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Hirsch MS. The Joys of Research and Mentorship: Personal Observations Over Six Decades. J Infect Dis 2023; 228:975-978. [PMID: 37145101 DOI: 10.1093/infdis/jiad139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/03/2023] [Indexed: 05/06/2023] Open
Affiliation(s)
- Martin S Hirsch
- Infectious Disease Division, Massachusetts General Hospital, Boston, MA, USA
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Affiliation(s)
- Robert J Jacobs
- School of Optometry, The University of Auckland, Auckland, New Zealand
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Cheng XX, Zhao LH, Klosterman SJ, Feng HJ, Feng ZL, Wei F, Shi YQ, Li ZF, Zhu HQ. The endochitinase VDECH from Verticillium dahliae inhibits spore germination and activates plant defense responses. PLANT SCIENCE : AN INTERNATIONAL JOURNAL OF EXPERIMENTAL PLANT BIOLOGY 2017; 259:12-23. [PMID: 28483050 DOI: 10.1016/j.plantsci.2017.03.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 03/01/2017] [Accepted: 03/06/2017] [Indexed: 05/06/2023]
Abstract
Chitinases function in the digestion of chitin molecules, which are present principally in insects and fungi. In plants, chitinase genes play important roles in defense, and their expression can be triggered in response to both biotic and abiotic stresses. In this study, we cloned and characterized an endochitinase (VDECH) from Verticillium dahliae, strain Vd080. The VDECH coding region consists of 1845bp with two exons and one 54bp intron, encoding a 615 amino acid protein with the predicted molecular weight (MW) of 63.9kDa. The VDECH cDNA without signal peptide-encoding region was introduced into pCold-TF vector and the recombinant protein HIS-VDECH with a predicted MW of ∼114kDa was expressed. HIS-VDECH showed high tolerance to extreme temperature, exhibiting efficient chitinolytic activity at 50°C. In addition, VDECH triggered typical plant defense responses, including a hypersensitive response, oxidative burst, and elicited increased expression of defense-related genes in both Arabidopsis and cotton. VDECH-treatment of the conidial spores of V. dahliae and Fusarium oxysporum resulted in marked reductions in the germination of these spores in both fungi. After 36h of incubation with VDECH, the inhibition rate of germination was recorded at 99.57% for V. dahliae, and 96.89% for F. oxysporum. These results provide evidence that VDECH is recognized by the plant to elicit defense responses, and also that VDECH is an effective inhibitor of conidia germination, both of which may be exploited for disease control.
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Affiliation(s)
- Xiao-Xiao Cheng
- State Key Laboratory of Cotton Biology, Institute of Cotton Research of Chinese Academy of Agricultural Sciences, Anyang, Henan, 455000, China
| | - Li-Hong Zhao
- State Key Laboratory of Cotton Biology, Institute of Cotton Research of Chinese Academy of Agricultural Sciences, Anyang, Henan, 455000, China
| | | | - Hong-Jie Feng
- State Key Laboratory of Cotton Biology, Institute of Cotton Research of Chinese Academy of Agricultural Sciences, Anyang, Henan, 455000, China
| | - Zi-Li Feng
- State Key Laboratory of Cotton Biology, Institute of Cotton Research of Chinese Academy of Agricultural Sciences, Anyang, Henan, 455000, China
| | - Feng Wei
- State Key Laboratory of Cotton Biology, Institute of Cotton Research of Chinese Academy of Agricultural Sciences, Anyang, Henan, 455000, China
| | - Yong-Qiang Shi
- State Key Laboratory of Cotton Biology, Institute of Cotton Research of Chinese Academy of Agricultural Sciences, Anyang, Henan, 455000, China
| | - Zhi-Fang Li
- State Key Laboratory of Cotton Biology, Institute of Cotton Research of Chinese Academy of Agricultural Sciences, Anyang, Henan, 455000, China.
| | - He-Qin Zhu
- State Key Laboratory of Cotton Biology, Institute of Cotton Research of Chinese Academy of Agricultural Sciences, Anyang, Henan, 455000, China.
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Lepage P, Van de Perre P. Nosocomial Transmission of HIV in Africa: What Tribute Is Paid to Contaminated Blood Transfusions and Medical Injections? Infect Control Hosp Epidemiol 2016. [DOI: 10.2307/30146444] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
AbstractWe reviewed the published data on the possible impact of medical injections and blood transfusions on the spread of human immunodeficiency virus (HIV) in Africa. We also compared these results to our experience in Rwanda, central Africa. The importance of medical injections in the epidemic of HIV infection seems to differ from one area to another. The excess of injections experienced by HIV seropositive subjects in Zaire could be secondary to the parenteral treatment of early HIV-related illness or to the treatment of sexually transmitted diseases, rather than being the cause of HIV infection, as suggested by Rwandese studies. In contrast, blood transfusions have been shown to represent an important source of nosocomial HIV infection in many African countries. Effective and relatively inexpensive measures to diminish the iatrogenic spread of HIV infection in developing countries are summarized.
