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Biomedical subjects

R Spira

Publications and source records attributed to R Spira.

At least 19 recordsLinked to original sources
PubMed2000

Preventing mother-to-child transmission of HIV-1 in Africa in the year 2000.

OBJECTIVES: Various approaches to preventing mother-to-child transmission (MTCT) of HIV have recently been, or are being, evaluated in developing countries, especially in Africa. New findings from these trials are now becoming available, the implications of which, for population-based intervention programmes, need urgent consideration. METHOD: A critical review of 18 randomized trials and other relevant studies from developing and industrialized countries. RESULTS: Most African results relate to trials of antiretroviral agents (ARV). They demonstrate efficacy in reducing transmission in the first 6 months of life with short regimens of zidovudine (ZDV), with or without lamivudine (3TC), and nevirapine (NVP) alone. Preliminary results suggest the long-term efficacy of zidovudine. Antiseptic and nutritional interventions have been shown to reduce maternal and infant mortality and morbidity but not MTCT of HIV. HIV confidential voluntary counselling and testing for pregnant women, a short regimen of peripartum ARV with alternatives to breastfeeding such as early weaning or breast milk substitutes from birth currently represent the best option to reduce MTCTof HIV in Africa. However, the prevention of postnatal transmission requires further research, particularly in view of the consequences of different feeding options and the possibility of post-perinatal exposure prophylaxis of newborns with ARV. Issues relating to the implementation of currently validated strategies are discussed.

Africa↗
PubMed1999

[Video-assisted thoracoscopic surgery for diagnosis of pulmonary lesions].

23 patients (age 11-66 years) underwent video-assisted thoracoscopic biopsy for diffuse disease or peripheral nodular lesions of the lung. 12 had been previously treated for extrapulmonary malignancy and lung biopsy was done for suspicious metastases. In all cases except 1, lesions were identified and biopsied by thoracoscopy. The postoperative course was easier and shorter as compared to thoracotomy and the mean hospital stay was only 2.5 days. Thoracoscopic lung biopsy is a safe, effective and accurate diagnostic modality for diffuse lung disease and peripheral lesions. It is associated with minimal postoperative pain and discomfort, short hospital stay, early return to normal activity, and gives good cosmetic results.

Adolescent↗
PubMed1999

Natural history of human immunodeficiency virus type 1 infection in children: a five-year prospective study in Rwanda. Mother-to-Child HIV-1 Transmission Study Group.

OBJECTIVE: To compare morbidity and mortality of human immunodeficiency virus type 1 (HIV-1)-infected and HIV-1-uninfected children and to identify predictors of acquired immunodeficiency syndrome (AIDS) and death among HIV-1-infected children in the context of a developing country. DESIGN: Prospective cohort study. SETTING: Maternal and child health clinic of the Centre Hospitalier de Kigali, Rwanda. PARTICIPANTS: Two hundred eighteen children born to HIV-1-seropositive mothers and 218 born to seronegative mothers of the same age and parity were enrolled at birth. OUTCOME MEASURES: Deaths, clinical AIDS, nonspecific HIV-related manifestations, and use of health care services. RESULTS: Fifty-four infected and 347 uninfected children were followed up for a median of 27 and 51 months, respectively. With the exception of chronic cough, the risk of occurrence of nonspecific HIV-related conditions was 3 to 13 times higher in infected than in uninfected children. The recurrence rate and severity of these findings were increased systematically in infected infants. Estimated cumulative risk of developing AIDS was 28% and 35% at 2 and 5 years of age, respectively. Estimated risk of death among infected children at 2 and 5 years of age was 45% and 62%, respectively, a rate 21 times higher than in uninfected children. Median survival time after estimated infection was 12.4 months. Early infection, early onset of HIV-related conditions, failure to thrive, and generalized lymphadenopathy were associated with subsequent risk of death and/or AIDS, whereas lymphoid interstitial pneumonitis was predictive of a milder disease. CONCLUSIONS: In Africa, HIV-1-infected children develop disease manifestations early in life. Specific clinical findings are predictive of HIV-1 disease, AIDS stage, and death. Bimodal expression of HIV-1 pediatric disease is encountered in Africa, as in industrialized countries, but prognosis is poorer. human immunodeficiency virus infection, children, vertical transmission, natural history, Africa.

AIDS-Related Opportunistic Infections↗
PubMed1998

Rapid change in the use of antiretroviral agents and improvement in a population of HIV-infected patients: France, 1995-1997. Groupe d'Epidémiologie Clinique du SIDA en Aquitaine (GECSA).

