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Biomedical subjects

K M De Cock

Publications and source records attributed to K M De Cock.

At least 73 records · Page 4Linked to original sources
PubMed1996

Fatal haemorrhage following liver biopsy in patients with HIV infection.

A retrospective review of all 248 liver biopsies performed in patients with HIV infection at two referral centres in London over a 12 year period revealed five cases of major bleeding following biopsy, with four deaths. The risk of major bleeding was 2.0%, and mortality was 1.6% following liver biopsy. The risk of bleeding as much higher than in published series of biopsies done in patients without HIV infection, owing in part to the high prevalence of thrombocytopaenia and clotting abnormalities in patients with HIV infection. HIV infection per se may also increase the risk of bleeding following liver biopsy.

Adult↗
PubMed1996

Crusted ("Norwegian") scabies in a specialist HIV unit: successful use of ivermectin and failure to prevent nosocomial transmission.

A nosocomial outbreak of scabies in a specialist inpatient HIV unit resulted from a patient admitted with crusted scabies. Treatment of his infestation with topical scabicides alone failed and he remained infectious for several weeks. His infestation was then eradicated with combined topical treatment and oral ivermectin. In total, 14 (88%) out of 19 ward staff became symptomatic, and 4 (21%) had evidence of scabies on potassium hydroxide examination of skin scrapings. The ward infection control policy was changed to distinguish patients with crusted scabies from those with ordinary scabies. A second patient with crusted scabies was treated with combined oral and topical therapy early in his admission and nursed with more stringent isolation procedures. No nosocomial transmission occurred and his infestation responded rapidly to treatment. Patients with crusted scabies require strict barrier nursing if nosocomial transmission is to be avoided. Ivermectin combined with topical scabicides may be a more efficacious treatment than topical scabicides alone in such patients.

Adult↗
PubMed1996

Tuberculosis 2000.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Preventing opportunistic infections in human immunodeficiency virus-infected persons: implications for the developing world.

More than 18 million persons in the world are estimated to have been infected with human immunodeficiency virus (HIV), the cause of the acquired immunodeficiency syndrome (AIDS). As immunodeficiency progresses, these persons become susceptible to a wide variety of opportunistic infections (OIs) The spectrum of OIs varies among regions of the world. Tuberculosis is the most common serious OI in sub-Saharan Africa and is also more common in Latin America and in Asia than in the United States. Bacterial and parasitic infections are prevalent in Africa; protozoal infections such as toxoplasmosis, cryptosporidiosis, and isosporiasis are also common in Latin America. Fungal infections, including cryptococcosis and Penicillium marneffei infection, appear to be prevalent in Southeast Asia. Despite limited health resources in these regions, some measures that are recommended to prevent OIs in the United States may be useful for prolonging and improving the quality of life of HIV-infected persons. These include trimethoprim-sulfamethoxazole to prevent Pneumocystis carinii pneumonia, toxoplasmosis, and bacterial infections; isoniazid to prevent tuberculosis; and 23-valent pneumococcal vaccine to prevent disease due to Streptococcus pneumoniae. Research is needed to determine the spectrum of OIs and the efficacy of various prevention measures in resource-poor nations, and health officials need to determine a minimum standard of care for HIV-infected persons. An increasing problem in the developing world, HIV/AIDS should receive attention comparable to other tropical diseases.

AIDS-Related Opportunistic Infections↗
PubMed1996

Summary of track B: clinical science.

AIM: To review Track B on clinical science. Major topics covered were quantitative HIV-1 plasma RNA measurement, combination antiretroviral therapy, protease inhibitors, treatment of primary HIV-1 infection, HIV-1 drug resistance, future use of antiretroviral drugs, paediatric HIV-1 infection, opportunistic infections and HIV/AIDS in developing countries. QUANTITATIVE HIV-1 PLASMA RNA MEASUREMENT: Quantification of HIV-1 RNA is a predictor of progression of immune deficiency and death in HIV-infected adults and children, and is useful in monitoring response to antiretroviral therapy. THERAPY: Combination antiretroviral therapy is now the standard of care, although questions about optimal starting time and the best initial regimen remain unresolved. Protease inhibitors are a powerful new class of antiretroviral agents which in combination with other drugs can produce profound reductions in plasma HIV-1 RNA levels. Trials are in progress of combination antiretroviral therapy, including protease inhibitors, in persons recently infected with HIV-1 to assess the feasibility of permanent suppression or eradication of HIV-1. Adherence to therapy and drug resistance will become increasingly important subjects. CONCLUSIONS: The genuine improvements in patient management are out of reach to the majority of the world's HIV-infected persons, a conclusion with implications which dampened the optimism generated by the conference.

