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E Fox

Publications and source records attributed to E Fox.

At least 73 records · Page 4Linked to original sources
PubMed1993

Estimating the seroincidence of HIV-1 in the general adult population in Kigali, Rwanda.

OBJECTIVE: To estimate the seroincidence of HIV-1 infection in the general adult population of Kigali, Rwanda. DESIGN: Repeated standardized cross-sectional studies. SETTING: Two urban prenatal clinics. PATIENTS: A total of 4486 consecutive pregnant women consulting in 1989 and 1990. MAIN OUTCOME MEASURES: Prevalence of HIV-1 antibodies. RESULTS: HIV seropositivity increased by 3-5% annually over this period, indicating that it has not reached a plateau in this sentinel population. The percentage infection rates, calculated using two complementary methods, were 26.2-30.7% in 1990. Extrapolating these results to the general population of Kigali, we estimate that 2300-3800 new infections in young women and 3600-6100 new infections in young men occur annually among the total population of 350,000 in Kigali. CONCLUSIONS: A new HIV infection occurred in an adult every 50-90 min, on average, in Kigali during 1989-1990, while every 6-7 h a baby with maternally acquired HIV infection was born. Our HIV surveillance system, which is based on prenatal sentinel posts, is a useful tool for monitoring the progression of the HIV epidemic in Kigali.

Cross-Sectional Studies↗
PubMed1993

Cognitive function and quality of life in end-stage renal failure.

The Sickness Impact Profile (SIP) and the Wechsler Memory Scale--Revised (WMS-R) were administered to a small sample of end-stage renal failure patients. The memory test successfully discriminated between patients who were rated by their nurses to be well adjusted or poorly adjusted to dialysis treatment. It is concluded that this instrument may be useful in investigating cognitive function in this patient population.

Adaptation, Psychological↗
PubMed1993

Trends of human immunodeficiency virus type-1 infection in female prostitutes and males diagnosed with a sexually transmitted disease in Djibouti, east Africa.

A cross-sectional serosurvey for human immunodeficiency virus type 1 (HIV-1) was conducted during the first quarter of 1991 among high risk groups in Djibouti, East Africa, and compared with previous surveys in 1987, 1988, and 1990. The survey demonstrated evidence of HIV-1 infection in 36.0% (n = 292) of street prostitutes, 15.3% (n = 360) of prostitutes working as bar hostesses, and 10.4% (n = 193) of males diagnosed with a sexually transmitted disease. By multivariate modeling, HIV-1 seropositivity in prostitutes was associated with Ethiopian nationality, working as a street prostitute, and residing in Djibouti for two years or less. We suggest that prostitution, particularly street prostitution, is a major route of HIV-1 transmission in Djibouti.

Adolescent↗
PubMed1992

Redefining the emergency physician's role in do-not-resuscitate decision-making.

In summary, Wrenn and Brody's [14] study raises important questions about the appropriate role of emergency physicians in discussing DNR decisions in the emergency setting. Their approach to DNR orders expands, appropriately we believe, the traditional role of emergency physicians. We suggest that it is desirable for emergency physicians to give patients and family members the option of DNR status when there is a significant likelihood that the patient will experience cardiopulmonary arrest before the admitting physician can address the DNR issue and the patient is profoundly debilitated or terminally ill. In addition, emergency physicians have a heightened obligation to promptly address DNR status when appropriate decisions about resuscitation have been reached previously, as in the following cases: (1) when a clearly valid portable prehospital DNR order is in effect; (2) when the patient's primary physician clearly indicates to the emergency physician that the patient is DNR; (3) when an incompetent patient has an advance directive that explicitly precludes CPR and unquestionably applies to the current situation; (4) when a clearly competent, informed patient requests that a DNR order be entered. Finally, we advise emergency physicians against using the principle of futility as sole justification for DNR orders except in situations in which cardiopulmonary arrest is expected, and outcome data suggest that survival is virtually unprecedented.

Decision Making↗
PubMed1992

Monitoring for HIV-1, HIV-2, HTLV-I sero-progression and sero-conversion in a population at risk in east Africa.

