Impact of the Coronavirus Disease 2019 Outbreak on Activity and Exercise Levels among Older Patients.

OBJECTIVES: This study aimed to clarify the impact of the coronavirus disease 2019 outbreak on the levels of activity among older patients with frailty or underlying diseases. A total of 175 patients (79.0±7.0 years) undergoing outpatient or home-based rehabilitation, stratified into groups, based on frailty status. The percentage of patients who went out at least once a week decreased after the outbreak from 91% to 87%, from 65% to 46%, and from 47% to 36% in the non-frail, frail, and nursing care requirement groups, respectively. The proportion of older patients participating in exercise during the outbreak was 75%, 51%, and 41% in the non-frail, frail, and nursing care requirement groups, respectively. The proportion of older patients participating in voluntary exercise after instruction was lowest in the frail group (35%). Older patients with frailty are susceptible to the negative effects of refraining from physical activity and require careful management.

Pneumocystis carinii pneumonia in HIV/AIDS patients at an urban district hospital in Kenya.

BACKGROUND: Pneumocystis carinii pneumonia has generally been regarded to be an uncommon opportunistic infection in HIV infected individuals in sub-Saharan Africa. The reason for this has not been clear but postulates included a lack of suitable pathogenic types in the African environment, diagnostic difficulties and the more commonly held belief that African HIV infected individuals were dying early from common non-opportunistic pathogens before severe degrees of immunosuppression occured. Recently a trend has emerged at the Mbagathi district hospital whereby an increasing number of HIV infected patients are empirically treated for Pneumocystis carinii pneumonia (PCP) based on clinical and radiological features. OBJECTIVE: To determine the prevalence of PCP and clinical outcomes of HIV infected patients presenting at the Mbagathi District Hospital, Nairobi with the presumptive diagnosis of PCP. SETTING: Mbagathi District Hospital, a 169-bed public hospital in Nairobi, Kenya. METHODS: Patients presenting with a sub-acute onset of cough and dyspnoea were eligible for the study if they were found to have bilateral pulmonary shadows and had negative sputum smears for AFBS. Consenting patients who had no contraindication to fiberoptic bronchoscopy had a clinical evaluation which was followed with a fiberoptic bronchoscopy procedure where bronchoalveolar lavage fluid (BALF) was obtained. BALF was examined for cysts of P. carinii using toluidine blue stain and immunofluorescent antibody test (IFAT). BALF was also processed for fungi, bacteria and mycobacteria using routine procedures. Standard treatment with high dose cotrimoxazole was offered to all patients who were then followed up until discharge from hospital or death whichever came first. RESULTS: Between June 1999 and August 2000 a total of 63 patients were referred for bronchoscopy. Of these four declined to undergo the fiberoptic bronchoscopy procedure, four died before the procedure could be done, one was judged too sick to undergo the procedure and three had been on cotrimoxazole for longer than five days. Thus 51 patients underwent bronchoscopy. Pneumocystis carinii stain was positive in 19 (37.2%) while death occured in 16 (31.4%) of the 51 patients. There were more deaths in those without PCP but this difference was not statistically significant (odds ratio 0.68 (95% CI 0.35-1.32; P=0.2). CONCLUSION: PCP was found to be common in HIV infected patients presenting with clinical and radiological features of the disease. The mortality rate for patients with a presumptive diagnosis of PCP is high. This study suggests that cotrimoxazole preventive therapy may be a useful intervention in symptomatic HIV infected patients in Kenya for the prevention of PCP and may avert deaths from this disease.

[Three dimensional culture of human salivary gland using irradiated collagen gel embedding technique].

Embedding culture was performed on normal salivary gland cells from five subjects using 0.2% irradiated collagen gel. Collagen was collected from rat tail tendon and gelatinized at the final concentration of 0.2%. D-MEM added BSA (5mg/ml), insulin (10 micrograms/ml) and EGF (5 micrograms/ml) was used as a serum-free medium. Within the collagen gel, the cells were found to grow in a branch-like pattern, and then to form a lot of radial duct-like structures containing alcian blue positive secretions. Immunohistochemical observation of myoepithelial cells with monoclonal antibody from human mammalian cancer suggested that these cells play an important role in the process of glandular ducts formation. Salivary gland cells being able to grow in collagen gel in a very similar fashion to in-vivo condition, the present collagen gel embedding culture is useful for morphological or functional studies on salivary gland cells.

Morphological study of normal and tumor cells in the head and neck region using irradiated collagen gel embedding technique: morphological study using collagen gel.

Fourteen specimens of normal, benign, or malignant tumor cells from the head and neck region were subjected for culture using 0.2% of irradiated collagen gel embedding technique. Re-differentiation of glands within the gel in serum-free medium was observed. There were marked differences in the growth patterns within the gel between normal or benign and malignant cells. Four normal glands and 5 out of 6 benign tumors showed branch-like growth patterns. On the other hand, malignant tumors showed no branch-like pattern, or could not grow at all. The results showed that the collagen gel technique could be useful for the differential diagnosis of malignancy in head and neck tumors.