Early predictors of in-hospital mortality for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome.

One hundred forty-five patients were initially seen with Pneumocystis carinii pneumonia (PCP). Of the many features examined, several variables were identified early in the hospitalization for PCP that were associated with poor survival. These included multiple admissions, leukocytoses, elevated serum lactate dehydrogenase levels, decreased arterial oxygen pressure (tension), decreased arterial carbon dioxide pressure (tension), and decreased serum albumin levels. Variables that were associated with increased survival included normal respiratory rates and normal findings on lung examination. Patients with multiple pulmonary infections displayed higher mortality rates than patients who had only PCP. Finally, our data did not suggest that the degree of immunosuppression affected in-hospital mortality for PCP.

Further observations on tuberculin reactions in active tuberculosis.

One hundred patients with active tuberculosis were tested for tuberculin reactivity within 24 hours of their admission to the hospital. Commercial intermediate tuberculin, Tween stabilized intermediate tuberculin and the Tine test as well as a mumps antigen were applied simultaneously. False negative reactions were obtained in 28 per cent with Tine testing and in 21 per cent with Tween stabilized as well as plain tuberculin. These nonreactors were clinically identifiable as seriously ill with manifestations primarily attributable to protein depletion as a result of their illness. This is not specifically related to the effects of tuberculosis itself, but can be demonstrated in patients suffering the same sequelae of other debilitating illness. After two weeks of protein supplementation via a high calorie, high protein, hospital diet, skin reactivity was restored in the vast majority of these nonreactors. It is concluded that the lack of tuberculin reactivity on hospital admission probably results from impaired lymphocyte function in patients suffering serious protein depletion as a result of their illness; it is not attributable to deficiencies in the tuberculin test itself.

The spectrum of tuberculosis in a New York City men's shelter clinic (1982-1988)

The objective of this study was to determine the prevalence of tuberculous infection and the incidence of active tuberculosis in homeless men attending a shelter-based clinic and to examine risk factors for acquisition of infection and development of active disease. The design was a prospective cross-sectional survey. Men were evaluated by standardized interviews using a questionnaire. Where indicated, skin testing with PPD, collection of sputum for smear and culture for acid-fast bacilli, and chest x-ray films were performed. The setting was an on-site clinic at a men's shelter in New York City. The patients were men attending the clinic for physical examinations for the work program or requesting evaluation of various medical problems. A total of 1,853 men were evaluated over a 73-month period. The overall rate of infection was 42.8 percent, including 27.0 percent with a positive PPD test, 9.8 percent with a history of a positive PPD test, and 6.0 percent with active tuberculosis. Increasing age, length of stay in the shelter system, black race, and intravenous drug use were found to be independently associated with tuberculous infection. Age, length of stay in the shelter system, and intravenous drug use were independently associated with active tuberculosis. We achieved a compliance rate of 36 percent completing treatment and 13 percent receiving treatment at the conclusion of the study.

A computer-assisted instruction course in the diagnosis and treatment of respiratory diseases.

A computer-assisted simulation of the 'chart method' of teaching has been developed and was used to provide instruction in clinical decision-making in the diagonosis and treatment of pulmonary diseases. The course requires a student to reach and to defend a diagonisis and to provide appropriate treatment for each of 10 simulated cases. Evaluation of performance and immediate feedback and correction of errors of commission and ommission are an integral part of the course. The course provides a model for development of additional programs in other subject areas.