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PubMed2005

Asbestosis in an asbestos composite mill at Mumbai: a prevalence study.

BACKGROUND: Of an estimated 100,000 workers exposed to asbestos in India, less than 30 have been compensated. The reasons for such a small number are: refusal by management sponsored studies to grant medical certifications to workers suffering from occupational diseases, lack of training for doctors in diagnosis of occupational lung diseases, deliberate misdiagnosis by doctors of asbestosis as either chronic bronchitis or tuberculosis and the inherent class bias of middle class doctors against workers. The aim of the study was to identify workers suffering from Asbestosis (parenchymal and pleural non-malignant disease) among the permanent workers of the Hindustan Composites Factory and assess their disability and medically certify them, whereupon they could avail of their basic rights to obtain compensation and proper treatment. METHODS: The study was conducted by the Occupational Health and Safety Centre and the Workers' Union. Asbestosis was diagnosed if they had an occupational history of asbestos exposure for at least 15 years and showed typical radiographic findings. RESULTS: Of 232 workers in the factory, 181 participated in the survey. 22% of them had asbestosis. All the asbestos affected workers had at least 20 years of exposure. 7% had rhonchi, 34% had late basal inspiratory rates, 82% had more than 80% of Forced Expiratory Volume in the first second (FEV1)/Forced Vital capacity (FVC) ratio and 66% had FVC less than 80% of the predicted value. On radiology 7% had only pleural disease, 10% had both pleural and parenchymal disease and 82% had only parenchymal disease. The association of pleural disease with chest pain was statistically significant. CONCLUSION: We found the prevalence of asbestosis among exposed workers to be less than that anticipated for the number of years of exposure due to "Healthy Worker Effect". We suggest that all affected asbestos workers (including those who have been forced to leave) in India be medically certified and compensated. We also recommend better control of asbestos use in India. We also implore the management to provide all information about the work process and its hazards, conduct medical checkups as mandated by law and give the medical records to the workers.

Adult↗

PubMed1989

The contribution of discrimination analysis to the diagnostic decision in patients with lung carcinoma.

A set of 620 patients was examined. Out of them, 245 suffered from lung carcinoma of different type and stage, 28 suffered from other malignant tumors, 37 were affected with benign tumors, and 166 were suffering from a nonmalignant respiratory disease (tuberculosis, nonspecific pneumonia, chronic bronchitis, abscesses, cysts, asthma, lung fibrosis, bronchiectasis and sarcoidosis). In addition to these patients, 144 blood donors were examined who represented the control group of healthy individuals. In a blind test another set of 266 persons was examined. By completing the values of selected markers (orosomucoid, prealbumin, glycoprotein electrophoresis, erythrocyte sedimentation, age of the individual, and the number of smoked cigarettes) into the discrimination rule and by calculating the discrimination function, a sensitivity of 80.6% and a specificity of 75.6% were obtained. A comparative cytological examination of the same set revealed lower sensitivity (61.0%) but higher specificity (98.0%). These values were verified in a blind test, as the patients were admitted to the hospital. Sensitivity in lung cancer was found to be 83.9%; in nonmalignant diseases the respective value was 77.1%. This approach can be applied to individuals suspect of cancer, in secondary prevention and in individuals with a high risk of lung cancer.

Adult↗

PubMedDate not supplied

Preventive health care and screening of Latin American immigrants in the United States.

