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Biomedical subjects

T L Nielsen

Publications and source records attributed to T L Nielsen.

At least 19 recordsLinked to original sources

Prevalence of overweight, obesity and physical inactivity in 20- to 29-year-old, Danish men. Relation to sociodemography, physical dysfunction and low socioeconomic status: the Odense Androgen Study.

OBJECTIVE: To assess the prevalence of overweight, obesity and physical inactivity in 20- to 29-year-old men and to analyze whether sociodemography, physical dysfunction and low socioeconomic status are independent correlates of obesity and physical inactivity. DESIGN: Population-based, cross-sectional study. SUBJECTS: Seven hundred and eighty-three Caucasian, Danish men, aged 20-29 years recruited from 2042 respondents in a questionnaire survey of 3000 men, randomly drawn from the Danish Civil Registration System. METHODS: Questionnaire, interview and physical examination. RESULTS: The 783 included men and the 2042 questionnaire respondents matched the background population demographically. The 783 men matched the questionnaire respondents as regards BMI, physical activity, chronic disease, medication, smoking, sociodemography and socioeconomic status. The prevalence of overweight and obesity was 31.7 and 7.9%, respectively (World Health Organization criteria). Using waist circumference (WC) cutoffs of 94 and 102 cm, the prevalence was 16.2 and 10.6%, respectively; 24.4% were physically inactive. BMI and WC increased significantly from age 20 to 29 years. Physical activity decreased significantly with age and correlated inversely with WC, but not with BMI. Occupation, geography, partner status, fatherhood and tobacco exposure were independently related with obesity and physical inactivity. Obesity was also related to musculoskeletal complaints, whereas chronic diseases and low educational level were associated with physical inactivity. Age was not independently related with either outcome. CONCLUSION: In affluent societies, sociodemographic changes may partly explain the age-related decrease in physical activity and the parallel increase in WC and BMI.

Adiposity↗

Morphometric X-ray absorptiometry: reference data for vertebral dimensions in a population-based sample of young Danish men.

PURPOSE: To determine reference values for vertebral heights in healthy young Danish males using morphometric X-ray absorptiometry (MXA). MATERIAL AND METHODS: A population-based study group of 487 males aged between 20 and 30 years (mean 25 years) from the county of Funen, Denmark, were recruited. Using a Hologic QDR 4500 (dual energy X-ray absorptiometry) DXA-scanner, MXA scans covering the vertebrae from T4 to L4 were acquired for each subject. Anterior (Ha), middle (Hm), and posterior (Hp) heights of the thoracic (T4-T12) and lumbar (L1-L4) vertebral bodies were measured. Moreover, wedge, mid-wedge, crush I, and crush II ratios were calculated. RESULTS: No correlation between vertebral dimensions and crush indices on the one hand and age or weight on the other were found. Body height, however, correlated significantly with the cumulated vertebral heights. Reference data for vertebral dimensions, wedge, mid-wedge, crush I, and crush II are tabulated. CONCLUSION: The anterior, middle, and posterior heights of the vertebral bodies of T4 to L4 can be measured reproducible with MXA. In young men, the cumulative vertebral heights correlated with body height but not with age. Moreover, the wedge and crush indices were unrelated of both age and height.

Absorptiometry, Photon↗

Dose-, IGF-I- and sex-dependent changes in lipid profile and body composition during GH replacement therapy in adult onset GH deficiency.

OBJECTIVE: Patients with GH deficiency of adult onset (GHDA) exhibit dyslipidaemia and increased cardiovascular morbidity. GH replacement potently reduces body fat and serum lipids in GHDA. In recent years, lower GH doses have been introduced. The purpose of this analysis was to explore the response relationship between GH doses, lipids and body composition. DESIGN: Two consecutive, randomized 12-month GH replacement studies covering placebo and three different doses of GH (0.5, 1.0 and 1.7 IU/m(2) per day). Low and intermediate doses were IGF-I titrated. PATIENTS: Fifty-eight patients with severe GHDA, not previously treated with GH and stably substituted for other endocrine deficiencies, were included in the study. METHODS: Serum lipoproteins, serum IGF-I and body composition analysis by dual energy X-ray absorptiometry (DXA) were used. RESULTS: Fifty-seven percent of patients exhibited low density lipoprotein (LDL) cholesterol levels above 4.16 mmol/l, corresponding to the American Heart Association threshold of 160 mg/dl. GH treatment resulted in significant decreases in total and LDL cholesterol, with no significant change in high density lipoprotein cholesterol or triglycerides. The low dose induced no significant changes in lipid levels, whereas the medium dose reduced LDL cholesterol and the high dose decreased both LDL and total cholesterol. The effects depended significantly on the GH dose and the level of IGF-I obtained, but not on gender. GH replacement induced dose-dependent reductions in fat mass and sex-dependent increases in lean mass. CONCLUSIONS: GH given for 1 year at a dosage between 0.5 and 1.7 IU/m(2) per day reduced fat mass in a dose-dependent manner, increased lean body mass and lowered total and LDL cholesterol in patients with severe GHDA. Low dose GH treatment with normal IGF-I levels induced smaller changes compared with high dose therapy, and may need a longer treatment time.