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Whitby M, Stead P, Najman JM. Needlestick Injury: Impact of a Recapping Device and an Associated Education Program. Infect Control Hosp Epidemiol 2016. [DOI: 10.2307/30146995] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
AbstractObjective:To determine the impact of the introduction of a plastic shield-shaped device (Needleguard, Biosafe, Auckland, New Zealand) and education program designed to allow safer recapping, on recorded rates of needlestick injury.Design:A before-after trial with a two-year duration of follow-up.Setting:Tertiary referral hospital.Participants:Nursing and other hospital personnel.Results:Prospectively collected baseline data, together with the results of an anonymous questionnaire of 25% of the hospital nursing staff, defined a reported needlestick injury rate of 6.9 per hundred full-time nursing staff per year. In the pre-intervention period, there were 6.7 needlestick injuries per 100 nursing staff members per year reported. This increased to 15.4 (p<.0001) needlestick injuries per 100 nursing staff members per year after the intervention. An anonymous survey undertaken at both time periods suggests that the apparent increase in officially reported needlestick injuries is due to an increase in the willingness of nurses to now report previously unreported needlestick injuries.Conclusions: The impact of the safety device and education program was the more accurate reporting of needlestick injuries; many nursing staff continued to resheath needles contrary to hospital policy. Many staff simply did not use the newly designed safety device. Approaches to improving compliance with such safety devices are considered.
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YOUNGS RP, STAFFORD ND, WEBER J. AIDS: otolaryngological presentation in the high-risk male homosexual. Clin Otolaryngol 2009. [DOI: 10.1111/j.1365-2273.1986.tb02005.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Borrego L, Rodríguez J, Soler E, Jiménez A, Hernández B. Neonatal lupus erythematosus related to maternal leukocytoclastic vasculitis. Pediatr Dermatol 1997; 14:221-5. [PMID: 9192418 DOI: 10.1111/j.1525-1470.1997.tb00243.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Neonatal lupus erythematosus (NLE) is an autoimmune disease whose major findings are skin lesions and congenital heart block. Affected infants have maternal, transplacentally acquired, autoantibodies to Ro/SSA, La/SSB, or U1-RNP antigens. Anti-Ro/SSA is the predominant autoantibody, present in about 95% of cases. Mothers of babies with NLE may be asymptomatic initially or may have Sjögren syndrome, lupus erythematosus, overlap syndrome or, uncommonly, leukocytoclastic vasculitis. When evaluating a young woman with a cutaneous leucocytoclastic vasculitis, dermatologists should be aware of the possible presence of antibodies related to NLE. If any patient suffering a disorder related to NLE becomes pregnant, testing for autoantibodies and close obstetric prenatal care with fetal echocardiogram is necessary. In cases of fetal bradycardia, treatment with dexamethasone or betamethasone should be considered, as these drugs are accessible to the fetal circulation.
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Affiliation(s)
- L Borrego
- Department of Dermatology, Hospital Insular, Las Palmas de Gran Canaria, Canary Islands, Spain
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Abstract
The perception of degree of risk can vary markedly from actual risk. About 5% of the cases of AIDS and HIV infection in the United States have occurred in health care workers, a percentage that has remained stable over time. Nearly all of these infections are related to lifestyle factors, not occupational risk. The rise of occupational transmission is greatest with parenteral injuries. If there is an HIV risk to patients, it appears to be very much smaller than the risk to workers although it has received even more publicity. Apprehension exists concerning the future framework of the medical care delivery system and who will care for whom. The sensitive handling of legitimate fears and the balancing of conflicting risks will continue to be a challenging task in the decades ahead.
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Affiliation(s)
- S H Weiss
- Division of Infectious Diseases Epidemiology, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, USA
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Turnbull J. Temporal arteritis and polymyalgia rheumatica: nosographic and nosologic considerations. Neurology 1996; 46:901-6. [PMID: 8780060 DOI: 10.1212/wnl.46.4.901] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Original reports on temporal arteritis and polymyalgia rheumatica were reviewed before and after the introduction of steroid therapy to prevent blindness in temporal arteritis. In some cases, the original data were reworked. There is evidence that both diseases have become more benign. As a result, the perceived risk of blindness is presently overestimated, as is the perceived benefit of steroids in reducing this risk, and neither should be used as support for an essential difference between temporal arteritis and polymyalgia rheumatica. Indeed, no qualitative differences otherwise exist and both are best viewed as facets of a common disease spectrum with variable risk of adverse outcome. Some of the difficulties in dealing with diseases characterized by variable risk within present dichotomous classifications are discussed. It is likely that in many patients benign disease is presently undiagnosed. It is likely that certain classifications of temporal arteritis and polymyalgia rheumatica now in use lead to an overtreatment of some patients with relatively benign disease.
