlebitis and metastatic emboli, most often to the lungs and joints. The syndrome is most commonly associated with the anaerobic gram-negative rod Fusobacterium necrophorum. Diagnosis is established with evidence of metastatic infection and internal jugular vein thrombophlebitis. CT is considered the diagnostic procedure of choice. Treatment should include an extended course of a beta-lactamase-resistant antibiotic and surgical drainage of any purulent fluid collection. Anticoagulation remains controversial, and ligation of the internal jugular vein is reserved for patients with persistent sepsis and recurrent emboli. With appropriate therapy, mortality is 4% to 12%; but mortality is increased when therapy is delayed.
RESUMEN
Although human immunodeficiency virus type 1 (HIV-1) infection in the United States has predominantly involved subtype B, increasing global travel is leading to wider dissemination of genetically heterogeneous subtypes. While physicians depend on HIV-1 viral load measurements to guide antiretroviral therapy, commonly used molecular assays may underestimate the viral load of patients with non-B subtypes. Nine patients with non-B subtypes of HIV-1 were identified by physicians who suspected a non-B subtype on the basis of a low or undetectable HIV-1 viral load, by the Amplicor HIV-1 Monitor test, version 1.0, in conjunction with either a declining CD4 cell count or history of travel outside the United States. Use of version 1.5 of the Amplicor HIV-1 Monitor test detected a median HIV-1 viral load that was 2.0 log(10) RNA copies/mL higher than was determined with version 1.0. Clinical management was altered in all cases after diagnosis of a non-B-subtype infection. These cases demonstrate that it is critical for physicians to suspect and diagnose non-B subtypes of HIV-1 so that an assay with reliable subtype performance can be used to guide antiretroviral therapy.
Asunto(s)
Infecciones por VIH/diagnóstico , VIH-1 , Adulto , Fármacos Anti-VIH/uso terapéutico , Recuento de Linfocito CD4 , Estudios de Seguimiento , Genotipo , Infecciones por VIH/sangre , Infecciones por VIH/virología , VIH-1/clasificación , VIH-1/efectos de los fármacos , VIH-1/genética , Humanos , Masculino , Personal Militar , ARN Viral/sangre , ARN Viral/efectos de los fármacos , Factores de Tiempo , Carga ViralRESUMEN
The pharmacokinetics of levofloxacin, administered in high doses and with extended dosing intervals, was studied in human immunodeficiency virus (HIV)-infected patients. Thirty patients received either 750 mg of the drug or a placebo once daily for 14 days, followed by 750 mg or 1,000 mg of the drug or a placebo three times weekly for an additional 14 days. Levofloxacin disposition was characterized by rapid oral absorption, with peak concentrations occurring approximately 1.5 h after dosing and elimination half-lives from 7.2 to 9.4 h. The overall incidence of any adverse effect was 70% (1,000 mg) to 95% (750 mg) for levofloxacin-treated patients and 71% for those taking the placebo. Levofloxacin pharmacokinetic parameters for HIV-infected patients were consistent with those observed in studies of healthy volunteers.
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Antiinfecciosos/farmacocinética , Infecciones por VIH/metabolismo , Levofloxacino , Ofloxacino/farmacocinética , Administración Oral , Adulto , Antiinfecciosos/administración & dosificación , Antiinfecciosos/efectos adversos , Área Bajo la Curva , Recuento de Linfocito CD4/efectos de los fármacos , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Esquema de Medicación , Femenino , Infecciones por VIH/sangre , Infecciones por VIH/tratamiento farmacológico , Semivida , Humanos , Absorción Intestinal , Masculino , Ofloxacino/administración & dosificación , Ofloxacino/efectos adversosAsunto(s)
Anemia Macrocítica/inducido químicamente , Fármacos Anti-VIH/efectos adversos , Infecciones por VIH/complicaciones , Inhibidores de la Transcriptasa Inversa/efectos adversos , Estavudina/efectos adversos , Anemia Macrocítica/complicaciones , Fármacos Anti-VIH/uso terapéutico , Índices de Eritrocitos , Infecciones por VIH/tratamiento farmacológico , Humanos , Estudios Retrospectivos , Inhibidores de la Transcriptasa Inversa/uso terapéutico , Estavudina/uso terapéuticoRESUMEN
Berkeley Power Station was a world leader when in June 1962 it became the UK's first commercial nuclear power station to produce electricity for the National Grid. Berkeley then stood at the leading edge of nuclear technology. After 27 years of successful operation and the supply of nearly 40 billion units of electricity, Berkeley ceased generation in March 1989. Just as it was at start-up, Berkeley is continuing to lead the way as the UK's first commercial nuclear power station to be decommissioned. A three-stage decommissioning process is under way to safely dismantle the plant and eventually return the site to its original 'green field' state. Stage 1 of this process is well advanced. To set the scene, and for general interest, this paper first provides some background to the development of the decommissioning strategy and a brief summary of the progress to date. Recognising the specific interest of the reader, the paper then focuses on the radiological aspects of the work carried out, specifically the hazards, the risk assessment process and the ALARP performance. Finally, and in some detail, the paper reports on the important lessons learnt and discusses one of the issues arising.