Adipose Tissue↗

Meiotic crossing-over in the regions of homology between homologous chromosomes V.

Homologous chromosomes V of Saccharomyces cerevisiae and S. carlsbergensis virtually do not recombine in meiosis. Artificially created short regions of homology were found to induce meiotic crossing-over if they contained sequences located upstream of the S. carlsbergensis ILVI gene. Heterozygous restriction site markers were introduced within the 1.1 kb region of homology to monitor conversion events associated with the crossovers. In the presence of five heterozygosities, 85% of crossovers showed associated conversion. Crossovers with no detected conversion were found in the two largest (0.34 and 0.29 kb) intervals, into which the 1.1 kb region was divided by the introduction of the five markers, whereas the shortest conversion tracts observed did not exceed 0.26 kb. Several lines of evidence suggest that each crossover required a formation of heteroduplex DNA with the considerable minimal length of approximately 200-260 bp.

Crossing Over, Genetic↗

[Anesthesiologic aspects in patients with HIV infections].

A review of anaesthesia for patients with HIV-infection is given. The use of new antiretroviral drug combinations to treat HIV-infection may result in longer survival, and therefore more cases of HIV-positive patients who undergo surgery and require anaesthetic services. Clinical manifestations of the HIV infection in humans can be seen in almost every organ. The anaesthetist must have an understanding of the many manifestations of the syndrome. Physical examination and preoperative preparation is essential. Considerations for the anaesthetist include: the effects of medications and possible drug interactions, organ dysfunction, altered metabolism and choice of anaesthetic technique for the HIV-positive patient. Anaesthetists and other health care professionals must know about the manifestations of HIV-infection in order to provide competent and compassionate care.

Anesthesia↗

Pneumocystis carinii pneumonia in HIV-infected patients: effect of steroid therapy on surfactant level.

Previous studies have suggested alterations in pulmonary surfactant lipid in the setting of Pneumocystis carinii pneumonia in HIV-infected patients. Because pulmonary surfactant lipid is composed of a variety of lipid products and because other phospholipids might be present in bronchoalveolar lavage (BAL) lipid determinations, a single molecular species of phospholipid which comprises a substantial portion of the surfactant lipid fraction, dipalmitoyl phosphatidylcholine (DPPC), was measured by capillary column gas chromatography in BAL samples taken at the time of the diagnosis of P. carinii pneumonia, and 10 days after treatment for P. carinii pneumonia. DPPC was measured at day 0 and day 10 in seven patients who had been randomized to receive methylprednisolone adjuvant therapy for P. carinii pneumonia and in six patients who had been randomized to not receive methylprednisolone therapy. The level of DPPC in BAL from all patients at day 0 was 0.49 +/- 0.06 microgram ml-1 BAL. This level is significantly lower that the level of DPPC determined in BAL from five normal volunteers 2.48 +/- 0.40 micrograms ml-1. At day 0, the BAL level of DPPC in patients treated with methylprednisolone was not different from the BAL level of DPPC in patients not treated with methylprednisolone. By day 10 of therapy for P. carinii pneumonia, BAL levels of DPPC in all patients had increased to 1.05 +/- 0.19 micrograms ml-1 BAL. At day 10 DPPC levels in the methylprednisolone treated group were not different from the group not treated with methylprednisolone. We conclude that in HIV-infected patients, lung surfactant lipid is reduced in the setting of P. carinii pneumonia. The lipid levels return toward normal levels with treatment. Adjuvant therapy with corticosteroids does not alter the rate of recovery of surfactant lipid levels at least after 10 days of therapy.