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Affiliation(s)
- J Turnbull
- Department of Medicine (Neurology), McMaster University, Hamilton, ON, Canada
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Sloan EP, McGill BA, Zalenski R, Tsui P, Chen EH, Duda J, Morris M, Sherer R, Barrett J. Human immunodeficiency virus and hepatitis B virus seroprevalence in an urban trauma population. THE JOURNAL OF TRAUMA 1995; 38:736-41. [PMID: 7760401 DOI: 10.1097/00005373-199505000-00010] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To determine the seroprevalence of the human immunodeficiency virus (HIV) and the hepatitis B virus (HBV) in patients of an urban level I trauma center. DESIGN Prospective, blinded point prevalence study of serum HIV and HBV antibody and antigen. SETTING An urban level I trauma center that participates in a trauma system serving three million people. PATIENTS The study included 994 (94.8%) of 1049 consecutive trauma service patients treated between June 6, 1988 and September 22, 1988. The patients were 82.2% male and 73.1% black, with a mean age of 28.8 +/- 12.3 years. Blunt trauma was seen in 65.4% of patients, 5.2% were in shock, and 96.2% survived their trauma. MAIN OUTCOME MEASURES HIV and HBV seroprevalence, using both antibody and antigen testing. RESULTS HIV infection was seen in 43 patients (4.3%); 41 (95.3%) were HIV Ab+ and two (4.7%) were HIV Ab-/HIV Ag+. Infection with the HBsAg was seen in 31 patients (3.1%). Infection with either virus was seen in 70 patients (7%); four patients (0.4%) were infectious for both viruses. Infection was related to age 20 to 49 years, i.v. drug use, a hepatitis or sexually transmitted disease history, prior HIV testing, shock, and death (p < 0.05). Penetrating trauma was not predictive of infection. In a logistic regression model, IV drug use was the single significant predictor of infection (p < 0.05). CONCLUSIONS Young urban trauma patients, because of drug-related intentional violence, are 15.3 to 17.6 times more likely to be HIV infected and 3.9 to 7.9 times more likely to be infectious for HIV or HBV than the trauma population overall. The 12 to 21% infection rates in critically injured patients who require shock resuscitation and/or die reinforces the need for mandated universal precautions and for clear policies which govern the performance of procedures by physicians in training. Primary HIV infection in critically injured patients may worsen their outcome and may adversely affect the exposed health care worker. Emergency departments and trauma units should develop a referral system to HIV primary care services (HIV counselling and testing) for high risk patients and for adversely exposed health care workers.
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Affiliation(s)
- E P Sloan
- Department of Emergency Medicine, University of Illinois College of Medicine, USA
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12
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Serb P, Yeung S. HIV infection and the dentist. 1. The presence of HIV in saliva and its implications to dental practice. Aust Dent J 1994; 39:67-72. [PMID: 8018061 DOI: 10.1111/j.1834-7819.1994.tb01375.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The human immunodeficiency virus (HIV) has been detected in all body fluids. The presence and the detection of HIV virus in human saliva are reviewed. Modes of HIV transmission are discussed with particular reference to the possibility and risk of virus transmission via saliva. This risk is considered to be extremely low. The relevance of this information to the practising dentist is discussed and some practical suggestions in infection control are made.
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Affiliation(s)
- P Serb
- Department of Preventive Dentistry, University of Sydney
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Mandel M, Toren A, Hadani M, Engelberg I, Martinowitz U, Rechavi G. Ependymoblastoma in an HIV-positive hemophilic girl. MEDICAL AND PEDIATRIC ONCOLOGY 1994; 23:441-3. [PMID: 8084312 DOI: 10.1002/mpo.2950230509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A case of an HIV-positive hemophilic girl with an ependymoblastoma is presented. The unusual association between the HIV-related condition and her brain tumor is discussed, speculating a viral mechanism involved in the induction of neoplasia.
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Affiliation(s)
- M Mandel
- Institute of Hematology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
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Siew C, Chang SB, Gruninger SE, Verrusio AC, Neidle EA. Self-reported percutaneous injuries in dentists: implications for HBV, HIV, transmission risk. J Am Dent Assoc 1992; 123:36-44. [PMID: 1320064 DOI: 10.14219/jada.archive.1992.0149] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- C Siew
- Division of Toxicology, ADA Research Institute, Chicago
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Owens DK, Nease RF. Occupational exposure to human immunodeficiency virus and hepatitis B virus: a comparative analysis of risk. Am J Med 1992; 92:503-12. [PMID: 1580297 DOI: 10.1016/0002-9343(92)90747-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To estimate the occupational risk from infection with the human immunodeficiency virus (HIV) in terms of loss of (quality-adjusted) life expectancy, and to compare that risk to those posed by other hazards faced by health care workers. DESIGN Decision-analytic model. RESULTS For a 30-year-old female health care worker (unvaccinated for hepatitis B virus [HBV]), the loss of life expectancy from a needlestick from a symptomatic HIV-positive (HIV+) patient is 39 days (range, 17 to 93 days), as compared with a loss of 17 days from a needlestick from a patient who is hepatitis-B-surface-antigen-positive (HBsAg+), and 38 days from a needlestick from a patient who is hepatitis-B-e-antigen-positive (HBeAg+). When morbidity is included in the analysis of risk (through calculation of the quality-adjusted loss of life expectancy), the risk from both HBV and HIV increases. The quality-adjusted loss of life expectancy due to a needlestick exposure from a symptomatic HIV+ patient is 45 days (range, 20 to 108 days), as compared with a quality-adjusted loss of life expectancy of 48 days from a needlestick from an HBsAg+ patient, and 109 days from a needlestick from a patient who is known to be HBeAg+. By comparison, a cross-country automobile trip is associated with a loss of life expectancy of approximately 1 day. The 45- to 50-day loss of quality-adjusted life expectancy from percutaneous exposures to HIV and HBV is approximately the same magnitude as the gain in life expectancy from 10 years of annual screening for breast cancer with mammography and physical examination. CONCLUSIONS The risk associated with percutaneous exposures to symptomatic HIV+ patients is comparable to other risks that health care workers have faced knowingly and have accepted in the recent past. However, the loss of quality-adjusted life expectancy associated with a needlestick exposure is significant. Identification of cost-effective methods that increase the safety of medical personnel but also ensure full access to high-quality care for HIV+ patients should be a high priority.