BACKGROUND: The Central and South American immigrant population in the United States is large and growing. A review of the preventive health care needs of this population has not previously been done but would be helpful to clinicians caring for immigrants in this country. METHODS: Using MEDLINE, the literature related to immigrants and their health status was searched, using the key words "immigrant," "refugee," "South/Central/Latin America," "health status," "screening," "nutrition," "parasites," "stomach/gastric cancer," "children," and "psychological." The American Statistics Index and Index to International Statistics were also resources. The available literature was reviewed and led to the recommendations in this article. RESULTS: Screening strategies for Latin American immigrants are discussed for intestinal parasites, tuberculosis, hepatitis B, schistosomiasis, leprosy, American trypanosomiasis (Chagas disease), malaria, human immunodeficiency virus (HIV) infection, cervical and gastric cancer, sickle cell trait, malnutrition, iron-deficiency anemia, incomplete immunizations, dental problems, psychological problems, impairment in the elderly, alcohol use, smoking, physical inactivity, and hypertension. There are not enough data to evaluate fully the screening strategies for most of these conditions, but recommendations are offered based on current knowledge. CONCLUSIONS: Screening is recommended for intestinal parasites and schistosomiasis, tuberculosis, hepatitis B in prenatal patients, leprosy in immigrants from high-risk areas, yearly Papanicolaou smears, malnutrition, iron-deficiency anemia, incomplete immunizations, dental problems, history of violence, and depression. Screening for sickle cell trait in prenatal patients from South America and universal hepatitis B screening are less clearly indicated but could be appropriate. Screening for American trypanosomiasis (Chagas disease), malaria, and gastric cancer is not recommended. Screening for HIV infection, functional impairment in the elderly, alcohol use, cigarette smoking, physical inactivity, and hypertension should be the same as for the general population.

Central America↗

PubMed2005

Efficacy and safety of two dosages of cotrimoxazole as preventive treatment for HIV-infected Malawian adults with new smear-positive tuberculosis.

OBJECTIVE: To assess the efficacy and safety of two different dosages of cotrimoxazole (CTX) in prophylaxis in HIV-positive new smear-positive pulmonary tuberculosis (TB) patients in Blantyre, Malawi. METHOD: Randomized, double-blind trial using 480 and 960 mg of CTX given to new TB patients, who were followed up until the end of the tuberculosis treatment. The primary outcome was survival. The outcome in the two groups was also compared with an unselected cohort of similar patients registered in Zomba, Malawi in 1995 and new smear-positive patients registered in the National Tuberculosis Programme in 1999. The secondary outcome was the occurrence of (opportunistic) events, especially bacterial pneumonia. RESULTS: There were no statistically significant differences in mortality and bacterial pneumonia between the groups receiving the two different dosages. The case fatality rate at the end of the tuberculosis treatment was 15.4% in the 480 mg group and 14.0% in the 960 mg group. This was lower than the case fatality rate in the Zomba cohort (19.2%, P = 0.10) and lower than the case fatality rate in the national programme (21.0%, P < 0.001). CTX was well tolerated. Compliance was fair. CONCLUSIONS: CTX prophylaxis may have a beneficial effect on mortality and morbidity in HIV-infected smear-positive tuberculosis patients in Malawi. The efficacy of both dosages is not significantly different. The intervention is cheap and easy to implement. These results would support implementation of CTX in this patient group until better strategies are available or evidence is convincingly presented to suggest that its benefit is marginal.

Adolescent↗

PubMed1996

Long-term anticonvulsant therapy in tuberculous meningitis--a four-year follow-up.

