Biomedical subjects

M E Epstein

Publications and source records attributed to M E Epstein.

8 recordsLinked to original sources

PubMed1998

HIV in the elderly.

Greater than 10% of persons with AIDS in the United States are over 50 years of age, and the number of elderly persons in their 60s and 70s living with HIV/AIDS is increasing. Contrary to the perceptions of some within the health-care community and the general population, the elderly are at risk for HIV infection and carry a high mortality if diagnosed. Many older persons with AIDS are less likely to practice safe sex; others go undiagnosed and therefore untreated due to perceptions that the elderly are not at high risk for HIV infection, and treatments may be less efficacious. As age increases, the incidence of mortality does as well; 37% of individuals 80 years and older have been reported to die within a month of diagnosis. The history of a 62-year-old HIV-positive woman is presented as a case representative of many of the issues confounding timely diagnosis and treatment. Initial complaints of an undiagnosed elderly person can vary from nonspecific constitutional symptoms to those resembling an AIDS-defining disease. Both normal age-related changes in immune function and poor nutrition may confound the differential diagnosis or contribute to disease progression. Although the perception exists that the elderly are not at great risk for HIV disease, data from the National AIDS Behavior Surveys indicates that 10% of persons over 50 years of age have, at minimum, one risk factor for infection. Further education needs to be directed at physicians and their elderly patients, research on HIV/AIDS pharmacotherapy in the elderly should be extended, and the impact of the HIV/AIDS elderly population on the health-care system needs greater recognition and study.

Aged↗

PubMed1998

HIV wasting syndrome: treatment update.

OBJECTIVE: To review the pathophysiology and treatment of HIV wasting syndrome. DATA SOURCES AND STUDY SELECTION: MEDLINE searches (January 1987-September 1997) of the English-language medical literature were conducted. Bibliographies were also selected during a manual review. DATA SYNTHESIS: HIV-related weight loss, often referred to as HIV wasting syndrome, is a common manifestation of advanced HIV infection. Wasting in HIV involves the preferential loss of lean body mass with a paradoxical preservation of body fat. The etiology of wasting appears to be the result of many factors, which may include decreased caloric intake, malabsorption, alterations in energy expenditure and metabolism, cytokine effects, and endocrine dysfunction. Pharmacologic treatment options include appetite stimulants (e.g., dronabinol, megestrol acetate), cytokine inhibitors (e.g., thalidomide, cyproheptadine, ketotifen, pentoxifylline, fish oil, N-acetylcysteine), and anabolic agents (e.g., testosterone, nandrolone, oxandrolone, recombinant human growth hormone). CONCLUSIONS: Wasting associated with HIV has a high morbidity and mortality rate if not adequately managed. Therapeutic strategies include appetite stimulants, cytokine inhibitors, and growth-promoting agents. Selection of the appropriate agent(s) depends on the underlying cause for weight loss, adverse effects, and cost of therapy.

HIV Infections↗

PubMed1997

Extracellular matrix heparan sulfate modulates endothelial cell susceptibility to Staphylococcus aureus.

The ability of extracellular matrix heparan sulfate to alter the susceptibility of human endothelial cells to S. aureus was investigated. Endothelial cells grown on extracellular matrix synthesized by S. aureus-infected endothelial cells were more susceptible to subsequent staphylococcal infection than endothelial cells grown on the extracellular matrix synthesized by untreated endothelial cells. Endothelial cells were more susceptible to S. aureus infection when 1) grown on heparitinase-treated extracellular matrix that removed heparan sulfate chains, 2) grown on extracellular matrix produced by chlorate-treated endothelial cells that reduced sulfation in the matrix heparan sulfate proteoglycans, 3) grown on heparan sulfate purified from extracellular matrix elaborated by infected endothelial cells, and 4) endothelial cells were chlorate-treated and therefore expressed desulfated cellular heparan sulfate proteoglycans. Extracellular matrix produced by S. aureus-infected endothelial cells contained heparan sulfate proteoglycans with reduced sulfation. The altered extracellular matrix with reduced sulfated heparan sulfate proteoglycans signalled the uninfected endothelial cells to produce under sulfated cellular heparan sulfate proteoglycans that increased S. aureus adherence to the endothelial cells.

Bacterial Adhesion↗

PubMed1997

Antimicrobial agents for the dermatologist. II. Macrolides, fluoroquinolones, rifamycins, tetracyclines, trimethoprim-sulfamethoxazole, and clindamycin.

This article is the second of a two-part series reviewing antimicrobial agents that are used by the dermatologist. In part I we reviewed beta-lactam antibiotics and related compounds. In this section we again emphasize some newer agents (macrolides, fluoroquinolones) as well as some of the more commonly employed older agents (rifamycins, tetracyclines, trimethoprim-sulfamethoxazole, and clindamycin.

Anti-Bacterial Agents↗

PubMed1997

Antimicrobial agents for the dermatologist. I. Beta-lactam antibiotics and related compounds.

We review the newer antimicrobial agents that are being employed by dermatologists with increased frequency as well as some of the more commonly used older agents. Particular emphasis is based on selection factors such as causative pathogens and their resistance profiles, routes of administration, toxicity, drug interactions, and dosing requirements. Emphasis in this review is on the newer classes of antimicrobials such as third- and fourth-generation cephalosporins; beta-lactam, beta-lactamase inhibitor combination agents; monobactams; carbapenems; macrolides; and fluoroquinolones. Dermatologic indications and treatment alternatives are highlighted; this will expand the practicing clinician's therapeutic armamentarium and enable him/her to make rational decisions concerning treatment approaches to infectious disease problems encountered in daily practice.

Anti-Bacterial Agents↗

PubMed1993

Cost accounting the Gamma Knife.

The cost of the three dominant technologies for delivering radiosurgery to the brain are compared. Included in the analysis is the cost of the equipment and labor costs for each procedure. Once a unit is treating more than 100 patients per year the Gamma Knife becomes the most cost-effective technology by a factor of almost 100%. These findings are primarily a result of the greater labor input required for alternate technologies.

Brain Neoplasms↗

PubMedDate not supplied

Clinical feline toxoplasmosis. Serologic diagnosis and therapeutic management of 15 cases.

Clinical toxoplasmosis was diagnosed in 15 cats by correlating serologic evidence of infection and clinical signs to either response to therapy or histopathologic demonstration of the organism. Ophthalmic manifestations, primarily involving the anterior segment, were common. Other common physical examination abnormalities included muscle hyperesthesia, fever, and weight loss. Response to therapy was variable, but administration of clindamycin hydrochloride resulted in resolution of all clinical signs not involving the eyes in surviving animals. This drug, alone or in combination with corticosteroids, led to total resolution of clinical signs in four of four cats with active retinochoroiditis and in six of nine cats with anterior uveitis. Four of the 15 cats had concurrent infection with feline immunodeficiency virus (FIV). Feline leukemia virus antigen or antibodies to feline infectious peritonitis virus were not detected.

Animals↗

PubMedDate not supplied

New species in the New World Natada complex (Lepidoptera: Limacodidae).

The following new species in the New World Natada complex are described: Natada minuscula, Natada cecilia, Natada lalogamezi, Natada kokii, Natada monteverdensis, Narosopsis iangauldi, and Euprosterna wemilleri. Natada minuscula is the smallest known species in the complex. Of the new species, only Natada kokii, Natada cecilia and Narosopsis iangauldi are known to occur outside of Costa Rica. Previously the New World Natada complex had 43 species in the neotropics. It is anticipated that the proportion of new species in the complex will exceed other major lineages of Limacodidae found in Costa Rica.

Animals↗