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Affiliation(s)
- D K Owens
- Department of Veterans Affairs Medical Center, Palo Alto, CA
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Abstract
The perception of degree of risk can vary markedly from actual risk. About 5% of the cases of AIDS and HIV infection in the United States have occurred in healthcare workers, a percentage that has remained stable over time. Nearly all of these infections are related to lifestyle factors, not occupational risk. The risk to patients appears to be very much smaller, but has received even more publicity. Apprehension exists concerning the future framework of our medical care delivery system and who will care for whom. The sensitive handling of legitimate fears and the minimization and balancing of conflicting risks will be a challenging task in the decades ahead.
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Affiliation(s)
- S H Weiss
- Department of Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark
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Ortiz R, Aaberg TM. Human immunodeficiency virus disease epidemiology and nosocomial infection. Am J Ophthalmol 1991; 112:335-42. [PMID: 1882946 DOI: 10.1016/s0002-9394(14)76737-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- R Ortiz
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA
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Cavalcante NJ, Abreu ES, Fernandes ME, Richtmann R, Piovesana MN, Yamada FT, Carvalho ES. Risk of health care professionals acquiring HIV infection in Latin America. AIDS Care 1991; 3:311-6. [PMID: 1932195 DOI: 10.1080/09540129108253078] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This study describes the professional risk of acquiring HIV infection while caring for AIDS patients at a teaching hospital in Brazil. Since 1985 we have tested health care professionals (HCP) for HIV-1 antibody after accidents with blood and body fluids from AIDS patients. The blood samples were tested twice using an ELISA FDA approved test and, if positive, we performed Western blot. Two hundred and forty seven health care professionals reported 338 accidents (50% were percutaneous and 22% were mucous membrane exposures to blood). A further 404 HCPs reported no occupational exposure but wanted to be tested. From 247 HCPs with at least one accident, we analyzed 115 with more than 6 months of follow up. None were HIV antibody positive. Nobody received zidovudine as a prophylaxis. Of the 404 HCPs with no accident, 6 (1.5%) were positive and had confirmed risk factors for HIV. Our results support other studies that report a low occupational risk (about 0.4%) of acquiring HIV infection.
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Abstract
Neuroendocrine activity was studied in 60 consecutive untreated patients with dyspnoea and a clinical suspicion of heart failure. On the basis of the so-called Boston clinical criteria the diagnosis of heart failure was regarded as unlikely in 26 patients, possible in 15 patients, and definite in 19 patients. These groups were studied before any drug treatment was started and were compared with a control group of 69 healthy individuals. Plasma atrial natriuretic peptide concentration was clearly raised in patients with definite heart failure and slightly raised in patients with possible heart failure. Plasma adrenaline concentration was somewhat raised in patients with definite or possible heart failure, whereas plasma noradrenaline concentration was raised only in patients with definite heart failure. Plasma renin activity was not increased in any of the patient groups and plasma aldosterone concentration was slightly increased only in patients with definite heart failure. In the total patient series there were significant correlations between plasma atrial natriuretic peptide concentration and markers of the severity of left ventricular dysfunction. There was some evidence of neuroendocrine activation in untreated heart failure: plasma concentrations of atrial natriuretic peptide and catecholamines were increased but the renin-angiotensin-aldosterone system showed little or no activation.
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Affiliation(s)
- J Remes
- Kuopio University, Central Hospital, Finland
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20
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Whitby M, Stead P, Najman JM. Needlestick injury: impact of a recapping device and an associated education program. Infect Control Hosp Epidemiol 1991; 12:220-5. [PMID: 2061580 DOI: 10.1086/646328] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To determine the impact of the introduction of a plastic shield-shaped device (Needleguard, Biosafe, Auckland, New Zealand) and education program designed to allow safer recapping, on recorded rates of needlestick injury. DESIGN A before-after trial with a two-year duration of follow-up. SETTING Tertiary referral hospital. PARTICIPANTS Nursing and other hospital personnel. RESULTS Prospectively collected baseline data, together with the results of an anonymous questionnaire of 25% of the hospital nursing staff, defined a reported needlestick injury rate of 6.9 per hundred full-time nursing staff per year. In the pre-intervention period, there were 6.7 needlestick injuries per 100 nursing staff members per year reported. This increased to 15.4 (p less than .0001) needlestick injuries per 100 nursing staff members per year after the intervention. An anonymous survey undertaken at both time periods suggests that the apparent increase in officially reported needlestick injuries is due to an increase in the willingness of nurses to now report previously unreported needlestick injuries. CONCLUSIONS The impact of the safety device and education program was the more accurate reporting of needlestick injuries; many nursing staff continued to resheath needles contrary to hospital policy. Many staff simply did not use the newly designed safety device. Approaches to improving compliance with such safety devices are considered.
