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Biomedical subjects

P F Pinsky

Publications and source records attributed to P F Pinsky.

32 records · Page 2Linked to original sources
PubMed1988

Reye's syndrome and aspirin. Evidence for a dose-response effect.

Data collected from the Public Health Service Main Study of Reye's Syndrome and Medications were analyzed to assess the relationship between the development of Reye's syndrome and the dose of aspirin received during the antecedent respiratory or chickenpox illness. Among those exposed to aspirin, case-patients were found to have received greater average daily and maximum daily doses of aspirin and greater doses of aspirin on the first four days of the antecedent illness (median, 25.1 mg/kg; 33.0 mg/kg; and 65.4 mg/kg; respectively) than did controls (median, 14.5 mg/kg; 19.0 mg/kg; and 27.0 mg/kg; respectively). The excess risk associated with increasing aspirin doses was due primarily to intermediate levels of dose (eg, 15 to 27 mg/kg per day) rather than higher levels (greater than 27 mg/kg per day). The dose difference between exposed case-patients and controls was greatest on days 3 and 4 of the antecedent illness.

Adolescent↗
PubMed1988

Neurological complications of human immunodeficiency virus infection in patients with lymphadenopathy syndrome.

To determine if there is a relationship between neurological abnormalities and human immunodeficiency virus (HIV) infection in patients with lymphadenopathy syndrome (LAS), we studied 39 homosexual/bisexual men with LAS (mean duration of LAS, 4.1 years) and 38 homosexual/bisexual men who were seronegative for HIV (controls). Six LAS patients had histories of symptoms suggesting mononeuropathy, 9 had symptoms suggesting distal symmetrical polyneuropathy, and 9 had histories of herpes zoster radiculitis. Overall, significantly more LAS patients (18) than controls (3) had histories of symptoms or signs of neurological abnormality (odds ratio, 10.0; p = 0.0003). By neuropsychological assessment, 9 of 18 LAS patients and 2 of 26 controls were abnormal (odds ratio, 12.0; p = 0.004). Of those abnormal on the neuropsychological assessment, the majority scored in the mildly impaired range. Magnetic resonance imaging was abnormal in 1 LAS patient and in 1 control. Neither neurological nor neuropsychological abnormalities correlated with duration of LAS, absolute T-helper lymphocyte count, or T-helper/T-suppressor lymphocyte ratio. These results indicate an association of neurological and neuropsychological abnormalities with HIV in patients with LAS. They suggest that mild neurological abnormalities in LAS are common and that HIV may directly or indirectly be the cause.

AIDS-Related Complex↗
PubMed1988

Neurological symptoms and neuropsychological abnormalities in lymphadenopathy syndrome.

This case-control study of 39 homosexual or bisexual men who were human immunodeficiency virus (HIV)-seropositive and had lymphadenopathy syndrome and 38 HIV-seronegative homosexual or bisexual men indicates an association between neurological and neuropsychological abnormalities and HIV infection in patients with lymphadenopathy syndrome.

AIDS-Related Complex↗
PubMed1988

Community outbreak of thyrotoxicosis: epidemiology, immunogenetic characteristics, and long-term outcome.

Between January and March 1984, the first community outbreak of transient thyrotoxicosis in the United States was documented in a seven-county area of southeastern Nebraska; 36 of the total 49 patients resided in York County (2.4 cases per 1,000 population). The median age of patients was 36 years, range six to 82 years; 51 percent were women. By definition, all patients were symptomatic, visited a physician, and had a newly identified elevated serum concentration of thyroxine or triiodothyronine of unknown cause. None had a goiter or a painful thyroid gland. Low 131I uptake measurements were found in all nine patients studied. Six patients were hospitalized; none died. Investigation of all 12 household contacts of eight selected patients revealed five additional persons with thyrotoxicosis and four with asymptomatic hyperthyroxinemia. A case-control study revealed that illness was associated with a significantly higher frequency of a reported recent respiratory viral-like condition. In another case-control study, the HLA-DR3 antigen was present in more case subjects (39 percent) than control subjects (14 percent). In addition, a significantly higher proportion of patients than control subjects purchased beef from one of the three supermarkets in York Country. Concomitant with the outbreak, the supermarket implicated in the outbreak purchased an unusually large quantity of beef (7,000 pounds) from a nonregular supplier in Nebraska, which had reportedly instituted the practice of trimming gullets (a procedure that removes the muscles from bovine larynx for beef) about three months earlier. Thus, it is concluded that the Nebraska outbreak, like one in Minnesota that occurred 18 months later, probably resulted from patients having eaten ground beef that was contaminated with bovine thyroid gland. This form of thyrotoxicosis, perhaps misdiagnosed as painless thyroiditis in the past, probably represents a previously under-recognized public health problem.

Adult↗
PubMed1988

25- to 30-nm virus particle associated with a hospital outbreak of acute gastroenteritis with evidence for airborne transmission.