A treatment protocol for long-term anticonvulsant therapy (ACT) in children with tuberculous meningitis (TBM) has been followed depending upon clinical characteristics and EEG/CT scan findings suggestive of the underlying cause of convulsions. Sixty-three children which included all patients with focal seizures (FS), and those with generalized tonic and clonic seizures (GTCS), and tonic spasms (TS) manifesting more than once during hospitalization and/or associated with abnormal CT/EEG findings were given long-term ACT (Group A). Thirty-eight cases with GTCS before hospitalization, and/or not more than one seizure during first week of hospitalization and without any specific CT/EEG abnormalities (Group B) and 35 cases without any seizures (Group C) did not receive any ACT. Forty-four patients who were finally discharged on long-term ACT, were given phenobarbitone (57 per cent), phenytoin (23 per cent), and a combination of phenobarbitone+phenytoin (14 per cent), and phenobarbitone+sodium valproate (7 per cent). Follow-up was continued for 4 years with 93, 84 and 81 per cent attendance, respectively, in groups A, B and C. Some of the side-effects observed with anti-convulsant drugs included gingival hypertrophy in 11 out of 16 cases (69 per cent) on phenytoin, hyperkinetic behaviour in 3 out of 34 (9 per cent) cases on phenobarbitone, hypocalcaemia in 3 out of 44 cases (7 per cent), hypophosphataemia in 10 out of 44 cases (23 per cent) and increase in alkaline phosphatase in 14 out of 44 cases (32 per cent). CT scan of brain repeated in six cases with multiple tuberculomas showed marked improvement. While 4 out of 41 (10 per cent) cases in group A had recurrence of seizures in the follow-up, only 2 out of 28 cases (7 per cent) in group B presented with GTCS during first 3 months after discharge which was successfully controlled by long-term ACT in later part of the follow-up. Two out of 21 cases (10 per cent) in group C also presented with myoclonic seizures 3 and 5 months after discharge. There was no statistically significant difference in the recurrence/appearance of seizures in the three groups (P = > 0.05). Our results suggest that long-term ACT is not indicated in all cases of TBM with seizures. In view of the known side-effects of anticonvulsant drugs and danger of interaction with antitubercular drugs, it is mandatory to clinically evaluate the patients, identify the cause and restrict long-term ACT only to those cases who are likely to have some abnormal focus resulting in secondary epilepsy. All the cases with FS and some of the patients with GTCS and TS may need to be started on ACT. However, a close follow-up is necessary in all particularly in those for whom ACT has been withheld.

Anticonvulsants↗

PubMed2001

Attitude and social consequences of tuberculosis in Addis Ababa, Ethiopia.

OBJECTIVE: To gain a better understanding of the attitude and social consequences of tuberculosis (TB) in Addis Ababa, Ethiopia. DESIGN: A cross sectional survey using a structured questionnaire and a qualitative study based on the focus group discussion (FGD) technique. SETTING: Eight different kebeles (urban dwellers' associations) of six woredas (next higher administrative level to kebele). SUBJECTS AND METHODS: Seven hundred and three participants, comprising 326 males and 377 females were interviewed using the written questionnaire and 36 recent and current TB patients through focus group discussion. Data were analysed using SPSS/PC statistical package. The proportions were compared using univariate and bivariate analyses to show the frequency distribution and evaluate the relationship among different variables. In FGD, topics relevant to the research questions were identified, sorted and analysed. Conclusions were then formulated. MAIN OUTCOME MEASURES: Attitude of participants towards TB and its victims and social consequences of being a TB patient. RESULTS: Eighty three per cent of the respondents were aware that TB is a disease transmitted from one person to another and 80.1% perceived TB as an extremely severe disease. Of the total, 81.5% answered that TB is caused by cold, 69.0% feel that TB patients are not accepted in the community and 78.3% fear physical contact with TB patients. Most participants of the FGD sessions agreed that TB is a very dangerous, contagious but curable disease and the community has a generally negative attitude towards them. They also think that TB is associated with HIV/AIDS in the society. These attitudes have social consequences particularly the stigmatization and social isolation of TB patients. Four hundred and four (57.5%) respondents were found to be in favour of the short course chemotherapy against 226 (32.1%) choosing the longer course. Clinical improvement and unavailability of some drugs or their cost were the first and second main reasons indicated, respectively, for defaulting by respondents. CONCLUSION: The perception by most respondents that tuberculosis is incurable, transmittable and associated with HIV/AIDS, led to the understanding that TB is a very dangerous disease. This, in turn, contributes to social avoidance and the resultant consequences in TB patients. Health education must be stepped-up within the TB control programme, and the psychosocial implications of TB should be given due attention.

Adolescent↗

PubMed2001

The use of adenosine deaminase as a diagnostic tool for peritoneal tuberculosis.