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Affiliation(s)
- M Whitby
- Department of Infectious Diseases, Princess Alexandra Hospital, Brisbane, Australia
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Affiliation(s)
- A E Cowen
- Department of Gastroenterology, Royal Brisbane Hospital, Australia
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22
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Tandberg D, Stewart KK, Doezema D. Under-reporting of contaminated needlestick injuries in emergency health care workers. Ann Emerg Med 1991; 20:66-70. [PMID: 1984732 DOI: 10.1016/s0196-0644(05)81122-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
STUDY HYPOTHESIS There is considerable under-reporting of contaminated occupational needlestick and other sharp object injuries among emergency health care workers. POPULATION A convenience sample of emergency physicians, emergency nurses, and emergency medical technicians (EMTs). METHODS A survey instrument eliciting demographic and work-related factors was developed and administered; survey items included age, sex, occupation, years in occupation, number of procedures performed per week, number of contaminated needlestick (and other "sharps") injuries recalled, and number of these injuries formally reported during the previous five years. Nonsegmented visual analog scales were used to assess eight attitudes possibly associated with nonreporting. Analysis was by analysis of variance and multiple linear regression with stepwise variable election. RESULTS Two hundred fifty-nine subjects recalled 643 contaminated exposures during the five-year study period, but only 228 (35%) were formally reported. One or more injuries occurred in 55% of EMTs compared with 72% of nurses and 80% of physicians (P less than .05). Physicians recalled a mean of 3.8 contaminated exposures, whereas nurses recalled 2.8 and EMTs recalled only 1.8 (P less than .05). Physicians formally reported a mean of 0.26 exposures, whereas EMTs reported 0.85 and nurses reported 1.25 (P less than .05). Physicians formally reported only one eighth of their injuries compared with EMTs and nurses, who each reported two thirds of these events (P less than .05). Perception of risk, occupation, years in occupation, and concern about excessive paperwork were the most powerful predictors of low reporting rate (P less than .05). CONCLUSIONS Work-related contaminated sharp object injuries are under-reported by emergency health care workers, especially emergency physicians.
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Affiliation(s)
- D Tandberg
- Division of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque 87131
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Krueger GR, Ablashi DV, Lusso P, Josephs SF. Immunological dysregulation of lymph nodes in AIDS patients. CURRENT TOPICS IN PATHOLOGY. ERGEBNISSE DER PATHOLOGIE 1991; 84 ( Pt 2):157-88. [PMID: 2044408 DOI: 10.1007/978-3-642-75522-4_5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Changes in immune competent tissues of the HIV-1-infected person reflect to a certain extent the kind and intensity of immunological dysregulations. The diagnostic approach, however, must include immunophenotyping of cells, immunovirological studies of virus distribution in diseased tissues, and functional tests in addition to classical morphology. The latter technique alone just serves as a crude screening method since structural lesions in lymphoid tissues do not permit discrimination from other HIV-independent immune deficiency and autoimmune disorders. Although the overall appearance of lymph nodes in HIV infection and in chronic autoimmune disorders, such as collagen vascular diseases (e.g., rheumatoid arthritis and systemic lupus erythematosus), is similar, immunophenotyping shows a progressive loss of CD4 cells in HIV infection yet a quantitative increase in this cell population in autoimmune disorders (Krueger 1985a). In addition, there are other persistent active infections by lymphotropic viruses (e.g., EBV or HHV-6) which can cause structural and cellular changes in lymphoid tissues closely resembling HIV-induced lesions (Krueger et al. 1988b; Krueger 1985b). The pathological diagnosis therefore nedds to be supplemented by serological studies and--in selected cases--by in situ hybridization for the demonstration of viral genome. Southern blotting for viral DNA can only detect high numbers of viral genome copies in tissue extracts, not in which cell population the virus resides (e.g., malignant cells vs associated "normal" cells), while the polymerase chain amplification reaction, the most sensitive of all (Buchbinder et al. 1988), cannot yet differentiate between latent and (disease-related) active infection. Taking into consideration the above-described precautions in the evaluation of lymphatic lesions, there are a number of characteristic changes which reflect well the sequelae of HIV infection itself and of the ensuing immune dysregulation. Progressive loss of CD4 cells in the paracortex of lymph nodes and in the peripheral blood leads to inversion of the CD4/CD8 ratio. Loss of demonstrable CD4 cells is probably the consequence not only of cell lysis by HIV-1 infection (note: discrepancy between HIV-1 genome positive cell numbers and depletion of CD4 cells) but also of decreased CD4 marker synthesis in infected cells (Stevenson et al. 1987). In this context it is interesting that Fouchard et al. (1986) were able to show HIV expression in CD8 cells and theorized that these developed from infected CD4 cells which subsequently lost the CD4 epitope and expressed CD8.(ABSTRACT TRUNCATED AT 400 WORDS)
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Abstract