Asunto(s)
Centrales Eléctricas/organización & administración , Protección Radiológica , Descontaminación , Inglaterra , Humanos , Residuos Radiactivos , Medición de Riesgo , SeguridadRESUMEN
Partial cDNA sequencing was used to obtain 169 expressed sequence tags (ESTs) in the moss, Physcomitrella patens. The source of ESTs was a random cDNA library constructed from 7 day-old protonemata following treatment with 10(-4) M abscisic acid (ABA). Analysis of the ESTs identified 69% with homology to known sequences, 61% of which had significant homology to sequences of plant origin. More importantly, at least 11 ESTs had significant similarities to genes which are implicated in plant stress-responses, including responses which may involve ABA. These included a cDNA associated with desiccation tolerance, two heat shock protein genes, one cold acclimation protein cDNA and five others that may be involved in either oxidative or chemical stress or both, i.e., Zn/Cu-superoxide dismutase, NADPH protochlorophyllide oxidoreductase (PorB), selenium binding protein, glutathione peroxidase and glutathione S transferase. Analysis of codon usage between P. patens and seed plants indicated that although mosses and higher plants are to a large extent similar, minor variations also exists that may represent the distinctiveness of each group.
Asunto(s)
Bryopsida/genética , Etiquetas de Secuencia Expresada , Genes de Plantas , Ácido Abscísico/farmacología , Codón/genética , ADN Complementario/genética , ADN de Plantas/genética , Biblioteca de Genes , Datos de Secuencia Molecular , ARN Mensajero/genética , ARN de Planta/genéticaAsunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Adulto , Recuento de Linfocito CD4 , Quimioprevención , Protocolos Clínicos , Toma de Decisiones , Farmacorresistencia Microbiana , Quimioterapia Combinada , VIH/genética , VIH/crecimiento & desarrollo , Infecciones por VIH/transmisión , Infecciones por VIH/virología , Inhibidores de la Proteasa del VIH/uso terapéutico , Humanos , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Planificación de Atención al Paciente , ARN Viral/análisis , Inhibidores de la Transcriptasa Inversa/uso terapéutico , Carga Viral , Viremia/virología , Replicación Viral/efectos de los fármacos , Zidovudina/uso terapéuticoRESUMEN
BACKGROUND: Interleukin-2 is a cytokine that regulates the proliferation and differentiation of lymphocytes. In preliminary studies, intermittent infusions of interleukin-2 led to increases in CD4 counts in patients with human immunodeficiency virus (HIV) infection and more than 200 CD4 cells per cubic millimeter. We conducted a controlled study to evaluate the long-term effects of such therapy on both CD4 counts and the viral burden. METHODS: Sixty HIV-infected patients with base-line CD4 counts above 200 cells per cubic millimeter were randomly assigned to receive either interleukin-2 plus antiretroviral therapy (31 patients, 1 of whom was lost to follow-up) or antiretroviral therapy alone (29 patients). Interleukin-2 was administered every two months for six cycles of five days each, starting at a dosage of 18 million i.u. per day. Safety and immunologic and virologic measures were monitored monthly until four months after the last treatment cycle. RESULTS: In patients treated with interleukin-2, the mean (+/-SE) CD4 count increased from 428 +/- 25 cells per cubic millimeter at base line to 916 +/- 128 at month 12, whereas in the control group, the mean CD4 count decreased from 406 +/- 29 cells per cubic millimeter to 349 +/- 41 (P < 0.001). There were no significant differences between the groups in serial measurements of the plasma HIV RNA or p24 antigen concentration during the 12 months of treatment. Constitutional symptoms (fever, malaise, and fatigue) and asymptomatic hyperbilirubinemia were the chief dose-limiting toxic effects of interleukin-2 therapy. CONCLUSIONS: In patients with HIV infection and base-line CD4 counts above 200 cells per cubic millimeter, intermittent infusions of interleukin-2 produced substantial and sustained increases in CD4 counts with no associated increase in plasma HIV RNA levels.
