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P Alpert

Publications and source records attributed to P Alpert.

5 recordsLinked to original sources
PubMed2000

A pneumococcal capsular polysaccharide vaccine induces a repertoire shift with increased VH3 expression in peripheral B cells from human immunodeficiency virus (HIV)-uninfected but not HIV-infected persons.

The molecular mechanism of pneumococcal vaccine failure in human immunodeficiency virus (HIV)-infected persons is not fully understood. A polymerase chain reaction ELISA was used to determine the proportion of peripheral IgG, IgA, and IgM CD19-positive B cells expressing 6 immunoglobulin heavy-chain variable region (VH) subgroups before and 7 days after pneumococcal vaccination of 12 HIV-infected and 12 HIV-uninfected subjects. Significant postvaccination increases in the expression of the VH3 subgroup by IgG and IgA and a greater serologic response to vaccination were observed in the HIV-uninfected group. In contrast, the HIV-infected group had reduced prevaccination IgG VH3 and a postvaccination increase in IgG VH5. These results demonstrate that pneumococcal vaccination changes the pattern of B cell VH gene expression and support the concept that aberrant VH3 expression may translate into a poor antipneumococcal response in the setting of HIV infection.

AIDS-Related Opportunistic Infections↗
PubMed2000

Spirituality for nurses and their practice.

This descriptive study compared the inclusion of spirituality in the practice of two groups of nurses: nurses prepared in parish nursing (PN) and nurses not specifically prepared in spiritual care (NonPN). The Spirituality in Nursing Care tool was used to determine sources of spiritual strength and spiritual experiences of the respondents, the application of spirituality in their practice, and the interventions and indicators they used in determining the need for spiritual assistance. Random sampling using U.S. postal codes selected 600 members from a national mailing list of nurses prepared in parish nursing and 600 similarly selected nurses not prepared in parish nursing. A total of 645 questionnaires were returned with complete data. The following question was asked: How do nurses prepared in providing spiritual care (PN) compare to nurses not similarly prepared (NonPN) in terms of: (a) personal sources of spiritual strength, (b) spiritual experiences, (c) application of spirituality in their practice, (d) identification of indicators of spiritual needs in their clients, and (e) interventions used to meet the spiritual needs of their clients? The findings indicate there are differences in how PN and NonPN groups of nurses respond to spirituality of self and their use of spirituality in clinical practice. It is suggested that parish nurses take the lead to further study spirituality and the indicators and appropriate interventions, and identify patient outcomes when spiritual needs are addressed by nurses in providing "holistic nursing practice."

Adult↗
PubMed1995

Multidrug-resistant tuberculosis in patients without HIV infection.

BACKGROUND: Investigations of outbreaks of multidrug-resistant tuberculosis have found low rates of treatment response and very high mortality, and they have mainly involved patients with advanced human immunodeficiency virus (HIV) infection. For patients without HIV infection, one study reported an overall rate of response to treatment of 56 percent, and the mortality from tuberculosis was 22 percent. We investigated treatment response and mortality rates in 26 HIV-negative patients in New York with multidrug-resistant tuberculosis. METHODS: We obtained detailed data from seven teaching hospitals in New York City on patients with multidrug-resistant tuberculosis--defined as tuberculosis resistant at least to isoniazid and rifampin--who were HIV-negative on serologic testing. Lengths of times from diagnosis to the initiation of appropriate therapy and from the initiation of appropriate therapy to conversion to negative cultures were assessed. Therapeutic responses were evaluated by both microbiologic and clinical criteria. RESULTS: Between March 1991 and September 1994, 26 HIV-negative patients were identified and treated. Of the 25 patients for whom adequate data were available for analysis, 24 (96 percent) had clinical responses; all 17 patients for whom data on microbiologic response were available had such a response. The median times from diagnosis to the initiation of appropriate therapy and from the initiation of therapy to culture conversion were 44 days (range, 0 to 181) and 69 days (range, 2 to 705), respectively. Side effects requiring the discontinuation of medication occurred in 4 of 23 patients (17 percent) who were treated with second-line antituberculosis medications. The median follow-up for the 23 patients who responded and who received appropriate therapy was 91 weeks (range, 41 to 225). CONCLUSIONS: In this report from New York City, HIV-negative patients with multidrug-resistant tuberculosis, contrary to previous reports, responded well to appropriate chemotherapy, both clinically and microbiologically.

Adult↗