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Biomedical subjects

A Malin

Publications and source records attributed to A Malin.

16 recordsLinked to original sources
PubMed2000

Double blind randomised placebo controlled trial of adjunctive prednisolone in the treatment of effusive tuberculous pericarditis in HIV seropositive patients.

OBJECTIVE: To determine the effect of adjunctive prednisolone on morbidity, pericardial fluid resolution, and mortality in HIV seropositive patients with effusive tuberculous pericarditis. DESIGN: Double blind randomised placebo controlled trial. SETTING: Two medical school affiliated referral hospitals in Harare, Zimbabwe. PATIENTS: 58 HIV seropositive patients aged 18-55 years with tuberculous pericarditis. INTERVENTIONS: All patients received standard short course antituberculous chemotherapy and were randomly assigned to receive prednisolone or placebo for six weeks. MAIN OUTCOME MEASURES: Clinical improvement, echocardiographic and radiologic pericardial fluid resolution, and death. RESULTS: 29 patients were assigned to prednisolone and 29 to placebo. After 18 months of follow up there were five deaths in the prednisolone treated group and 10 deaths in the placebo group. Mortality was significantly lower in the prednisolone group (log rank chi(2) = 8. 19, df = 1, p = 0.004). Resolution of raised jugular venous pressure (p = 0.017), hepatomegaly (p = 0.007), and ascites (p = 0.015), and improvement in physical activity (p = 0.02), were significantly more rapid in the prednisolone treated patients. However, there was no difference in the rate of radiologic and echocardiographic resolution of pericardial effusion. CONCLUSIONS: Adjunctive prednisolone for effusive tuberculous pericarditis produced a pronounced reduction in mortality. It is suggested prednisolone should be added to standard short course chemotherapy to treat HIV related effusive tuberculous pericarditis.

AIDS-Related Opportunistic Infections↗
PubMed1996

Can and should level II nurseries care for newborns who require mechanical ventilation?

Perinatal regionalization was conceived roughly 25 years ago to provide centralized care for critically ill newborn infants. As for many 25-year-old concepts, the obligatory centripetal design of many regionalization policies may need to be modified. This article presents the outcomes of 408 surviving patients who required mechanical ventilation (136 born in one community hospital and 272 birthweight-matched infants born in our tertiary center), and were cared for in our perinatal network. Mechanical ventilation of a resident population of newborns at a community NICU appeared to be as effective as ventilatory care at a regionalized tertiary neonatal intensive care unit, when assessed by comparing birthweight-matched populations for length of hospital stay, days on ventilator, and the need for home O2. Some may still claim that every baby who requires mechanical ventilation must be transferred to a tertiary care center. In an era of heightened interest in health services, health outcomes, and cost-effectiveness analysis, however, the authors believe that such claims will be subjected to increasing scrutiny. Our study represents a first attempt at determining the shape such scrutiny might take, and the sort of data analyses that may be required to reformat a perinatal network.

Humans↗
PubMed1993

A self-psychological approach to the analysis of resistance: a case report.

This paper attempts to explore the understanding of resistance from a self-psychological perspective through presenting a case report. This view is contrasted to the traditional psychoanalytic model which assumes that whatever impedes the analysis is a resistance, and construes such resistance in terms of the drive-defence model. The motivation for this blockade of the analysis is the protection of the ego from anxiety. By contrast, a self-psychological model suggests that 'so called defence-resistances' (Kohut, 1984, p. 141) are required for the protection of the weakened self. There is no blockade of the analytic process; rather, the 'resistance' safeguards the self so that the analysis may continue. The motivation for 'resistance' is to protect the self so that it will be ready to resume development when a safe, attuned selfobject environment is available. In the case presented the patient beseeched the analyst to refrain from speaking. The analyst's dilemma is discussed and the resolution of the resistance is described.

Adult↗
PubMed1992

Fusobacterium nucleatum bacteraemia with multiple liver abscesses in an HIV-I antibody positive man with IgG2 deficiency.

Liver abscess formation due to Fusobacterium nucleatum is rare. We describe an HIV-I antibody positive man, with normal surrogate markers of cell-mediated immunity, who presented with F. nucleatum bacteraemia and liver abscess formation. He was found to have IgG2 subclass deficiency. This case illustrates the clinical importance of altered B-cell function in patients who are at an early stage of HIV disease.

Adult↗
PubMed1992

HIV infection among heterosexual travellers attending the Hospital for Tropical Diseases, London.