Thirty-three individuals from East Africa, at risk for acquiring sexually transmitted infections, were selected to be monitored over a five month period for evidence of sero-progression and/or sero-conversion for human immunodeficiency virus type-1 and type-2 (HIV-1, HIV-2), and human T cell leukemia virus type-1 (HTLV-I). Initially, all sera were reactive by at least one retroviral screening assay, but most produced negative or indeterminate results by western blot assays. Five months after the initial screening, western blot assays indicated that one individual exhibited full sero-conversion for HIV-1; one HIV-1 positive individual also became positive for HIV-2; and two subjects showed sero-progression to become HTLV-I confirmed positive. Sera from fourteen individuals produced indeterminate results by western blot for HIV-1, ten of which were previously negative; the remaining four sera exhibited reactivity to at least one additional viral specific antigen after the five months. Circulating HIV-1 antigen was not demonstrated in any of the sera but DNA isolated from one of the individuals with indeterminate results produced a positive reaction for HIV-1 by the polymerase chain reaction.

Blotting, Western↗
PubMed1992

Diagnostic challenges: lymphotropic sero-"questionables".

During a sero-survey for lymphotropic retroviruses, seven screening tests were performed for the three lymphotropic retroviruses of relevance in Djibouti, East Africa (HIV-1, HIV-2 and HTLV-1). Of the 82 subjects whose sera reacted in at least one retroviral screening assay, about one third could be followed, and their sera were re-examined after a 5-month interval, and then after an additional 3-month interval. Six selected individuals are reported here, whose retroviral serologies presented important and often unexplained changes over an eight-month period. The six cases summarize prototypic situations and present serological results in a style appropriate to stimulate thought on the significance and interpretation of lymphotropic viral serologies. Each case study is followed by a set of questions that formulate pertinent serological concepts.

Adult↗
PubMed1991

Tryptophan and high-carbohydrate diets as adjuncts to smoking cessation therapy.

Treatments that reduce the immediate effects of smoking withdrawal have potential for helping smokers quit. Serotonin-enhancing substances, such as tryptophan and high-carbohydrate diets, have been used in clinical disorders to relieve negative affect, a classic symptom of cigarette withdrawal. This research project investigated the use of tryptophan (50 mg/kg/day) and high-carbohydrate diets, together with more traditional smoking cessation treatment techniques, to ameliorate the smoking withdrawal syndrome and to improve abstinence rates. Subjects were randomly assigned to receive either tryptophan (n = 16) or placebo (n = 15). Standard smoking cessation treatment was identical for the experimental and control groups and consisted of four 2-hr weekly sessions of multicomponent group therapy. Smoking behavior, symptoms of nicotine withdrawal, and negative affect were assessed during a 2-week withdrawal period. Tryptophan-treated subjects who could not fully abstain were able to smoke fewer daily cigarettes. Reported anxiety and other withdrawal symptoms were lower in the tryptophan group compared with control subjects. These data suggest that serotonin-enhancing substances show promise for use as an adjunct to existing smoking cessation programs.

Adolescent↗
PubMed1991

"Quality of life" for patients with end-stage renal failure.

The assessment of health status and quality of life among chronically ill patients is an area of current scientific interest. This paper considers the utility of a short but comprehensive instrument to assess the quality of life for end-stage renal failure patients. the Spitzer QL-Index was completed by 8 nurses for all patients in the Wellington region currently being treated with home hemodialysis (n = 58); hospital hemodialysis (n = 13); and continuous ambulatory peritoneal dialysis (n = 37). Results indicated that home hemodialysis patients achieve the highest quality of life in comparison to the other two treatment modalities. It is concluded that the QL-Index has some discriminative validity for this patient population, and its use may contribute to informed decision making by both patients and doctors.

Adaptation, Psychological↗
PubMed1991

A partnership in epidemiological research.

Four medical research teams completed ten epidemiological investigations in Djibouti and thus provided the country's Ministry of Health with valuable information on infectious disease risks. A major factor contributing to the success of the work was the high degree of cooperation between the Ministry, a United States naval medical research unit, and the World Health Organization as coordinator.

Africa↗
PubMed1990

Adenovirus and minute virus of mice DNAs are localized at the nuclear periphery.

The localization of adenovirus 2 (Ad2) and Minute Virus of Mice (MVM) DNAs was studied in situ in infected HeLa cell nuclei using fluorescent DNA probes and confocal microscopy. Ad2 DNA was found in multiple foci which were localized along the periphery of the infected cell nuclei. MVM DNA was found in HeLa cell nucleoli which are associated with the nuclear envelope, and when co-infected with Ad2 MVM DNA was compartmentalized to multiple foci which again were localized at the nuclear periphery. The data are discussed in terms of a model for the role of intranuclear compartmentalization in eukaryotic DNA structure and function.

Adenoviridae↗
PubMed1990

Replication of minute virus of mice DNA in adenovirus-infected or adenovirus-transformed cells.

