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D Podzamczer Palter

Publications and source records attributed to D Podzamczer Palter.

7 recordsLinked to original sources
PubMed1998

[Estimating the costs of health care for patients infected with the human immunodeficiency virus in a university hospital in Catalonia].

BACKGROUND: To estimate the use of resources and costs of health care to patients infected with the human immunodeficiency virus (HIV). METHODS: Prospective study in university hospital in Catalonia including 166 patients. AIDS was defined following 1987 criteria of the Centers for Disease Control. AIDS phase was divided into three grades according to the evolutive course: AIDS grade I, II and III. Resources/costs were calculated in function of the degree of disease, transmission mode and demographic variants. RESULTS: The mean cost per patient/year (PY) was 1,571,900 pesetas, ranging from 88,700 for the asymptomatic phase and 2,561,000 per AIDS phase. Within the AIDS phase costs ranged from 1,593,317 for AIDS grade I to 4,903,183 for grade III. This increase was due to differences in hospitalization days for PY (up to 12.4 days in pre-AIDS phases, 45.8 for AIDS phase I and 119.4 for AIDS phase III) and days in day-hospital per PY (38.1 days for AIDS grade III). Parenteral drug abusers (PDA) had a PY cost 42% lower than that corresponding to sexually infected patients. CONCLUSIONS: Health care costs per PY of HIV infected patients increase with disease progression, which relates to the increase in hospitalization days and day-hospital hospitalization that occurs in the advanced phases of the disease. Our results suggest that health care to PDA is cheaper than that for sexually infected patients.

Acquired Immunodeficiency Syndrome↗
PubMed1998

[Cerebral toxoplasmosis].

Toxoplasmic encephalitis is associated with high mortality and morbidity and still presents a notable incidence in our setting. Neither the clinical symptoms nor radiological features are diagnostic of this disease; however, because of its frequency and clinical importance, specific treatment is begun whenever toxoplasmosis is suspected. In patients with negative serology, or who are receiving adequate prophylaxis, or who do not respond to 2 weeks of treatment, or who present radiological lesions suggestive of another illness, diagnosis should not be delayed, and brain biopsy should be considered as soon as possible. In these cases, SPECT with 201TI (sensitivity and specificity over 90-95% for lymphoma) and/or the PCR technique to detect T. gondii (sensitivity 50-65% and specificity 95-100%) or Epstein-Barr virus (sensitivity 70-80% and specificity 95% for lymphoma) can be very useful. The treatment of choice is pyrimethamine (100 mg the first day followed by 50 mg/day) and sulphadiazine (1-1.5 g/6 h) during 6-8 weeks. If the patient is allergic to sulfadiazine and cannot be desensitized the regimen of choice is pyrimethamine and clindamycin (600 mg/6 h), with similar efficacy. Clinical experience with other therapeutic alternatives is limited. Pyrimethamine can be associated with clarithromycin (0.5-1 g/12 h), azithromycin (1-1.5 g/day) atovaquone (750 mg/6 h), dapsone (100 mg/day) or doxycyclin (200 mg/12 h). Cotrimoxazole or clindamycin can be administered intravenously to patients who cannot receive enteral treatment. The toxicity of these therapeutic regimens is significant and treatment has to be suspended in 10-40% of cases. The interactions that can be produced with other drugs used to treat HIV-infected patients are generally of little clinical relevance.

AIDS-Related Opportunistic Infections↗
PubMed1996

[The spectrum of bronchopulmonary infection caused by Pseudomonas aeruginosa in patients infected with the human immunodeficiency virus].

OBJECTIVE: To describe the clinical spectrum of bronchopulmonary infections caused by Pseudomonas aeruginosa in patients infected with HIV. METHODS: A retrospective study of cases with P. aeruginosa pneumonia and tracheo-bronchitis in patients infected with HIV, diagnosed over a 5-year period (January 1990-December 1994) in a third level university hospital. RESULTS: Seven patients with pneumonia and 15 with tracheobronchitis were identified, with a mean age of 33 years. All patients were in an advanced stage of immunosuppression (median CD4 count 11/mm3) and 21 (95%) had AIDS. In 6 cases (86%) pneumonia was acquired in the community and no patient had severe neutropenia. Clinical presentation ranged from severe pneumonia with respiratory insufficiency and shock to subacute less severe disease. Two patients (29%) died in the first episode as a result of pneumonia. The combination of cough, purulent expectoration and fever was the usual presenting form of tracheo-bronchitis. Nine out of the 15 patients (60%) had been treated previously because of tracheo-bronchitis and/or bacterial pneumonia episodes not caused by P. aeruginosa. Twelve patients required hospital admission; ten patients (83%) because of tracheo-bronchitis symptoms. The initial response to therapy was satisfactory, but 12 (80%) relapsed, with 2.6 relapses per patient after a mean follow-up of 7.4 months. CONCLUSIONS: P. aeruginosa bronchopulmonary infections emerge in late stages of HIV disease. P. aeruginosa should be considered in the differential diagnosis of every patient with pneumonia and advanced AIDS, even in the absence of the traditionally reported risk factors. Initially, tracheo-bronchitis responds well to therapy, but its management is difficult because of the frequent relapses and the development of antibiotic resistance.

Adult↗