SETTING: Tygerberg Hospital, an academic hospital in the Western Cape, South Africa. OBJECTIVE: To determine the diagnostic utility of ascitic fluid adenosine deaminase (ADA) in the diagnosis of tuberculous peritonitis. DESIGN: A prospective study, carried out from February 1995 to February 1998, resulted in 178 paired ascites and serum specimens being collected from adult patients. Specimens were evaluated for biochemistry, ADA, microbiology and cytology; further investigations were done at the treating clinician's discretion. Diagnoses were made according the pre-determined criteria. RESULTS: The median (range) ADA activity in the tuberculous group was 61.6 (17.5--115.0) U/L and was significantly higher than in any other diagnostic group (p<0.05). Using ROC curves, a cut-off level of 30 U/L for the diagnosis of tuberculous peritonitis was found to yield the best results; corresponding sensitivity and specificity was 94% and 92%, respectively. No statistically significant difference in ADA activity was observed when tuberculous ascites occurred in the absence or presence of cirrhosis. CONCLUSIONS: Ascitic fluid ADA activity is useful in identifying those patients in whom the diagnosis of tuberculous peritonitis should be actively pursued to justify its routine use, at least in areas such as South Africa where TB is endemic. The presence or absence of underlying cirrhosis does not appear to distract from its diagnostic utility.

Adenosine Deaminase↗

PubMed2006

Decreased expression of CD3zeta and nuclear transcription factor kappa B in patients with pulmonary tuberculosis: potential mechanisms and reversibility with treatment.

BACKGROUND: The protective immune response against Mycobacterium tuberculosis relies both on antigen-presenting cells and on T lymphocytes. In patients with different forms of tuberculosis, varying degrees of T cell function--ranging from positive delayed-type hypersensitivity, in asymptomatic infected healthy individuals, to the absence of the response, in patients with miliary or pulmonary tuberculosis (PTB)--have been reported. The decreased expression of CD3zeta reported in T cells from patients with either cancer or leprosy has provided possible explanations for the altered immune response observed in these diseases. METHODS: The present study aimed to compare the expression of CD3zeta , nuclear transcription factor- kappa B (NF- kappa B), arginase activity, and cytokine production in 20 patients with PTB, in 20 tuberculin-positive asymptomatic subjects, and in 14 tuberculin-negative control subjects. RESULTS: Compared with those in tuberculin (purified protein derivative)-negative control subjects, peripheral-blood T lymphocytes from patients with active PTB had significantly (P < .001) decreased expression of CD3zeta and absence of the p65/p50 heterodimer of NF- kappa B. These alterations were reversed only in patients who responded to treatment. Also reported here for the first time is that the presence of arginase activity in peripheral-blood mononuclear-cell lysates of patients with PTB parallels high production of interleukin-10. CONCLUSIONS: The presence of arginase could, in part, explain the decreased expression of CD3zeta . These findings provide a novel mechanism that may explain the T cell dysfunction observed in patients with PTB.

Adult↗

PubMed2002

Evaluation of brainstem auditory evoked response audiometry findings in children with tuberculous meningitis at admission.

OBJECTIVE: To determine the characteristics of Brainstem auditory evoked response (BAER) findings in children with tuberculous meningitis (TBM) at admission. METHODS: Twenty-seven children with highly probable TBM were admitted to the University Hospital. The control group was 23 healthy, age and sex matched subjects. Brainstem response audiometry recording was performed in all patients and controls. Ninety dB sound pressure level (SPL) was used for comparisons. The main BAER measurements analysed were the I-III, III-V, I-V interpeak intervals. In statistical analysis, t-test for independent groups were performed. At the same time, for interpeak intervals, values exceeding 2.5 standard deviations (S.D.) above the means of the normal controls were considered abnormal. To the result of BAER findings, HL was classified as mild (until 40 dBHL), severe (until 80 dBHL) and total HL (no hearing was detected). RESULTS: The latencies of interpeak intervals (except III-V latency at 10 per s) have significantly prolonged in comparison with controls. Mild HL was detected in four ears. In eight ears, any wave form could not be obtained at 110 dBSPL. Abnormal BAER result was seen in 13 of 54 ears (24%) at the click of 10 per s and five ears (12%) at the click of 50 per s. CONCLUSION: Abnormal BAER result was seen in 24% of patients with TBM before treatment. Depending on these findings, it can be inferred that hearing impairments must be lower than those values which was detected by BAER during the acute phase of TBM, since the abnormal BAER may be reversible following the illness, returning to normal with recovery.