The effect of adenovirus infection or transformation on the DNA replication of Minute Virus of Mice (MVM) was studied in human fibroblast cell lines. In WI38, HeLa, and 293 cells MVM infection allowed production of viral NS-1 and capsid proteins with or without adenovirus 2 (Ad2) co-infection. However, MVM DNA replication varied markedly. In HeLa cells MVM DNA was replicated weakly in host nucleoli, and replication was increased markedly by Ad2 co-infection as well as recompartmentalized to Ad2 replication factories. In Ad-transformed 293 cells MVM DNA was replicated very efficiently when infected alone or with Ad2 co-infection although recompartmentalization from nucleoli to replication factories was also seen. In WI38 cells MVM DNA was not replicated under any conditions. The variation in DNA replication in WI38, HeLa, and 293 cells despite viral protein production in all cases suggests that MVM DNA replication is uncoupled from viral gene expression and that host factors required for MVM DNA replication are induced or recompartmentalized by adenovirus infection or transformation.

Adenoviruses, Human↗
PubMed1990

Epidemiology of bacterial pathogens associated with infectious diarrhea in Djibouti.

During a survey examining the causes of diarrhea in the East African country of Djibouti, 140 bacterial pathogens were recovered from 209 diarrheal and 100 control stools. The following pathogens were isolated at comparable frequencies from both diarrheal and control stools: enteroadherent Escherichia coli (EAEC) (10.6 versus 13%), enterotoxigenic E. coli (ETEC) (11 versus 10%), enteropathogenic E. coli (EPEC) (7.7 versus 12%), Salmonella spp. (2.9 versus 3%), and Campylobacter jejuni-C. coli (3.3 versus 5%). Surprisingly, the EAEC strains isolated did not correspond to well-recognized EPEC serogroups. No Yersinia spp., enteroinvasive E. coli, or enterohemorrhagic E. coli were isolated during the course of this study. Only the following two genera were recovered from diarrheal stools exclusively: Shigella spp. (7.7%) and Aeromonas hydrophila group organisms (3.3%). Shigella flexneri was the most common Shigella species isolated. Patients with Shigella species were of a higher average age than were controls (27 versus 13 years), while subjects with Campylobacter or Salmonella species belonged to younger age groups (2.6 and 1.6 years, respectively). Salmonella cases were more often in females. Shigella diarrhea was associated with fecal blood or mucus and leukocytes. ETEC was not associated with nausea or vomiting. Anorexia, weight loss, and fever were associated with the isolation of Salmonella and Aeromonas species. EAEC, ETEC, EPEC, and Shigella species were resistant to most drugs used for treating diarrhea in Africa, while the antibiotic most active against all bacteria tested was norfloxacin. We conclude that in Djibouti in 1989, Shigella and Aeromonas species must be considered as potential pathogens whenever they are isolated from diarrheal stools and that norfloxacin should be considered the drug of choice in adults for treating severe shigellosis and for diarrhea prophylaxis in travelers.

Diarrhea↗
PubMed1990

Serological evidence for human immunodeficiency virus type 2 in east Africa.

Infection by human immunodeficiency virus type 2 (HIV-2) has not previously been described in North or East Africa. We examined over 1200 sera of high-risk individuals from three North/East African countries for antibodies to HIV-2. Results indicated that 17 were repeatedly reactive by ELISA; 4 were confirmed by Western blot. Of the 4 confirmed, 2 produced strong reactions to the envelope antigens of HIV-2 but not of HIV-1. One of these subjects was a foreigner from Senegal who was tested while in Egypt and one was a Djiboutian prostitute who was infected presumably prior to October 1987. We conclude that HIV-2 has been introduced into this region and that specific testing of selected individuals for HIV-2 is warranted.

Adult↗
PubMed1990

Coronal biparietal diameter. A reliable alternative to the traditional transverse biparietal diameter.

The traditional ultrasonically derived fetal biparietal diameter (BPD) is important in the determination of fetal age, weight, and growth. This measure cannot be obtained, however, with direct occiput anterior or posterior or with a head in the pelvis. This study looked at the BPD utilizing coronal (anatomically at right angles to the traditional BPD through the thalami, third ventricle, and cavum septum pellucidum) rather than transverse section through the fetal head. In 265 patients at 14 to 41 weeks' gestation, simultaneous measurement of the coronal and transverse BPDs revealed that they were interchangeable (r = 0.99). The major drawback of the coronal BPD is the inability to obtain a head circumference because of the absence of the occipitofrontal diameter.

Cephalometry↗