Between November 1 and 22, 1985, an outbreak of acute, nonbacterial gastroenteritis occurred in a 600-bed hospital in Toronto, Ontario, Canada. Illness in 635 of 2,379 (27%) staff was characterized by fatigue, nausea, diarrhea, and vomiting and had a median duration of 24-48 hours. The finding of virus-like particles measuring 25-30 nm in six stool specimens and low rates of seroresponse to Norwalk virus (3/39) and Snow Mountain agent (1/6) suggest that a Norwalk-like virus was responsible for the outbreak. The outbreak was of abrupt onset and high incidence, affecting 79 people in a single day. No common food or water exposure could be identified. The attack rate was greatest (69%) for staff who had worked in the Emergency Room. Of 100 patients and their companions who visited the Emergency Room on November 11-12 for unrelated problems, 33 (33%) developed gastroenteritis 24-48 hours after their visit, versus 0 of 18 who visited the Emergency Room on November 8 (p less than 0.001). An analysis of housekeepers who worked at least once during the period from November 9-13, which included those who became ill during the period of November 9-14, showed that the risk of becoming ill was four times greater for those who visited or walked through the Emergency Room than for those who did not (p = 0.028). These data are consistent with the possibility of the airborne spread of a virus.

Adult↗
PubMed1987

A cluster of patients with a chronic mononucleosis-like syndrome. Is Epstein-Barr virus the cause?

A cluster of 134 patients who had undergone Epstein-Barr virus (EBV) serological testing because of suspected chronic EBV syndrome was investigated in Nevada. Fifteen case-patients were identified who had severe, persistent fatigue of undetermined etiology for more than two months. When compared with the remaining 119 patients who had less severe illnesses and with 30 age-, sex-, and race-matched control-persons, these 15 patients had significantly higher antibody titers against various components of EBV and against cytomegalovirus and herpes simplex and measles viruses. Epstein-Barr virus serology could not reliably differentiate individual case-patients from the others, and the reproducibility of the tests within and among laboratories was poor. As a group, the case-patients appear to have had a syndrome that is characterized by chronic fatigue, fever, sore throat, and lymphadenopathy. The relationship of this fatigue syndrome to EBV is unclear; further studies are needed to determine its etiology.

Adolescent↗
PubMed1987

Lymphadenopathy syndrome in homosexual men. Evidence for continuing risk of developing the acquired immunodeficiency syndrome.

Seventy-five homosexual men with lymphadenopathy syndrome (LAS) for three months or more and antibody against the human immunodeficiency virus were enrolled in a prospective study in Atlanta in 1982 and 1983. Fourteen developed the acquired immunodeficiency syndrome (AIDS) three to 38 months after enrollment in the study and five to 56 months after onset of LAS. The five-year cumulative incidence rate of AIDS after onset of LAS was 29%; yearly incidence rates showed no decreasing trend with time. Of 18 patients with constitutional symptoms and a low T-helper cell count at their first visit, nine developed AIDS; of the remaining 57 patients, five developed AIDS (five-year cumulative incidence rates, 57% and 18%, respectively, P less than .001). Patients with lymphadenopathy syndrome are at continuing risk for the development of AIDS. Those with constitutional symptoms and a low T-helper cell count at their first visit appear to be at higher risk; other LAS patients are at lower risk but may still develop AIDS.

AIDS-Related Complex↗
PubMed1985

Unexplained lymphadenopathy in homosexual men. A longitudinal study.

In January 1982, the Centers for Disease Control began a prospective study of unexplained generalized lymphadenopathy syndrome in 78 homosexual or bisexual men. As of Aug 1, 1984, the median durations of lymphadenopathy and enrollment were 29.5 months and 20 months, respectively. Antibodies to human T-cell lymphotropic virus type III/lymphadenopathy-associated virus were present in 75 (96%) of the study patients. Five (6%) of the patients were diagnosed as having the acquired immunodeficiency syndrome five to 25 months after the onset of lymphadenopathy. At the time of their initial visit, these five patients had lower T-helper cell counts, hematocrits, lymphocyte counts, and pokeweed mitogen stimulation ratios and were more likely to report severe symptoms than patients who did not develop the acquired immunodeficiency syndrome. During 318 follow-up visits, except for the development of the acquired immunodeficiency syndrome in five patients, there has been little change in the initial laboratory and clinical measures of this cohort. Within the follow-up period of this study, the features of lymphadenopathy syndrome have been unremitting for the majority of patients.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Heterosexual and homosexual patients with the acquired immunodeficiency syndrome. A comparison of surveillance, interview, and laboratory data.