Child, Preschool↗

PubMed1997

[Rifampicin toxicity in HIV-infected patients: A study of its incidence and the risk factors].

OBJECTIVE: Evaluate the effect of HIV infection in the appearance of toxicity in patients treated with rifampin, analysing the involved elements in its genesis. METHODS: We realized a comparative study of the epidemiologic and clinical characteristics, and the incidence of adverse reactions to rifampin (between 1986-1993), comparing the seropositive patients treated with rifampin, during more than 3 months, with one control group, of equal number of patients, without evidence of HIV infection, taken at random, with epidemiologic characteristics (age and sex) similar to the first group and also treated with rifampin during a similar period. In the group with HIV infection, we analysed the related epidemiologic, clinical and analytic characteristics, in a way statistically significative, with the appearance of toxicity to rifampin. RESULTS: The risk of toxicity to rifampin was associated significantly to HIV infection (p < 0.01), without finding any other distinguishing characteristics among the analysed groups. Indicative parameters of advanced HIV infection: advanced clinical stage, minor level of lymphocytes CD4+, total leukocytes, total lymphocytes and quotient CD4+/CD8+, also high levels of beta 2-microglobulinemia and [correction of 2-microglobulina e] IgA, and a negative protein purified derivative test (PPD) were found statistically related with the appearance to toxicity to rifampin. Patients with number of lymphocytes CD4+ between 20-50/mm3, showed a major predisposition of suffering toxicity to rifampin. CONCLUSION: HIV infection involved a notably increase of toxicity risk to rifampin. Clinical or analytic parameters associated with advanced illness conditioned an increase of this risk, essentially among patients with number of CD4+ between 20-50/mm.

AIDS-Related Opportunistic Infections↗

PubMedDate not supplied

[Survival of patients with HIV-related tuberculosis. Study of mortality during the first 9 months of treatment].

BACKGROUND: Among the individuals with tuberculosis who are infected with HIV a high degree of lethality has been found to exist during the first few weeks following the start of tuberculosis treatment. In this study, the survival of these individuals is studied within the framework of a retrospective cohort study. METHODS: This study included 1135 subjects infected by HIV over age fifteen and residents of Barcelona who were registered by the Barcelona Tuberculosis Prevention and Control Program and were diagnoses within the 1988-1993 period. The variables analyzed were age, gender, former imprisonment, municipal district, risk group, percentage of T CD4+ lymphocytes, tuberculin test, AIDS diagnosis (as per CDC-1987), X-ray pattern, bacteriology and part of the body affected by the tuberculosis. The Cox semiparametric method, the Kaplan-Meir curves and the log-rank test were employed. RESULTS: A 77% probability of survival during the first nine months was found to exist, with wide-ranging variations among the different subgroups. The only significant variables in the Cos multivariate model were AIDS, the percentage of T CD4+ lymphocytes and their interaction. The risk of death for an individual not having AIDS and a T CD4+ lymphocyte percentage of 14% or lower was 7.69 times higher than the risk of dying for an individual not having AIDS who had a T CD4+ lymphocyte percentage of above 14%. CONCLUSIONS: The survival of those individuals having tuberculosis who are infected with HIV varies greatly. Those who died in the short term were diagnosed as having AIDS on starting the tuberculosis treatment and who also had a T CD4+ lymphocyte percentage of 14% or lower.

AIDS-Related Opportunistic Infections↗

PubMed2004

Childhood tuberculosis in a low-income Paris suburb: lessons from a resurgence brought under control.