PURPOSE: To describe the recent evolution of antiretroviral prescriptions and to look for clinical and biological changes among a population of HIV-infected patients. SUBJECTS: Patients received follow-up in the hospital-based information system of the Groupe d'Epidémiologie Clinique du SIDA en Aquitaine (GECSA), Southwestern France, from 1995 to 1997. METHODS: Quarterly evolution of the prescriptions of antiretroviral treatments and of the population clinical and biological indicators were studied in this observational survey of computerized records obtained after each hospital contact. RESULTS: Overall numbers of patients who received follow-up and of hospital contacts remained stable. The proportion of untreated patients decreased from 38.5% to 10.5%. Monotherapies were progressively abandoned. Double combination therapies with two nucleoside analogues were used for 55% of the patients by early 1996 and then decreased, whereas triple combination therapies with one protease inhibitor (PI) rapidly increased to comprise up to 40% of the prescriptions in 1997. PIs were prescribed earlier and earlier in the course of HIV infection. Overall incidence of AIDS diagnoses and mortality rate decreased by 18% and 22%, respectively, in the first 9 months of use of PIs compared with the preceding 9 months, and by 47% and 56%, respectively, in the following 9 months (p<.001). The number of hospitalizations and the proportion of patients with a CD4 cell count <200/mm3 decreased. AIDS cases diagnosed after introduction of PIs had rarely been treated with PIs. CONCLUSION: Over this 3-year period, physicians prescribed antiretroviral treatments more and more frequently, and triple combination therapy with PI is now common practice in France. Patients clinical and biological patterns have improved 18 months after the introduction of PIs.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Prevalence of cutaneous disorders in a population of HIV-infected patients. Southwestern France, 1996. Groupe d'Epidémiologie Clinique du SIDA en Aquitaine.

OBJECTIVES: To estimate the current extent of cutaneous disorders in a large population of ambulatory and hospitalized human immunodeficiency virus (HIV)-infected patients and to describe characteristics associated with the presence of current skin manifestations. DESIGN: Cross-sectional survey. SETTING: Hospital units participating in the hospital-based information system of the Groupe d'Epidémiologie Clinique du SIDA en Aquitaine, southwestern France. PATIENTS: All the patients seen by physicians between November 18 and December 20, 1996, in the participating units (hospital ward, outpatient clinic, or day hospital). MAIN OUTCOME MEASURES: Prevalence and cumulative incidence of cutaneous disorders. RESULTS: Four hundred fifty patients at all stages of HIV disease were enrolled; 65.3% had at least 1 skin manifestation during the course of HIV infection. A history of skin disorder was reported for 269 patients (59.8%), and 199 patients (44.2%) had clinical dermatologic manifestations at the time of the study. The most frequent causes of cutaneous disorders were infections (fungal, viral, and bacterial), neoplasia, and miscellaneous disorders. Skin diseases were more likely to be reported in homosexual and bisexual men and in patients with clinically and biologically advanced HIV infection. CONCLUSIONS: Cutaneous disorders occur more frequently as HIV infection advances and immune function deteriorates; however, they are common and of various types throughout the course of HIV disease. Taking cutaneous disorders into consideration for case management is essential to improve quality of life for HIV-infected patients.

Cross-Sectional Studies↗
PubMed1998

Care of human immunodeficiency virus-infected children in developing countries. International Working Group on Mother-to-Child Transmission of HIV.

CONTEXT: There is urgent need to strengthen the area of pediatric HIV/AIDS care in developing countries. Clinical research in this area is also scarce. METHODOLOGY: A literature review and a postal survey were used to obtain updated information on mortality, morbidity and current standards of care of children born to HIV-infected mothers in developing countries. A 2-day workshop was organized to review the available data and to identify the key areas where clinical research should be conducted. MAIN FINDINGS: Rates of mortality and morbidity were very different from one study to another but generally higher than in industrialized countries. Prognostic studies for HIV-1-infected children in developing countries were not available. Based on the report of 14 teams from 11 countries, specific protocols for HIV-infected children with persistent diarrhea or severe malnutrition were documented in fewer than one-half of the cases. Secondary antimicrobial prophylaxis after interstitial pneumonia or recurrent infections was still infrequent, as primary prophylaxis of opportunistic infections. The following list of clinical research priorities was identified by the workshop participants: primary prophylaxis of opportunistic and bacterial infections; case management of persistent diarrhea; reassessment of the performance of p24 antigen for diagnostic and prognosis use; studies on the etiology of pulmonary infections; long term observational pediatric cohorts; current weaning practices and duration of breast-feeding; counseling and HIV testing of children and families; prevention of HIV sexual transmission in children and adolescents.

AIDS Serodiagnosis↗
PubMed1986

Demonstration of nasolacrimal duct carcinoma by computed tomography.

Nasolacrimal duct neoplasms are unusual; when they do occur, clinical findings and contrast dacryocystography generally are utilized to establish the diagnosis. We report a case of squamous cell carcinoma of the nasolacrimal duct in which computed tomography was used to confirm the diagnosis and define the extent of the tumor.

Aged↗
PubMed1985

Bile duct varices.

The diagnosis of biliary duct varices and portal vein occlusion should be considered when nodular or notched defects in the wall of the biliary duct system are shown by cholangiography or when pedunculated vascular structures in the bile ducts are seen at surgery. We present two cases of common hepatic and common bile duct varices due to portal vein occlusion.

Adult↗