Biomedical subjects
Publications and source records attributed to M K Zaman.
The crystal structure of gliclazide, N-[(perhydrocyclopenta [c]pyrrol-2-yl)aminocarbonyl]-p-toluenesulfonamide, C15H21B3O3S, a second-generation oral hypoglycemic agent, contains discrete molecules with normal molecular dimensions. Both of the five-membered fused rings adopt envelope conformations. The molecules are linked into chains by intermolecular hydrogen bonds involving amino-H atoms, with N...O separations of 2.967 (3) and 2.949 (3) A.
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The authors provide an overview of the spectrum of pulmonary disorders commonly encountered in the HIV-infected patient. Then an approach to assessment of patients and the limitations and indications for specific diagnostic techniques are discussed. Finally, recommendations for prophylactic measures are given.
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A 39-year-old man with AIDS presented with cough, chest pain, dyspnea on exertion, fever, and a cavitary lesion in the upper lobe of the left lung. The cavity increased in size over the next five months with disease involvement limited to the left upper lobe. Pneumocystis carinii infection was then diagnosed. Symptoms and cavity resolved with trimethoprim/sulfamethoxazole therapy.
Pneumocystis carinii organisms cluster in alveolar casts. A method for concentrating alveolar casts in sputum specimens might improve the diagnostic usefulness of sputum studies in possible cases of pulmonary infection with Pneumocystis carinii. The use of sputum induction to detect Pneumocystis carinii was studied in 40 consecutive patients with known or suspected human immunodeficiency virus infection having bronchoscopy for evaluation of pulmonary disease. Sputum produced by deep coughing induced by 3% saline via a jet nebulizer was liquefied with dithiothreitol, and cells were sedimented and stained. Liquefaction of mucus allowed concentration of alveolar casts where P. carinii cysts were readily identified. A total of 28 patients were found to have P. carinii, which was detected in concentrated sputum in 21 of 38 patients, unconcentrated sputum in 10 of 38 patients, and by bronchoscopy in 25 of 37 patients. Sensitivity of concentrated sputum compared with bronchoscopy was 78% (95% CI, 58 to 90), with a negative predictive value of 71% (95% CI, 47 to 87). Values for unconcentrated sputum were 43% (95% CI, 25 to 63) and 48% (95% CI, 30 to 67), respectively. Liquefaction of adequately induced sputum facilitates processing and interpretation and increases yield for P. carinii, eliminating the need for invasive procedures in most patients.
The level of serum lactate dehydrogenase (LDH) has been reported to be useful as a marker of Pneumocystis carinii pneumonia (PCP) in patients infected with the human immunodeficiency virus (HIV). In this study, we evaluated the clinical role of measurements of LDH in determining diagnosis and prognosis in 84 patients infected with HIV who presented with pulmonary problems. The mean serum LDH level of the 54 patients with PCP was 361 IU, which was significantly higher than the mean of 224 IU found in the 30 patients with other causes of pulmonary disease (p less than 0.001). Overlap of individual values occurred between the 2 groups. Levels greater than 450 IU consistently predicted PCP in our population, however, and normal values were found in only 7% of the patients with PCP. LDH levels in a group of 8 patients who developed PCP from conventional causes of immunosuppression were similar to those seen in PCP associated with HIV. LDH determinations prior to the episode of PCP were available in 45 patients and 39 (87%) showed an increase of greater than 50 IU at the time of diagnosis. The mean LDH in those who survived PCP was 340 IU, which was significantly less than the mean of 447 IU found in those who died (p less than 0.05). Significant overlap between the groups precluded use of the LDH as a predictor of mortality in an individual patient. Serial determinations of LDH during treatment for PCP showed that 27 of 36 (75%) of the survivors had gradual decreases of LDH, whereas 9 of 12 (75%) nonsurvivors had rising values during treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
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We report a case of endobronchial Pneumocystis carinii infection in a patient who most likely had the acquired immune deficiency syndrome (AIDS). Although many unusual manifestations of Pneumocystis pneumonia have been reported in patients with AIDS, this is the first case of P carinii presenting as an endobronchial mass.