1,2-Dipalmitoylphosphatidylcholine↗

In vitro metabolism of quinidine: the (3S)-3-hydroxylation of quinidine is a specific marker reaction for cytochrome P-4503A4 activity in human liver microsomes.

The aim of this study was to evaluate the (3S)-3-hydroxylation and the N-oxidation of quinidine as biomarkers for cytochrome P-450 (CYP)3A4 activity in human liver microsome preparations. An HPLC method was developed to assay the metabolites (3S)-3-hydroxyquinidine (3-OH-Q) and quinidine N-oxide (Q-N-OX) formed during incubation with microsomes from human liver and from Saccharomyces cerevisiae strains expressing 10 human CYPs. 3-OH-Q formation complied with Michaelis-Menten kinetics (mean values of Vmax and Km: 74.4 nmol/mg/h and 74.2 microM, respectively). Q-N-OX formation followed two-site kinetics with mean values of Vmax, Km and Vmax/Km for the low affinity isozyme of 15.9 nmol/mg/h, 76.1 microM and 0.03 ml/mg/h, respectively. 3-OH-Q and Q-N-OX formations were potently inhibited by ketoconazole, itraconazole, and triacetyloleandomycin. Isozyme specific inhibitors of CYP1A2, -2C9, -2C19, -2D6, and -2E1 did not inhibit 3-OH-Q or Q-N-OX formation, with Ki values comparable with previously reported values. Statistically significant correlations were observed between CYP3A4 content and formations of 3-OH-Q and Q-N-OX in 12 human liver microsome preparations. Studies with yeast-expressed isozymes revealed that only CYP3A4 actively catalyzed the (3S)-3-hydroxylation. CYP3A4 was the most active enzyme in Q-N-OX formation, but CYP2C9 and 2E1 also catalyzed minor proportions of the N-oxidation. In conclusion, our studies demonstrate that only CYP3A4 is actively involved in the formation of 3-OH-Q. Hence, the (3S)-3-hydroxylation of quinidine is a specific probe for CYP3A4 activity in human liver microsome preparations, whereas the N-oxidation of quinidine is a somewhat less specific marker reaction for CYP3A4 activity, because the presence of a low affinity enzyme is demonstrated by different approaches.

Algorithms↗

[Hepatitis B vaccination status among Danish physicians].

As part of a nation-wide questionnaire survey among Danish doctors, the incidence of hepatitis B vaccination was studied. For each specialty the findings were related to the risk of hepatitis B exposure assessed by the incidence of percutaneous and mucocutaneous blood exposure (PCE and MCE). A total of 6256 of 9375 doctors (67%) responded and 6005 (64%) questionnaires were eligible for analysis. Only 34.3% of the doctors had been vaccinated against hepatitis B, ranging from 8.9% in Psychiatry to 56.9% in Obstetrics-Gynaecology. The annual incidence of PCE and MCE was high in surgical as well as non-surgical specialties with an average of 3.0 PCE and 3.9 MCE per person. In conclusion all doctors must be considered at risk of exposure to hepatitis B during part of or the entire career. The current level of hepatitis B vaccination is insufficient. Hepatitis B vaccination of all doctors before entering clinical work seems to be indicated.

Blood-Borne Pathogens↗

[Percutaneous blood exposure among Danish physicians. Mechanisms and prevention].

The study describes the mechanisms of percutaneous blood exposure (PCE) among Danish doctors and discusses rational strategies for prevention. Data were obtained as part of a nation-wide survey of occupational blood exposure. The most recent percutaneous or mucocutaneous exposure within the previous three months was described. Of 9375 doctors, 6005 (64%) participated. A total of 971 PCE were described. Inattentiveness contributed to 30.5%. Use of fingers rather than instruments was a contributing cause of 36.9% of 483 PCE on suture needles. Common concomitant causes in such cases (n = 199) were poor space in (30.2%) or view of (18.6%) the operation field. Of 689 PCE in surgical specialties, 17.4% were inflicted by colleagues. Up to 53.3% of PCE on hollow-bore needles could be attributed to unsafe routines only. In conclusion, education in safer working routines are needed in all specialties. Introduction of safer devices should have a high priority in surgical specialties, and should be considered in non-surgical specialties too.