Asunto(s)
Infecciones por VIH/terapia , Interleucina-2/uso terapéutico , Infecciones Oportunistas Relacionadas con el SIDA/mortalidad , Adulto , Fármacos Anti-VIH/uso terapéutico , Recuento de Linfocito CD4 , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , VIH/genética , VIH/aislamiento & purificación , Proteína p24 del Núcleo del VIH/sangre , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/inmunología , Humanos , Masculino , Persona de Mediana Edad , ARN Viral/sangre , Resultado del Tratamiento , Carga ViralRESUMEN
Tumor necrosis factor-alpha (TNF-alpha), a proinflammatory cytokine known to stimulate human immunodeficiency virus type 1 (HIV-1) replication, has been implicated in the pathogenesis of HIV-1 infection. Inhibition of TNF-alpha by a chimeric humanized monoclonal antibody, cA2, was investigated in 6 HIV-1-infected patients with CD4 cell counts < 200/mm3. Two consecutive infusions of 10 mg/kg 14 days apart were well tolerated, and a prolonged serum half-life for cA2 (mean, 257 +/- 70 h) was demonstrated. Serum immunoreactive TNF-alpha concentrations fell from a mean prestudy value of 6.4 pg/mL (range, 4.2-7.9) to 1.1 pg/mL (range, 0.5-2.2) 24 h after the first infusion and returned to baseline within 7-14 days. A similar response was seen after the second infusion. No consistent changes in CD4 cell counts or plasma HIV RNA levels were observed over 42 days. Future studies evaluating the therapeutic utility of long-term TNF-alpha suppression using anti-TNF-alpha antibodies are feasible and warranted.
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Síndrome de Inmunodeficiencia Adquirida/inmunología , Anticuerpos Monoclonales/uso terapéutico , Anticuerpos/uso terapéutico , VIH-1 , Proteínas Recombinantes de Fusión/uso terapéutico , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Síndrome de Inmunodeficiencia Adquirida/sangre , Adulto , Animales , Femenino , Humanos , Masculino , Ratones , Proteínas Recombinantes de Fusión/farmacocinética , Proteínas Recombinantes/farmacocinética , Proteínas Recombinantes/uso terapéutico , Factor de Necrosis Tumoral alfa/inmunologíaAsunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Fármacos Anti-VIH/administración & dosificación , Ensayos Clínicos como Asunto , Didanosina/administración & dosificación , Didanosina/uso terapéutico , Quimioterapia Combinada , Inhibidores de la Proteasa del VIH/uso terapéutico , Humanos , Lamivudine/administración & dosificación , Lamivudine/uso terapéutico , Metaanálisis como Asunto , Inhibidores de la Transcriptasa Inversa/administración & dosificación , Inhibidores de la Transcriptasa Inversa/uso terapéutico , Estavudina/administración & dosificación , Estavudina/uso terapéutico , Zalcitabina/administración & dosificación , Zalcitabina/uso terapéutico , Zidovudina/administración & dosificación , Zidovudina/uso terapéuticoRESUMEN
Cidofovir (HPMPC; (S)-1-[3-hydroxy-2-(phosphonylmethoxy)propyl]cytosine) is a nucleotide analog with activity against human cytomegalovirus (CMV). A phase I/II dose escalation trial was conducted with asymptomatic human immunodeficiency virus (HIV)-infected patients with CMV viruria to determine its pharmacokinetics, maximally tolerated dose, and preliminary antiviral activity against CMV. Qualitative CMV blood and urine cultures were monitored weekly to assess anti-CMV activity. Twenty-one HIV-infected persons with CD4 counts from 0 to 389 cells per microliters (median, 39) were enrolled in six dose-ranging groups. The first five groups enrolled four patients each to receive cidofovir infusions either weekly or biweekly for 4 weeks or every 3 weeks for 12 weeks. The sixth group enrolled one patient who received infusions of 5 mg/kg of body weight every other week. Patients