OBJECTIVE To assess the frequency and causes of needlestick injuries in medical and surgical housestaff. DESIGN A retrospective survey. SETTING Urban university teaching hospital. PARTICIPANTS 386 housestaff; 221 responded. INTERVENTION Survey questionnaire. MAIN RESULTS 1) Frequency of needlestick: Of 221 respondents, 57 (26%) reported never having had a needlestick, while 164 (74%) reported at least one needlestick injury with a suture or hollow-bore needle. The average frequencies were 0.63 per resident-year among 149 non-surgical residents and 3.8 per resident-year among 72 surgical residents. Among residents in internal medicine, 12 of 78 needlestick injuries (15%) sustained were from patients documented to be HIV-positive. 2) Causes of needlestick: The causes of injury were assessed in detail in a sample of the 157 most recent needlestick injuries. Suturing was the cause in 35 of 61 (57%) surgical residents, while recapping needles was the cause in 36 of 96 (38%) non-surgical residents. Inexperience was not the cause of injury; in 94% of cases the residents felt comfortable performing the procedure, and in 74% of cases the residents had performed the procedure more than 50 times before. 3) Reporting of injury: Only 30 (19%) of 157 injuries were reported to the personnel health service, thus compromising documentation for potential workmen's compensation. CONCLUSIONS Needlestick injuries are common among medical and surgical housestaff. Efforts should be made to prevent needlestick injuries and to report those that occur.
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Affiliation(s)
- A E Heald
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510-8025
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25
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René E, Verdon R. Upper gastrointestinal tract infections in AIDS. AIDS GIT Group. BAILLIERE'S CLINICAL GASTROENTEROLOGY 1990; 4:339-59. [PMID: 2282380 DOI: 10.1016/0950-3528(90)90005-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Upper gastrointestinal tract infection in AIDS is a complex multifactorial process. The approach to diagnostic evaluation can be based upon knowledge of the large spectrum of bacteria, viruses and protozoa involved. The availability of effective therapy is the most decisive factor in determining the duration of upper gastrointestinal tract infections in AIDS patients. Awareness of the clinical, epidemiological, immunological and therapeutic aspects should help to direct the diagnostic evaluation of these patients and to highlight areas of research.
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26
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Jui J, Modesitt S, Fleming D, Stevens P, Wayson B, Hulman S, Schriver JA. Multicenter HIV and hepatitis B seroprevalence study. J Emerg Med 1990; 8:243-51. [PMID: 2197320 DOI: 10.1016/0736-4679(90)90001-c] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Prior single institutional investigations have found unrecognized HIV seroprevalence in emergency department (ED) patients to range from 0.38% to 4%. A prospective, anonymous study of HIV and hepatitis B (HB) seroprevalence was performed on excess serum of all ED patients over two 48-hour periods in May and August, 1988, from 7 hospitals in the Portland metropolitan area. Demographics were known for 338/444 (76%) of patients. Forty-six percent were male, 85% white, with a median age group of 30-39 years. Ambulance transport, trauma, external blood, presentations requiring ED procedure(s), and acuity resulting in ICU admission were present on 21%, 7%, 10%, 34%, and 14% of patients, respectively. Two of 444 (.45%) patients were HIV +, one previously undiagnosed. Fifty-five of the 444 (12%) and 3 of 444 (0.6%) samples were positive for HBcAB and HBsAG respectively. Risk factor assessment was possible on 180/444 (40%) patients. HBcAB seroprevalence correlated with race (P less than 0.01), IV drug use (P less than 0.0001), and hospital location, (P less than 0.006) but were sensitive in detecting only 14%, 18%, and 38%, respectively, of HBcAB+ patients. HBcAB was not associated with the following factors: sex, area of residence, presence of blood externally, trauma, acuity of illness, ED procedures, or mode of transport. This data strongly support the use of universal body fluid precautions. Hepatitis B poses a significant and distinct risk to all emergency care providers. HB vaccination should be strongly advocated for all ED health care workers (HCWs). Emergency medicine multicenter studies are both desirable and feasible.
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Affiliation(s)
- J Jui
- Division of Emergency Medicine, Oregon Health Sciences University, Portland 97201-3098
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27
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Kelen GD. Human immunodeficiency virus and the emergency department: risks and risk protection for health care providers. Ann Emerg Med 1990; 19:242-8. [PMID: 2155551 DOI: 10.1016/s0196-0644(05)82037-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The AIDS epidemic is having an increasing impact on the practice of emergency medicine. In inner-city emergency departments, significant numbers of patients have unrecognized human immunodeficiency virus (HIV) infection. Transmission of HIV in the health care setting has been predominantly from exposure to patients' infected blood, but most of the exposures (80%) are due to injuries from sharp instruments. There are only 18 documented cases of occupational HIV transmission worldwide. Four of these have occurred from nonparenteral exposures. Based on surveillance studies, the best estimate of seroconversion after exposure is about 0.5%. However, due to methodologic limitations, these figures may be underestimations. The effectiveness of azidothymidine for postexposure prophylaxis has not been shown. Currently, the best protection against HIV and other blood-borne pathogens remains use of universal precautions.