Accidents, Occupational↗

[Poor compliance with universal precautions among Danish physicians].

In a nation-wide survey among Danish doctors, the compliance and reasons for non-compliance with universal precautions (UP) and the associated circumstances of mucocutaneous blood exposure (MCE) were studied. Of 9384 questionnaires, 6256 (67%) were returned and 6005 were eligible for analysis. Only 35% complied with the basic principles of UP. Compliance with protective barrier use in surgical versus non-surgical specialties was: Gloves 63.0% and 23.4%, masks 55.2% and 17.6% and protective eyewear 11.5% and 4.0% respectively. Common given reasons for non-compliance were: "Interferes with working skills", "forget", "wear spectacles", "not available", "too much trouble to get" or "gloves do not fit". Of 741 MCE described in detail, an estimated 84-98% were potentially preventable if appropriate barriers had been worn. More than half of MCE were preventable by two interventions only: Compulsory use of protective eyewear during operations and of gloves during insertion of peripheral i.v.-catheters. In conclusion compliance with UP is unacceptably low and the majority of MCE were potentially preventable if appropriate barriers had been worn.

Accidents, Occupational↗

Fluvoxamine is a potent inhibitor of the metabolism of caffeine in vitro.

The selective serotonin re-uptake inhibitor, fluvoxamine, is a very potent inhibitor of CYP1A2, and accordingly causes pharmacokinetic interactions with drugs metabolised by CYP1A2, such as caffeine, theophylline, imipramine, tacrine and clozapine. Interaction between caffeine and fluvoxamine has been described in vivo, leading to lowering of total clearance of caffeine by 80% during fluvoxamine intake. The main purpose of the present study was to evaluate this interaction in vitro in human liver microsomes. A high-performance liquid chromatography method was developed in order to assay 1,3-dimethylxanthine, 1,7-dimethylxanthine, 3,7-dimethylxanthine and 1,3,7-trimethyluric acid formed from caffeine by human liver microsomes. The limit of detection was 0.06 nmol.mg protein-1.hr-1. As expected, fluvoxamine was a very potent inhibitor of the formation of the N-demethylated caffeine metabolites, displaying Ki values of 0.08-0.28 microM. The formation of 1,7-dimethylxanthine was virtually abolished by 10 microM of fluvoxamine, indicating that the N3-demethylation of caffeine is almost exclusively catalysed by CYP1A2. The CYP3A4 inhibitors, ketoconazole and bromocriptine, inhibited 1,3,7-trimethyluric acid formation with Kis of 0.75 microM and 5 microM, respectively, thus further supporting the involvement of CYP3A4 in the 8-hydroxylation of caffeine. The study shows that fluvoxamine, as expected, is a potent inhibitor of the metabolism of caffeine in vitro.

Caffeine↗

[Underreporting and follow up of exposure to blood among Danish physicians].

In a nation-wide questionnaire survey concerning percutaneous (PCE) and mucocutaneous (MCE) blood exposure among Danish doctors, the frequency of and reasons for underreporting and compliance with initial follow-up were studied. Of 9384 doctors, 6256 (67%) responded and 6005 questionnaires were included. Only 3.5% of 3755 PCE and 0.4% of 4847 MCE had been reported. Major reasons for underreporting were "considered unnecessary" (37.1%) or "too time-consuming" (19.3%). Of 1712 PCE and MCE that were described in detail, the doctors were tested for anti-Hbs in 4.8%, anti-HIV in 5.0%, and received hepatitis B vaccination in 3.7%. Major reasons to refrain from anti-HIV test was "felt that there was no risk of HIV-transmission" (49.1%), "the risk so low that testing was unnecessary" (48.8%) or "too time-consuming" (18.9%). In conclusion, only a few percent of the exposures are reported, and the reports do not give a valid impression of the problem. The importance of initial serological follow-up and vaccination should be emphasized.

Blood-Borne Pathogens↗

[Occupational blood exposure among Danish physicians--incidence and risk factors].