receiving 0.5 or 1.5 mg/kg twice weekly experienced no serious toxicity. The first two patients who received 5 mg/kg twice weekly developed glycosuria and 2+ proteinuria. Subsequent patients received concomitant probenecid to attempt to ameliorate renal toxicity. Seventeen patients experienced proteinuria on one or more occasions; 6 of them experienced at least 2+ proteinuria. Four patients did not complete the study as planned because of renal toxicity. Positive CMV urine cultures reverted to negative in 2 of 8 patients receiving doses of < or = 1.5 mg/kg twice weekly and 11 of 13 patients receiving higher doses. Cidofovir has in vivo anti-CMV activity demonstrated by prolonged clearing of CMV viruria, although this observation is tempered by the fact that clearance of viremia could not be demonstrated. The dose-limiting toxicity is renal; however, concurrent administration of probenecid may be protective. The maximally tolerated weekly intravenous dose with probenecid is approximately 5 mg/kg. Efficacy trials with CMV disease will define the therapeutic utility and optimal dosing interval for cidofovir.
Asunto(s)
Antivirales/uso terapéutico , Infecciones por Citomegalovirus/tratamiento farmacológico , Citosina/análogos & derivados , Infecciones por VIH/tratamiento farmacológico , Organofosfonatos , Compuestos Organofosforados/uso terapéutico , Adulto , Cidofovir , Citosina/farmacocinética , Citosina/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Compuestos Organofosforados/farmacocinética , Orina/microbiologíaRESUMEN
OBJECTIVE: This study reports the clinical and radiologic findings in seven patients infected with HIV who had 10 consecutive episodes of symptomatic cholecystopathy induced by infusion of interleukin-2. SUBJECTS AND METHODS: Ten episodes of right upper quadrant pain associated with gallbladder wall thickening were seen in seven of 29 HIV-infected patients who received IV interleukin-2. Patients received 6-18 million IU/day of continuous interleukin-2 infusion for 5 days. Patients with right upper quadrant pain underwent sonographic examinations, which were interpreted prospectively. Medical records and previous sonographic studies were reviewed retrospectively. Follow-up was obtained through outpatient visits and sonography. RESULTS: Right upper quadrant pain during these 10 episodes of cholecystopathy usually developed 4-5 days after starting infusion of interleukin-2. Sonography during that time showed gallbladder wall thickening (mean thickness, 12.4 mm; range, 5-18 mm) and a wide variety of sonographic appearances. Tenderness during sonography was focal in six episodes, diffuse in one, and absent in three. Sludge was identified in one episode; calculi were not seen. Findings on radionuclide biliary scans were normal in three cases. Symptoms abated rapidly in every case after infusion of interleukin-2 was reduced or stopped. No surgery was necessary. When treatment was repeated, three patients had recurrent episodes, with clinical courses and sonographic aberrations showing little variance from the initial episodes. Follow-up sonography in three episodes showed a maximal thickness of the gallbladder wall of 4 mm. No patient had a history or laboratory evidence of intrinsic biliary disease. CONCLUSION: Symptomatic thickening of the gallbladder wall during infusion of interleukin-2 can exactly mimic other forms of acalculous cholecystitis, except that when associated with interleukin-2 the thickening is rapidly reversible and surgery is not required. Radionuclide scans can be useful in clinical decision making. The process appears to be benign, and cessation of interleukin-2 therapy, along with close clinical observation, appears to be the appropriate treatment.