SETTING: Few series of paediatric tuberculosis (TB) have been reported in the last 20 years. OBJECTIVE: To describe diagnostic and treatment practices in children with TB living in Seine-Saint-Denis, a low-income Paris suburb. METHODS: Local TB incidence in 1998 was 34.2/100,000 overall and 10.2/100,000 in children. Between September 1996 and December 1997, the hospitals and prevention units serving the area's paediatric population were sent questionnaires to identify TB cases in children aged under 15 living in Seine-Saint-Denis and treated with at least one anti-tuberculosis drug. RESULTS: Of 92 cases identified, 60 (65%) had been diagnosed during contact tracing; for 52 patients (60%), the index case had been found. The reason for anti-tuberculosis treatment was active TB in 26 (28.3%), latent TB in 46 (50%), and prophylaxis in 20 (21.8%). Forty per cent (37/92) of the patients were aged under 5. Only 15 of the 35 notified cases met the criteria for mandatory notification (at least three anti-tuberculosis drugs). CONCLUSION: TB remains a public health problem in Seine-Saint-Denis. The high proportion of cases identified by contact tracing attests to the efficacy of the local contact-tracing programme. The criteria for mandatory notification in France were too restrictive to ensure effective surveillance of childhood TB. Since 2002, notification has included cases of tuberculous infection in children.

Adolescent↗

PubMed1994

[Generalized septic infections in rheumatoid arthritis. Study of autopsy material].

In the randomized autopsy material of 161 patients with rheumatoid arthritis (RA), a letal, generalized septic infection (GSI) was observed in 22 cases (13.66%). The GSI was accompanied by a pyarthros in 12 (7.45%) and no pyarthros in 10 (6.21%) cases. The clinical parameters of 22 septic RA patients were compared with 139 age and sex matched RA patients without GSI. The average age of septic patients decreased (p < 0.02), with low serum electrophoretic b-globulin level (p < 0.04), and high Waaler-Rose (p < 0.02) and Latex level (p < 0.004). The clinical parameters of 22 septic patients were compared with 76 age and sex matched RA patients without sepsis, vasculitis, or generalized secondary amyloidosis (GSA), and/or miliary epitheloid granulomas of tuberculous type (mT). The differences between the two groups of patients were the same, with a statistically more pronounced age difference (p < 0.005). 29 out of 161 patients (18.01 %) suffered from a clinically manifest diabetes mellitus (in 6 patients accompanied by sepsis), and 11 (6.83 %) from a clinically latent diabetes mellitus (in 2 patients accompanied by sepsis). There was no significant relationship between sepsis and manifest diabetes mellitus. The controlled and treated diabetes mellitus does not influence the frequency of lethal sepsis. Significant correlations were found between sepsis and latent diabetes mellitus (based on the histological detection of amyloid deposition localized to the islets of Langerhans (p < 0.02). 34 out of 161 patients (21.12%) suffered from a generalized secondary amyloidosis (in 3 patients accompanied by sepsis). There was no significant relationship between sepsis and generalized secondary amyloidosis. The thickness of adrenal cortex represents the effect of steroid therapy. Critical random check, using the Mann-Whitney tests, supports significance relationship between the adrenal cortex atrophy and fatal sepsis (p < 0.010). The follicular lymphoid depletion in the spleen represents the effect of immunosuppressive therapy. The size of lympho-follicles decreased significantly in sepsis (p < 0.004). The long term corticosteroid therapy and immunosuppressive represent a potential danger for sepsis.

Adolescent↗

PubMed2000

Comparison testing of current (PPD-S1) and proposed (PPD-S2) reference tuberculin standards.