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Affiliation(s)
- G D Kelen
- Division of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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28
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Abstract
The goal of finding an effective vaccine against the human immunodeficiency virus (HIV) is hampered by our uncertainty of the mechanism(s) responsible for the pathogenesis as well as the lack of knowledge of protective mechanisms. The effects of HIV on the immune system are myriad and thus the truly significant manifestations of the pathology are difficult to dissociate from those more peripheral. In this article we will initially characterize the natural history of HIV infection which shows a chronic and perhaps inexorable course. The second part will deal with the immune response mounted against this assault and the final section is a discussion of the possible unfavorable consequences of the immune response that humans muster against this agent.
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Affiliation(s)
- D E Lewis
- Department of Microbiology and Immunology, Baylor College of Medicine, Houston, Texas 77030
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29
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Cello JP. AIDS and the gastroenterologist. SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY. SUPPLEMENT 1990; 175:146-58. [PMID: 2237276 DOI: 10.3109/00365529009093138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Over the next several decades the gastroenterologist practicing anywhere in the world will be confronted with patients with AIDS-related gastrointestinal disorders. Universal body substance isolation precautions should be practiced, however, in dealing with all patients, including those outside traditional 'risk' groups for AIDS. Principal among these precautions are using gloves for personnel involved in procedures and high-level disinfection or sterilization for all endoscopy equipment. Endoscopic procedures should be planned well in advance with special attention to endoscope selection and transport media availability. Organ-associated symptoms are reviewed, especially dysphagia, odynophagia, hemorrhage, diarrhea, and abdominal pain. Opportunistic infections and malignancies often present characteristic endoscopic appearances such as that seen for cytomegalovirus ulceration or Kaposi's sarcoma. AIDS-related biliary disorders should also be recognized, principally sclerosing cholangitic or papillary stenosis.
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Affiliation(s)
- J P Cello
- University of California, San Francisco
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30
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Abstract
An experimental field study examined dentists' attitudes and actual behaviors toward men who belong to groups at great risk of AIDS. A total of 102 randomly selected dentists were uninformed subjects who examined an actor in need of dental care and who played three roles as a patient: one who is heterosexual, homosexual, and an intravenous drug user. After each examination, the actor/patient completed a questionnaire about his experience and the dentists were interviewed about homosexuality and AIDS. The dentists were then debriefed and told that they were part of an experiment. Despite negative feelings toward homosexuality, only one dentist refused to treat the actor when he was perceived to be homosexual. One dentist also rejected him when he played the part of an intravenous drug user.
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Affiliation(s)
- H M Hazelkorn
- School of Public Health East, University of Illinois Chicago 60680
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31
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Turner SB, Kunches LM, Gordon KF, Travers PH, Mueller NE. Occupational exposure to human immunodeficiency virus (HIV) and hepatitis B virus (HBV) among embalmers: a pilot seroprevalence study. Am J Public Health 1989; 79:1425-6. [PMID: 2782520 PMCID: PMC1350194 DOI: 10.2105/ajph.79.10.1425] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We performed a serosurvey of 133 embalmers in an urban area where human immunodeficiency virus (HIV) infection is prevalent. Although we found histories of needlesticks to be common, and the seropositivity rate of hepatitis B virus (HBV) (13%) was approximately twice that of a blood donor comparison group, HIV antibody was uniformly absent in 129 embalmers who denied HIV risk factors, and present in one of four with self-described risk behaviors. The risk of HBV infection was higher among embalmers who have worked more than 10 years, relative risk (RR) 16.2 (95% confidence interval 2.1, 126.5), did not routinely wear gloves, RR 9.8 (CI 3.4, 28.5), or are employed in the city of Boston, RR 4.7 (CI 1.8, 12.0).
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Affiliation(s)
- S B Turner
- Division of Community Health Services, Boston Department of Health and Hospitals, MA
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32
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33
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Abstract
One hundred and fifty-five women attending antenatal clinics in an inner city area where the rate of AIDS reporting is high were interviewed to examine the acceptability of different modes and purposes of antenatal HIV testing. Eighty-two per cent of women felt the test should be available in antenatal clinics, but only 48% reported that they themselves would take the test. Seventy-four per cent would accept anonymous testing. Potential anxiety levels surrounding the HIV test were significantly higher than for other (currently routine) tests in antenatal clinics. The implications of these findings for policy are discussed.