Adult↗
PubMed1996

The emergence of HIV/AIDS in Africa.

The recent spread of HIV/AIDS in Africa must be seen in the broader context of emerging infectious diseases, whose epidemiology results from changes in the equilibrium between the agent, the host, and the environment. For sexually transmitted agents such as HIV, epidemic spread requires a high basic reproductive rate (number of secondary cases generated by one primary case), which is itself dependent on the rate of change of sex partners, the transmissibility of the agent, and the duration of infectiousness. Factors relating to the agent which may have influenced the spread of HIV in Africa are viral types (HIV-1, HIV-2) and subtypes, of which at least 9 exist for the main group of HIV-1. Major host factors include sexual behaviour and sexual networks, commercial sex, sexually transmitted diseases, condom use, and circumcision status in males. Most difficult to study are environmental factors in the broadest sense, such as behavioral norms, poverty, migration, and HIV/AIDS prevention efforts. Any model attempting to explain HIV/AIDS emergence must account for the extreme heterogeneity of the epidemic within the African continent, and must be relevant to the application of more effective interventions. Although descriptive and analytic epidemiology remain necessary, intervention-oriented research on HIV/AIDS is now the priority in Africa.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Tropical medicine for the 21st century.

The specialty of tropical medicine originated from the needs of the colonial era and is removed from many of the health care requirements of tropical countries today. Tropical medicine concentrates on parasitic diseases of warm climates, although other infections and diseases related to poverty rather than climate dominate medicine in developing countries challenged by population pressure, civil strife, and migration. In the new century, tropical medicine would best be absorbed into the specialty of infectious diseases, which should incorporate parasitic diseases, travel medicine, and sexually transmitted diseases. Pressing questions for health care and research in developing countries concern the provision of appropriate services for problems such as HIV/AIDS, tuberculosis, sexually transmitted diseases, and injuries. The question of how to provide appropriate clinical care in resource poor settings for the major causes of morbidity and premature mortality has been neglected by donors, academic institutions, and traditional tropical medicine.

Forecasting↗
PubMed1995

Response to treatment, mortality, and CD4 lymphocyte counts in HIV-infected persons with tuberculosis in Abidjan, Côte d'Ivoire.

We examined the severity of immune deficiency in patients with HIV-associated tuberculosis in Côte d'Ivoire and assessed its effect on mortality and response to treatment. Consecutive patients attending a tuberculosis treatment centre in Abidjan with smear-positive pulmonary or clinically diagnosed extrapulmonary tuberculosis were tested for HIV-1 and HIV-2 infections and had CD4 lymphocyte counts measured. Patients received standard short-course chemotherapy. Analysis of outcome (restricted to smear-positive tuberculosis patients) was done at 6 months. The 247 HIV-positive patients were significantly more likely than the 312 HIV-negative patients to have CD4 lymphocyte counts of less than 200/microL (43% vs 1%; odds ratio 56.9; [95% CI 19.7-185.3]) and 200-499/microL (39% vs 14%, odds ratio 3.8; [2.5-5.9]). Among HIV-positive patients, median CD4 lymphocyte counts in those with extrapulmonary tuberculosis (198/microL; n = 67) was lower, but not significantly so, than among those with pulmonary tuberculosis (257/microL; n = 180). Among 460 patients with pulmonary tuberculosis, the overall mortality rate was significantly higher in HIV-positive than HIV-negative persons (6% vs 0.4%; relative risk 17.1 [2.2-131.4]), and increased with the severity of immune deficiency; mortality rates in HIV-positive patients with CD4 counts of < 200/microL and 200-499/microL were 10% and 4%, relative risk 27.6 (3.5-220.8); and 11.5 (1.2-109), respectively, compared to HIV-negatives. Among patients completing treatment, cure rates were similar in HIV-positive patients (93%) and HIV-negative patients (92%), and were not related to CD4 counts. Severity of immune deficiency was the major determinant of mortality in HIV-associated tuberculosis. Among people completing treatment, microbiological response was satisfactory irrespective of serological or immune status.