Since 1951, the tuberculin PPD-S1 has been used to standardize commercial PPD reagents and perform special tuberculin surveys. PPD-S1 is now in short supply and a new standard (PPD-S2) has been manufactured. To determine if PPD-S2 is equivalent and can replace PPD-S1, we conducted a double-blind clinical trial. Between May 14 and October 28, 1997, 69 subjects with a history of culture-proven tuberculosis (TB patients) and 1,189 subjects with a very low risk for TB infection were enrolled, received four skin tests (with PPD-S1, PPD-S2, and one each of the commercially available PPDs), and had reactions measured by two trained observers. Among the TB patients, we found statistically indistinguishable immunogenicity (mean reaction size +/- standard deviation): 15.6 +/- 6.6 mm for PPD-S1 and 14.8 +/- 5.6 mm for PPD-S2. Among low-risk subjects, the tests had equally high specificities (PPD-S1, 98.7% and PPD-S2, 98. 5%), using a 10-mm cutoff. The number of discordant (negative versus positive) interpretations for PPD-S2, assuming that low-risk subjects who had a >/= 10 mm reaction to PPD-S1 were truly infected, was low (0.5%) and indistinguishable from the rate of discordant interpretations of the same test when read by two different observers (0.8%). The study results indicate that PPD-S2 is qualified to be used as the new U.S. reference standard for PPD tuberculin.

Adult↗

PubMed1999

Screening for endometrial cancer in asymptomatic postmenopausal women with conventional and colour Doppler sonography.

OBJECTIVE: To evaluate endometrial thickness and uterine arterial flow measurement as predictors of endometrial cancer. DESIGN: Prospective study among a cohort of women invited to age-adjusted, population-based breast cancer screening by mammography. SETTING: City of Turku, Finland. POPULATION: 1074 postmenopausal women aged 57-61 years (mean 59 years). METHODS: Conventional and colour Doppler sonography. Endometrial biopsy was taken when the endometrial thickness (double layer) was > or = 4.0 mm, if the uterine artery pulsatility index was < or = 1.0 or if there was a fluid accumulation in the endometrial cavity. MAIN OUTCOME MEASURES: Detection of endometrial cancer in endometrial biopsy. Record linkage with the files of the Finnish Cancer Registry three and a half years after the first ultrasound examination. Major statistical results are based on the analysis of variance and logistic regression models. RESULTS: An endometrial biopsy was taken from 291 women (27%). One woman had endometrial tuberculosis, three an endometrial polyp, 16 endometrial hyperplasia, three endometrial carcinoma (Stage Ib), and one had cervical carcinoma (Stage Ib). One woman was diagnosed as having endometrial cancer Stage Ib two and a half years after screening; she had refused further examination after a positive screen. A second endometrial cancer (Stage Ib) was diagnosed three years after a negative screening result. CONCLUSION: Transvaginal sonography is confirmed to have a very high sensitivity for the detection of early endometrial carcinoma, but the specificity remains low. If endometrial cancer is to be detected at an early stage, further examinations should be carried out when the endometrial thickness is > or = 4.0 mm, especially when the woman has risk factors such as obesity, late menopause or current use of hormonal replacement therapy. Doppler sonography does not improve the detection of premalignant and malignant endometrial lesions compared with normal ultrasound.

Biopsy↗

PubMed1991

[Lactates in the cerebrospinal fluid in patients with bacterial and viral meningitis--significance in differential diagnosis].

Lactate concentrations were determined in the cerebrospinal fluid of patients with purulent, tuberculous and viral meningitis. The control group consisted of 10 patients with meningism (the presence of the meningeal syndrome with a normal cytobiochemical finding of the cerebrospinal fluid). The enzymatic kinetic method of the firm "Behringer" was used. In all the patients with purulent meningitis lactate values were elevated (above 6.2 mmol/l), and the highest values (above 15.0 mmol.l) were found in the patients who also developed respiratory failure. The lactate values in the cerebrospinal fluid of patients with purulent meningitis were higher in statistical significance than in all other examined groups of patients (p less than 0.01). The lactate values were in correlation with the total number of leukocytes (r = 0.78, p less than 0.01) and with the percent of polimorphonuclear leukocytes in the cerebrospinal fluid (r = 0.80, p less than 0.01). Elevated lactate values (above 2.95) were also found in all the patients who had tuberculous meningitis and statistically they differed significantly from the cerebrospinal fluid values of the patients with viral meningitis and meningism (p less than 0.01). There was no difference in the cerebrospinal fluid lactates of patients with viral meningitis and meningism (p greater than 0.05). Elevated lactate values were also found in 2 patients who had paraneoplastic meningitis and in 3 patients with cerebral cysticercosis and hydrocephalus, but without meningitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacterial Infections↗

PubMed1999

[In old age ... AIDS. Is it worth to initiate antiretroviral treatment? Review of 37 patients more than 60 years of age].