Homosexual and heterosexual patients with the acquired immunodeficiency syndrome were compared by risk group. Race; diagnoses; history of sexually transmitted diseases, sexual behavior, and drug use; and socioeconomic indicators differed considerably among risk groups, suggesting different risk factors for acquisition of the syndrome. Patients in the homosexual, intravenous drug user, and Haitian risk groups differed in their serologic response to cytomegalovirus and syphilis testing, presumably due to lifestyle-related exposures. Differences in the rate of recovery of cytomegalovirus, serum levels of IgA and IgG, and antibody titers to Epstein-Barr virus were noted among patients with different diagnoses. We conclude that in studies of risk factors for the acquired immunodeficiency syndrome, patients should be analyzed by risk group and diagnoses.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Risk factors associated with echovirus 11' infection in a hospital nursery.

An outbreak of nosocomial echovirus 11' illness occurred between July 22 and August 12, 1983, infecting 14 infants in the nurseries at a hospital. Stool, throat or cerebrospinal fluid specimens for viral isolation were obtained from 142 and serum pairs from 98 of the 192 infants exposed to the nurseries during the outbreak. Infection was determined by isolation of virus from stool or cerebrospinal fluid and/or a 4-fold rise in neutralizing antibody to echovirus 11'. Eight infants were severely ill with seizures, pleocytosis or apnea; one infant died. Four infants were mildly ill; two were asymptomatic. Immune serum globulin, administered to all hospitalized infants on July 31, did not appear to attenuate echovirus 11' illness. Infants present in the Intermediate Care Unit greater than 48 hours were more likely to become infected than infants present less than or equal to 48 hours (attack rates, 25 and 3%, respectively). Among infants present in the Intermediate Care Unit, illness was associated with gavage feeding, mouth care and being a twin (P less than 0.05). These findings support the importance of good hygienic practices in preventing nosocomial viral infections.

Antibodies, Viral↗
PubMedDate not supplied

Disease manifestation among homosexual men with acquired immunodeficiency syndrome: a possible role of nitrites in Kaposi's sarcoma.

To identify risk factors that determine the major manifestations of the acquired immunodeficiency syndrome (AIDS), the authors analyzed data from three epidemiologic studies conducted by the Centers for Disease Control. The authors compared patients by outcome of disease. Eighty-seven homosexual patients (47 with Kaposi's sarcoma, 20 with Pneumocystis carinii pneumonia, and 20 with both) had participated in the earlier studies, and their interviews and laboratory test results were available. Compared with patients who have Pneumocystis carinii pneumonia only, patients with Kaposi's sarcoma and those with both diseases reported more different sexual partners, more recreational drug use, higher incomes and higher rates of non-B hepatitis. Multivariate analysis showed that the variable most strongly associated with Kaposi's sarcoma was the use of large quantities of nitrite inhalants. A multifactorial model is postulated to explain the various disease manifestations of AIDS. This study suggests that the use of nitrite inhalants may be a cofactor in the development of Kaposi's sarcoma. By identifying other cofactors, investigators may be able to define additional opportunities for prevention of the development of AIDS.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

A model to evaluate past exposure to 2,3,7,8-TCDD.

Data from several studies suggest that concentrations of dioxins rose in the environment from the 1930s to about the 1960s/70s and have been declining over the last decade or two. The most direct evidence of this trend comes from lake core sediments, which can be used to estimate past atmospheric depositions of dioxins. The primary source of human exposure to dioxins is through the food supply. The pathway relating atmospheric depositions to concentrations in food is quite complex, and accordingly, it is not known to what extent the trend in human exposure mirrors the trend in atmospheric depositions. This paper describes an attempt to statistically reconstruct the pattern of past human exposure to the most toxic dioxin congener, 2,3,7,8-TCDD (abbreviated TCDD), through use of a simple pharmacokinetic (PK) model which included a time-varying TCDD exposure dose. This PK model was fit to TCDD body burden data (i.e., TCDD concentrations in lipid) from five U.S. studies dating from 1972 to 1987 and covering a wide age range. A Bayesian statistical approach was used to fit TCDD exposure; model parameters other than exposure were all previously known or estimated from other data sources. The primary results of the analysis are as follows: (1) use of a time-varying exposure dose provided a far better fit to the TCDD body burden data than did using a dose that was constant over time; this is strong evidence that exposure to TCDD has, in fact, varied during the 20th century, (2) the year of peak TCDD exposure was estimated to be in the late 1960s, which coincides with peaks found in sediment core studies, (3) modeled average exposure doses during these peak years was estimated at 1.4-1.9 pg TCDD/kg-day, and (4) modeled exposure doses of TCDD for the late 1980s of less than 0.10 pg TCDD/kg-day correlated well with recent estimates of exposure doses around 0.17 pg TCDD/kg-day (recent estimates are based on food concentrations combined with food ingestion rates; food is thought to explain over 90% of total dioxin exposure). This paper describes these and other results, the goodness-of-fit between predicted and observed lipid TCDD concentrations, the modeled impact of breast feeding on lipid concentrations in young individuals, and sensitivity and uncertainty analyses.

Adolescent↗