AIDS-Related Opportunistic Infections↗
PubMed1995

The impact of human immunodeficiency virus infection on pelvic inflammatory disease: a case-control study in Abidjan, Ivory Coast.

OBJECTIVE: Our purpose was to assess the impact of human immunodeficiency virus infection on pelvic inflammatory disease. STUDY DESIGN: A case-control study was performed in Abidjan, Ivory Coast, women with pelvic inflammatory disease, 57 seropositive and 113 seronegative for the human immunodeficiency virus. Women underwent an interview, physical examination, pelvic ultrasonography, and laboratory testing. RESULTS: Seropositive women more often had an oral temperature > or = 38 degrees C (odds ratio 2.5, confidence interval 1.0 to 6.4), a genital ulcer (odds ratio 7.8, confidence interval 1.8 to 45.4), and a tuboovarian mass on ultrasonography (odds ratio 2.6, confidence interval 1.1 to 6.4) and were more likely to require surgery (odds ratio 6.5, confidence interval 1.1 to 67.5) and hospitalization (odds ratio 3.5, confidence interval 0.9 to 14.3). The mean clinical severity score was significantly higher among seropositive than among seronegative patients (17.4 vs 15.4 p = 0.01). Gonorrhea was detected in 50 (29.4%) and chlamydia in 16 (9.4%) of the 170 patients, and neither infection was significantly correlated with human immunodeficiency virus infection. After therapy similar proportions of seropositive and seronegative patients (95% and 93%) reported symptomatic improvement within 4 days, and none had persistent fever at day 4 or 14 of follow-up. CONCLUSIONS: Human immunodeficiency virus infection was associated with more severe clinical manifestations of pelvic inflammatory disease but did not affect microbial cause or response to therapy.

Adult↗
PubMed1995

Radiologic manifestations of pulmonary tuberculosis in HIV-1 and HIV-2-infected patients in Abidjan, Côte d'Ivoire.

OBJECTIVES: To compare the radiologic manifestations of pulmonary tuberculosis in HIV-1-infected, HIV-2-infected, and HIV-negative patients; and to assess the impact of HIV-related immunosuppression on the radiologic manifestations of pulmonary tuberculosis. METHODS: We compared chest radiographs from consecutive HIV-1-positive, HIV-2-positive and seronegative patients with pulmonary tuberculosis. Differentiation between HIV-1 and HIV-2 antibodies was based on a synthetic peptide-based enzyme immunoassay. A subset of patients had CD4+ lymphocyte levels estimated by flow cytometry; in these patients, abnormalities on chest radiographs were analysed in relation to the severity of CD4+ lymphocyte depletion. RESULTS: HIV-1-infected patients were significantly more likely to have extrapulmonary tuberculosis than were HIV-2-infected or HIV-negative patients (20% vs 8% and 9%). Among patients with pulmonary tuberculosis, no differences were observed in the rates of specific abnormalities on chest radiographs between HIV-1- and HIV-2-infected patients; both HIV-1- and HIV-2-infected patients had a higher frequency of pleural effusion than did HIV-negative patients (8% and 9% vs 4%). Among HIV-infected patients with CD4+ counts of > or = 400/mm3, 200-399/mm3, and < 200/mm3, respectively, the proportions with non-cavitary infiltrates and hilar adenopathy increased significantly (33% to 44% to 58%, and 0% to 14% to 20%), while the proportion with cavitary lesions decreased significantly (63% to 44% to 29%). CONCLUSIONS: The radiologic manifestations of pulmonary tuberculosis in HIV-infected patients varied significantly over the spectrum of immune deficiency. HIV-infected patients with tuberculosis and relatively high CD4+ counts showed only slight differences from HIV-negative persons. HIV-1-positive patients had a higher frequency of extrapulmonary tuberculosis at presentation than those infected with HIV-2. Radiographic abnormalities were broadly similar in HIV-2-infected and HIV-1-infected patients. Clinicians and radiologists must be alert to the altered radiologic spectrum of pulmonary tuberculosis in immunosuppressed HIV-infected patients.

Adult↗