INTRODUCTION: HIV infection is common in young persons and its clinical picture, outcome and response to antiretroviral therapy is well known, but it is not the case in the elderly. OBJECTIVES: To evaluate the clinical characteristics and response to antiretroviral therapy of HIV elderly patients. DESIGN: Retrospective study of 37 patients elder than 60 years. The control group comprised of 64 HIV positive patients with less than 60 years. None of them were drug abusers. RESULTS: The mean age of patients was 65 years (range 60-79), 86% were males. The most frequent causes for HIV testing were: wasting (22%), P. carinii pneumonia (19%), tuberculosis (13%) and Kaposi sarcoma (10%), but in the control group voluntary testing was the most common reason (64%). The mean CD4 count at diagnosis was lower in the elderly group (233 cells/microL vs 323 cells/microL). During follow up, the most frequent complications for those with less than 200 CD4 cells were: oral candidiasis (44%), P. carinii pneumonia (27%), Kaposi sarcoma (22%) and esophageal candidiasis (22%), while in the young group P. carinii pneumonia (22%), Kaposi sarcoma (9%) and esophageal candidiasis (9%) were less frequent. 67% of the elderly received antiretroviral therapy. Zidovudine had to be discontinued due to anaemia in half of them. Survival at 6 and 12 months was significantly longer in treated patients compared to those who did not received antiretrovirals (100% vs 14% at 6 months, P < 0.001; and 54% vs 0% at 12 months, p = 0.03); and at 2 years it was almost similar to that of the young group (36% vs 52%, p = 0.38). CONCLUSIONS: HIV infection in the elderly is generally diagnosed in an advance stage, but antiretroviral therapy prolongs survival. Zidovudine should be reserve as a second line drug because its frequent haematological toxicity.

AIDS-Related Opportunistic Infections↗

PubMed2005

Use of risk projection models to estimate mortality and incidence from radiation-induced breast cancer in screening programs.

The authors report on a method to calculate radiological risks, applicable to breast screening programs and other controlled medical exposures to ionizing radiation. In particular, it has been applied to make a risk assessment in the Valencian Breast Cancer Early Detection Program (VBCEDP) in Spain. This method is based on a parametric approach, through Markov processes, of hazard functions for radio-induced breast cancer incidence and mortality, with mean glandular breast dose, attained age and age-at-exposure as covariates. Excess relative risk functions of breast cancer mortality have been obtained from two different case-control studies exposed to ionizing radiation, with different follow-up time: the Canadian Fluoroscopy Cohort Study (1950--1987) and the Life Span Study (1950--1985 and 1950--1990), whereas relative risk functions for incidence have been obtained from the Life Span Study (1958--1993), the Massachusetts tuberculosis cohorts (1926--1985 and 1970--1985), the New York post-partum mastitis patients (1930--1981) and the Swedish benign breast disease cohort (1958--1987). Relative risks from these cohorts have been transported to the target population undergoing screening in the Valencian Community, a region in Spain with about four and a half million inhabitants. The SCREENRISK software has been developed to estimate radiological detriments in breast screening. Some hypotheses corresponding to different screening conditions have been considered in order to estimate the total risk associated with a woman who takes part in all screening rounds. In the case of the VBCEDP, the total radio-induced risk probability for fatal breast cancer is in a range between [5 x 10(-6), 6 x 10(-4)] versus the natural rate of dying from breast cancer in the Valencian Community which is 9.2 x 10(-3). The results show that these indicators could be included in quality control tests and could be adequate for making comparisons between several screening programs.

Adult↗