OBJECTIVE: To determine the prevalence of HIV infection in travellers attending the Hospital for Tropical Diseases, London, and to assess correlates and behavioural risk factors for infection. DESIGN: All patients tested for HIV infection during a 28-month period were included. Information was obtained from clinical records and standardised serological request forms. SETTING: Hospital for Tropical Diseases, London, UK. SUBJECTS: 298 patients (in-patient and out-patient) were tested. RESULTS: 258 of those tested were exclusively heterosexual and not injecting drug users. 5.4% of these were HIV-1 antibody positive. Rates in those originating from the UK and those from outside the UK were 1.8% and 33.2% respectively. Most non-UK citizens were symptomatic when tested; UK citizens were generally tested as part of a routine screening, therefore the two groups are not comparable. Rates of risk behaviour were high in both groups. CONCLUSION: The rate of HIV infection in heterosexual travellers was 5.4%. Amongst UK citizens the rate was 1.8%. All travellers should be made aware of the potential risk of acquiring HIV infection through sexual contact.

Emigration and Immigration↗
PubMed1992

A health shop to meet public needs. A health visiting service in the market place.

People who have the greatest need for health information are often reluctant to seek it out. A 'health shop' was set up in a busy town market to help bring health education to the heart of the community. It resulted in an increased uptake of community services and helped boost the health visiting profile.

Community Health Nursing↗
PubMed1991

Sputum induction for the diagnosis of pulmonary disease in HIV positive patients.

We prospectively compared sputum induction with bronchoalveolar lavage (BAL) in HIV positive patients presenting with acute respiratory episodes and also assessed the effects of using an experienced respiratory physiotherapist on the diagnostic yield from induced sputum. One hundred and fifty-one consecutive patients underwent sputum induction, in 96 the procedure was supervised by nursing and medical staff with no specific expertise (group I); in 55 patients a physiotherapist supervised sputum induction (group 2). Nine patients refused BAL having undergone sputum induction. Of the remaining 142 patients sputum induction failed (no sample expectorated) in 28 patients (25 from group 1 and three from group 2), the sample was inadequate (the material expectorated was not from the lower respiratory tract) in 29, and was adequate in 85 patients. Pneumocystis carinii was diagnosed in 82 patients (51 from group 1 and 31 from group 2). The sensitivity of induced sputum for the diagnosis of P. carinii was 13% and of BAL was 77%. In the subgroup of patients with an adequate induced sputum sample, the sensitivity of induced sputum was 28% and of BAL was 73%. Of the remaining 60 patients, 27 had other diagnoses made by induced sputum and BAL (eight patients), BAL only (15 patients) and induced sputum only (four patients). Eleven patients had bronchitis and responded to oral antibiotics. In 22 patients induced sputum and BAL were negative; alternative diagnoses were established by lung biopsy or by culture of blood, urine or CSF. During sputum induction, 15 patients had nausea and vomiting, eight became dyspnoeic, three had intractable cough and one developed acute bronchoconstriction; 17 patients found the procedure unpleasant. Compared with BAL, induced sputum has a lower diagnostic yield for P. carinii and other pathogens. Use of experienced, dedicated personnel increases the number of successful attempts at sputum induction but does not increase the diagnostic yield. Fibreoptic bronchoscopy and bronchoalveolar lavage remain necessary for patients with negative results from induced sputum and those whose disease course is at variance with the diagnosis made by sputum induction.

Acquired Immunodeficiency Syndrome↗
PubMed1990

NADP+ reduction by human lymphocytes.

The hexose monophosphate shunt (HMPS) is known to be responsible for the reduction of NADP+ by lymphocytes. We tried to find other enzymatic systems that might provide the lymphocytes with NADPH. By measuring the absorbance at 340 nm we noted that the addition of NADP+ to a preparation of disrupted lymphocytes resulted in the formation of NADPH at a rate of 4 nmol/10(6) cells per min. This phenomenon could not be changed by negative feedback inhibition of HMPS, and could not be attributed to the low concentration of glucose, glucose-6-phosphate (G-6-P) and isocitrate found in the cell preparation (NADP(+)-dependent isocitrate dehydrogenase in addition to HMPS NADP+ reducing enzymes was found to be present in lymphocytes). Because of the activity of a NADP(+)-dependent lactate dehydrogenase, pyruvate oxidized the NADPH as it was being formed. Here we demonstrate the presence of an unknown NADP+ reducer in lymphocytes which seems to play an additional role to HMPS in NADP+ reduction by lymphocytes. NADP(+)-dependent lactate dehydrogenase may play a role in regulating the NADP+/NADPH ratio.

Humans↗