Immediate nasal prosthetic rehabilitation following cytomegalovirus erosion: a clinical report.

The immediate prosthetic rehabilitation of a patient with erosive cutaneous cytomegalovirus (CMV) is presented. Although CMV is a major cause of morbidity and mortality in immunocompromised patients, skin lesions are rarely discussed in the literature. Recognition of the susceptibility of medically compromised patients to infections that can cause extraoral and intraoral deformity is essential to prevention, early diagnosis, and prompt intervention of a life-threatening destructive debilitation. A method for rapidly fabricating a nasal prosthesis is described, and the importance of prompt esthetic and psychological rehabilitation is reviewed.

[HIV and drug users: current trends]. / HIV-therapie und Drogensubstitution am besten aus einer Hand. Therapiebesonderheiten bei Drogenabhängigen.

Despite an extensive addiction treatment and rehabilitation system for heroin addicts, inadequate infectious disease care still prevails for this group of patients. The reasons are structural in nature since both of the required medical disciplines (addiction medicine and infectious diseases epidemiology) are rarely found at one treatment location. Appropriate interdisciplinary cooperation must first be established. In a specialized heroin addiction treatment setting, patient compliance isjust as good as in other risk groups. Prerequisites for this good compliance are: Elimination of social and psychiatric disruptive factors, the selection of a medication regimen that takes secondary diseases and concomitant medication into consideration and the employment of once-daily treatment regimens or simple regimens with twice-daily dosages.

Development of housing programs to aid in the treatment of tuberculosis in homeless individuals: a pilot study.

STUDY OBJECTIVES: To describe our experience with novel supervised housing programs developed to aid in the treatment of tuberculosis (TB) in homeless individuals, including a preliminary analysis of their effectiveness and estimate of potential cost savings. DESIGN: Retrospective chart review. SETTING: A county TB control program. METHODS: The San Diego County TB Control Program's computer database was used to identify homeless individuals placed in one of two supervised housing programs for treatment of TB [Young Men's Christian Association (YMCA), for noninfectious patients, or Bissell House, for infectious patients]. Charts for all these patients were reviewed and information regarding their demographics, underlying medical conditions, therapy, microbiologic markers of response to therapy, hospitalizations, and participation in supervised housing programs was recorded. MEASUREMENTS AND RESULTS: The sputum culture conversion and treatment completion rates for those housed in the YMCA were 100 and 84.6%, respectively. Of the patients in the Bissell House program, 100% had converted their smear and culture. In addition, all patients in this program completed an adequate course of supervised therapy. These rates of microbiologic conversion and treatment completion compare favorably with historical data from San Diego County and other locations. Estimated cost savings for placing medically stable infectious patients in the Bissell House for respiratory isolation and supervised treatment were estimated to be $27,034 per patient. CONCLUSIONS: Use of supervised housing to aid in treatment of TB in the homeless appears to be effective and results in substantial cost savings. A larger multicenter study should be considered to confirm these findings and better quantify the cost-effectiveness of such programs.

Pediatric HIV: evaluation, management, and rehabilitation.

AIDS: The evaluation and treatment of HIV in children are explored, including the effects of HIV infection on puberty and the central nervous system of adolescents, effects on the nutritional status of infected children, and the rehabilitation and therapeutic interventions that can be used. Several tables highlight management of HIV-infected children, the clinical manifestations of HIV-related encephalopathy in children, and the goals of rehabilitation in HIV-infected children. The Pediatric HIV Working Group of the National Cancer Institute uses an interdisciplinary approach to meet the medical, emotional, and psychosocial needs of these children and their families. Patients are encouraged to give form to their psychological experiences through play, writing, telling stories, and creating works of art.^ieng

Combined somatic and psychiatric care--effects on personnel treating drug addicts with infectious diseases.

Infectious disease care, psychiatric care of drug addicts, and social care were combined in a ward for drug addicts with infectious diseases. The aim of this study was to evaluate the effects on the personnel (n = 22). One ward with infectious disease care of HIV and AIDS patients (n = 24) and another with nonsomatic care of drug addicts (n = 18) were selected to make comparisons possible. The questionnaire concerned psychosocial work environment and health. The personnel at the new ward also participated in a semistructured interview. The personnel at the special ward experienced a significantly higher degree of emotional exhaustion and lack of ability to concentrate than the comparison groups. They also reported a higher degree of lack of clarity, more job strain, and more difficulties due to demands from patients. The combined care is probably associated with heavier psychological burdens than other forms of care. In spite of this, the personnel experienced their work as meaningful and mentally stimulating.

Transtibial prosthesis for a patient with Kaposi's sarcoma lesions on the residual limb.

A man with acquired immunodeficiency syndrome (AIDS) and widespread Kaposi's sarcoma (KS) presented with a transtibial amputation secondary to foot infection and intractable pain. Several open and draining KS lesions were present on the residual limb. There were two concerns: (1) prescribing a prosthesis to a person who likely had a limited future as a prosthetic user; and (2) how the lesions would tolerate pressure and shear forces in a prosthesis. There have been no previous reports of KS lesions of residual limbs. We prescribed a patellartendon-bearing prosthesis with supracondylar suspension. The lesions did not worsen with weight-bearing, and healed with concomitant treatment. The patient remains a functional ambulator 1 year after amputation. This case suggests that KS lesions can tolerate pressure and shear forces, which is important in considering prosthetic prescriptions as well as prescriptions of orthoses and other devices.

Infecciones en el Niño con Síndrome de Inmunodeficiencia Adquirida / Infection in Children with Acquired Immunodeficiency Syndrome

Similar a lo que ocurre en el adulto, el niño con Síndrome de Inmunodeficiencia Adquirida (SIDA) presenta compromiso de inmunidad celular que lo coloca en riesgo para presentar infecciones por gérmenes oportunistas tipo Pneumocystis carinii, pero a diferencia con el paciente adulto, el niño con SIDA presenta en forma temprana compromiso de la inmunidad humoral, por lo que puede presentar infecciones bacterianas a repetición (sinusitis, otitis media, bronconeumonías) generalmente por los mismos gérmenes que comprometen a los niños inmunocompetentes. Las infecciones por Micobacterias están aumentando su frecuencia en niños con infección por el Virus de la Inmunodeficiencia Humana (VIH), especialmente tuberculosis pulmonar en niños que viven en comunidades donde existe alta incidencia de SIDA y tuberculosis. La infección protozoaria más común y grave es la producida por P. carinii, cuya manifestación cardinal es la neumonía. Toxoplasma gondii produce infecciones en el sistema nervioso central, aunque con menor frecuencia que la producida en adultos. Los pacientes infectados con VIH están sujetos también a padecer múltiples alteraciones de su sistema digestivo; el VIH distorsiona el proceso normal de nutrición predisponiendo a un sinnúmero de infecciones entéricas

Toxoplasmic encephalitis in the AIDS patient.

Toxoplasmic encephalitis is recognized as a major cause of opportunistic infection of the central nervous system in patients with acquired immune deficiency syndrome (AIDS). Often this protozoal infection is benign, but in the AIDS patient it can cause life-threatening complications. Usually, toxoplasmic encephalitis is a latent infection activated in the brain in some 5% to 15% of AIDS patients. Treatment with oral antibiotics is effective, but relapse is common, and there may be permanent brain tissue damage with resultant neurological deficits. This article acquaints the rehabilitation nurse with the diagnosis and acute nursing care of toxoplasmic encephalitis. Rehabilitation nurses need to know about this chronic condition because rehabilitation is key to its successful long-term care and management.