In a nation-wide questionnaire survey, the incidence and risk factors of percutaneous (PCE) and mucocutaneous (MCE) blood exposure among doctors in Denmark were studied. Of 9375 doctors, 6256 (67%) responded and 6005 were included for analysis. The highest incidence per person-risk-year (pry) was found in General Surgery, Neurosurgery, Obstetrics-Gynaecology and Orthopaedic Surgery (6.2-8.5 PCE/pry and 7.3-8.8 MCE/pry) followed by Anaesthesiology and Oto-rhinolaryngology (2.6-3.1 PCE/pry and 6.0-6.9 MCE/pry) and Pathology, Internal medicine, Radiology and Paediatrics (0.8-1.3 PCE/pry and 1.3-2.9 MCE/pry). Employment as senior as compared to junior doctor was associated with a higher risk of PCE and MCE among surgeons and a higher risk of PCE in anaesthetists, but a lower risk of PCE and MCE in Internal Medicine, Radiology and Paediatrics. Only 35% adhered to the basic principles of universal precautions and non-compliance was associated with a considerably increased risk of exposures, especially in non-surgical specialties. In conclusion, we found an unacceptably high incidence of occupational blood exposures among Danish doctors and preventive measures to reduce the incidence are strongly needed.

Blood-Borne Pathogens↗

Examination of virus shedding in semen from vaccinated and from previously infected boars after experimental challenge with porcine reproductive and respiratory syndrome virus.

Danish artificial insemination (AI) centres house several boars antibody positive to porcine reproductive and respiratory syndrome virus as well as PRRSV-naive boars which may become acutely infected. The risk of transmission of PRRSV by semen may therefore constitute a serious problem to the Danish pig industry. The use of a vaccination-program may be a way to avoid or reduce the problem. This study evaluates the use of two vaccines: One live, attenuated vaccine and one inactivated vaccine. A pronounced reduction in viremia and shedding of virus in semen was demonstrated by use of the live vaccine compared to the non-vaccinated control animals. In contrast, no changes in onset, level and duration of viremia and shedding of virus in semen were observed using the inactivated vaccine. Neither viremia nor seminal shedding of virus was detected in previously PRRSV-infected, PRRSV-antibody positive boars after challenge with a Danish field strain of PRRSV.

Animals↗

Incidence and risk factors of occupational blood exposure: a nation-wide survey among Danish doctors.

Occupational blood exposures involves a risk of transmission of serious infections. We performed a nation-wide survey, to describe the incidence and risk factors of percutaneous (PCE) and mucocutaneous (MCE) blood exposures among hospital employed doctors in Denmark. Of 9,374 questionnaires, 6,256 (67%) were returned and 6,005 were eligible for analysis. The highest risk per person-risk-year (pry) was found in General surgery, Neurosurgery, Obstetrics-Gynaecology and Orthopaedic surgery (6.2-8.5 PCE/pry and 7.3-8.8 MCE/pry). The second risk group Anaesthesiology and Oto-rhino-laryngology (2.6-3.1 PCE/pry and 6.0-6.9 MCE/pry). Finally Pathology, Internal medicine, Radiology and Paediatrics had a considerable risk (0.8-1.3 PCE/pry and 1.3-2.9 MCE/pry). Potential risk factors were examined by Poisson regression. Employment as senior as compared to junior doctor was associated with a higher risk of PCE (RR 2.2) and MCE (RR up to 2.7 depending on experience) among surgeons and an increased risk of PCE in anaesthetists (RR 1.7). In contrast, senior physicians in Internal medicine, Radiology and Paediatrics had a several fold lower risk of PCE (RR 0.6) and MCE (RR 0.6 in males, 0.3 in females). Only 35% adhered to the basic principles of universal precautions (UP) and non-compliance was associated with a considerably increased risk of both MCE and PCE, especially in non-surgical specialties. In conclusion, we found an unacceptably high incidence of occupational blood exposures among Danish doctors. Non-compliance with UP was associated with an increased risk of exposure and efforts to improve compliance with UP as well as implementation and evaluation of other preventive measures are needed.

Blood-Borne Pathogens↗

Percutaneous blood exposure among Danish doctors: exposure mechanisms and strategies for prevention.

The objective of this study was to describe the mechanisms of percutaneous blood exposure (PCE) among doctors and discuss rational strategies for prevention. Data were obtained as part of a nation-wide questionnaire survey of occupational blood exposure among hospital employed doctors in Denmark. The doctors were asked to describe their most recent PCE, if any, within the previous 3 months. Detailed information on the instruments, procedures, circumstances and mechanisms that caused the PCE was obtained. Of 9375 doctors, 6256 (67%) responded, and 6005 questionnaires were eligible for analysis. Of 971 described PCE the majority were caused by suture needles (n = 483), i.v.-catheter-stylets (n = 94), injection needles (n = 75), phlebotomy needles (n = 53), scalpels (n = 45), arterial blood sample needles (n = 41) and bone fragments (n = 23). Inattentiveness was the most common cause, contributing to 30.5% of all PCE. Use of fingers rather than instruments was a major cause of injury in surgical specialities and was a contributing cause of 36.9% PCE on suture needles. Common contributing causes when fingers were used (n = 199) were poor space in (30.2%) or view of (18.6%) the operation field. It was often argued that instruments were not practical to use or might harm the tissue. Of 689 PCE in surgical specialties, 17.4% were inflicted by colleagues. Up to 53.3% of PCE on hollow-bore needles could be attributed to unsafe routines like recapping only, but other mechanisms like sudden patient movements and 'acute situation' were common, especially in the case of PCE on i.v.-catheter-stylets. It is concluded that the exposure mechanisms of PCE reflect both unsafe routines, difficult working conditions and unsafe devices. Education in safer working routines are needed in all specialties. Introduction of safer devices should have a high priority in surgical specialties, and should be considered in non-surgical specialties too.

Blood-Borne Pathogens↗

Noncompliance with universal precautions and the associated risk of mucocutaneous blood exposure among Danish physicians.

OBJECTIVE: To study the compliance, and reasons for noncompliance, with Universal Precautions and the associated circumstances of mucocutaneous blood exposure (MCE) among Danish physicians. DESIGN: A nationwide questionnaire survey. SETTING: All Danish hospitals. PARTICIPANTS: All hospital-employed physicians. RESULTS: Of 9,384 questionnaires, 6,256 (67%) were returned, and 6,005 were eligible for analysis. Only 35% of respondents were compliant with the basic principle of Universal Precautions. Compliance with specific barriers in the preceding week among "surgeons and pathologists" and "other physicians" was as follows: gloves, 63.0% and 23.4%; masks, 55.2% and 17.6%; and protective eyewear, 11.5% and 4.0%, respectively. Common arguments for non-compliance were "interferes with working skills," "forget," "wear spectacles," "not available," "too much trouble to get," or "gloves do not fit." Detailed descriptions of 741 MCEs were obtained. Blood splashes in the eyes (n = 320) was the most common MCE in surgical specialties and pathology, whereas blood on the hands (n = 290) was most common in other specialties. In 20% of MCEs of the eyes, the exposure occurred despite the use of spectacles. An estimated 84% to 98% of MCEs potentially would have been preventable had appropriate barriers been worn. More than one half of MCEs were preventable by two interventions only: compulsory use of protective eyewear during operations and use of gloves during insertion of peripheral intravenous catheters. CONCLUSION: Compliance with Universal Precautions is unacceptably low, as reflected by the circumstances of MCE. Increased efforts to ensure education in Universal Precautions, easy accessibility of protective barriers, and improved design of the barriers are necessary to improve compliance and reduce the risk of MCE.

Blood-Borne Pathogens↗

[Prognostic value of interleukin-8 in AIDS-related Pneumocystis carinii pneumonia].

UNLABELLED: We evaluated the significance of interleukin-8 (IL-8) in Pneumocystis carinii pneumonia (PCP). Bronchoalveolar lavage (BAL) fluid and serum was prospectively collected in 76 consecutive HIV-infected patients with a primary episode of PCP, as well as in ten healthy control subjects. Patients were found to have elevated levels of IL-8 in BAL fluid compared to control subjects (p < 0.01). Nine patients died during the course of PCP. Non-survivors had significantly higher IL-8 levels in BAL fluid than survivors (p < 0.05). Furthermore patients with levels of IL-8 in BAL greater then 90 pg/ml (i.e. greater than control subjects) had significantly worse vital prognosis (log rank test, p < 0.05). Thirteen patients required mechanical ventilation (MV), and these patients had significantly elevated levels of IL-8 compared with patients not requiring MV (p < 0.05). IN CONCLUSION: i) IL-8 in BAL fluid correlates to the clinical severity of the pneumonia, and ii) is a predictor of mortality and severe respiratory compromise.

AIDS-Related Opportunistic Infections↗