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Affiliation(s)
- A Stevens
- Department of Public Health, St Mary's Hospital, London, U.K
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34
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Regnier B. Transmission du VIH aux personnels des services de reanimation. Med Mal Infect 1989. [DOI: 10.1016/s0399-077x(89)80079-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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35
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Verrusio AC. Risk of transmission of the human immunodeficiency virus to health care workers exposed to HIV-infected patients: a review. J Am Dent Assoc 1989; 118:339-42. [PMID: 2646345 DOI: 10.14219/jada.archive.1989.0108] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The possibility of transmission of the human immunodeficiency virus (HIV) to health care workers with occupational exposure to infected patients has caused concern since the beginning of the AIDS crisis. This report summarizes both national surveillance data for AIDS among health care workers and the results of prospective studies on the risk of HIV transmission in the health care professions. All the available evidence indicates that HIV infection in health care workers in the United States results primarily from exposure outside the health care setting, and is acquired by one of the conventional routes of transmission. A small number of health care workers have been infected with HIV through occupational exposure. Prospective surveillance studies indicate that the risk of seroconversion after needlestick exposure to HIV-infected blood is about 0.5%. The level of risk associated with exposure of mucous membranes or nonintact skin is far less.
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Affiliation(s)
- A C Verrusio
- Council on Dental Research, American Dental Association, Chicago
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36
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Weber DJ, Rutala WA. Management of HIV-1 Infection in the Hospital Setting. Infect Control Hosp Epidemiol 1989. [DOI: 10.2307/30145173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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37
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McMahon KM. The Integration of HIV Testing and Counseling into Nursing Practice. Nurs Clin North Am 1988. [DOI: 10.1016/s0029-6465(22)01438-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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38
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Reisman EC. Ethical Issues Confronting Nurses. Nurs Clin North Am 1988. [DOI: 10.1016/s0029-6465(22)01437-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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39
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Govoni LA. Psychosocial Issues of AIDS in the Nursing Care of Homosexual Men and Their Significant Others. Nurs Clin North Am 1988. [DOI: 10.1016/s0029-6465(22)01434-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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40
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Affiliation(s)
- A J Block
- VA Medical Center, Gainesville, Florida 32605
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41
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42
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Abstract
A study of 177 baccalaureate nursing students was conducted to explore their knowledge, fears, beliefs and other attitudes regarding AIDS. Lazarus' theory related to coping with threatening events provided the theoretical framework. Students with a high fear score were less willing to care for AIDS patients, had higher knowledge scores, and were more homophobic. While 96.6% of the students felt that AIDS patients are entitled to the same care as any other patient, 49% preferred not to care for AIDS patients. Thirty-six percent thought nursing students should not be assigned to care for AIDS patients. Most of the students (70.6%) got their information about AIDS from the media. Nursing faculty must respond by including current, correct information when instructing students about AIDS. Faculty also need to provide opportunities for students to ask questions and share their fears regarding AIDS.
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Affiliation(s)
- L B Lester
- Nursing Education, Eastern Michigan University, Ypsilanti
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43
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Kelen GD. Reanalysis of surveillance data regarding health care worker risk of nosocomial acquisition of HIV. Ann Emerg Med 1988; 17:1101-2. [PMID: 3178003 DOI: 10.1016/s0196-0644(88)80456-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- G D Kelen
- Division of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland
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44
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45
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Baker JL. What is the occupational risk to emergency care providers from the human immunodeficiency virus? Ann Emerg Med 1988; 17:700-3. [PMID: 3382071 DOI: 10.1016/s0196-0644(88)80615-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The risk to health care providers of acquiring human immunodeficiency virus (HIV) infection through occupational exposure is very low, but the consequences of becoming infected are obviously severe. The magnitude of this risk has been debated extensively in the medical literature, but the majority of these discussions have focused on providers of surgical, orthopedic, and obstetric care, none of whom have ever been documented to have become infected with HIV through occupational exposure. In contrast, there has been very little information published regarding the degree of risk to emergency care providers, several of whom have been confirmed as having acquired HIV infection through occupational exposures. This report addresses the extent and nature of risk of HIV infection to emergency care providers and reviews the current management of significant exposures.
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Affiliation(s)
- J L Baker
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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46
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Kelen GD, Fritz S, Qaqish B, Brookmeyer R, Baker JL, Kline RL, Cuddy RM, Goessel TK, Floccare D, Williams KA. Unrecognized human immunodeficiency virus infection in emergency department patients. N Engl J Med 1988; 318:1645-50. [PMID: 3163774 DOI: 10.1056/nejm198806233182503] [Citation(s) in RCA: 221] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
To determine the extent of unrecognized human immunodeficiency virus (HIV) infection, we examined blood samples drawn from patients presenting to an inner-city emergency department. We found 119 of 2302 consecutive adult patients (5.2 percent) to be seropositive for HIV. Although 27 patients presented with known symptomatic HIV infection, 92 of the remaining 2275 patients (4.0 percent) had unrecognized HIV infection. The highest seroprevalence rate (11.4 percent) was found among black men 30 to 34 years of age. Blacks, other nonwhites, and patients under the age of 45 had high rates of unrecognized infection. The clinical team established risk-factor status in only 29.0 percent of the patients. Of the 276 patients with identified risk factors, 13.0 percent were seropositive, whereas 3.1 percent of the 1616 patients with unknown risk-factor status were seropositive. None of the 102 patients who reported no risk factors were seropositive. Although penetrating trauma (seroprevalence, 13.6 percent) was the only clinical presentation associated with an increased seroprevalence rate independent of other known predictors of infection (P = 0.02), seropositive patients were found in all categories of clinical condition. These data, although based on observations in one emergency department setting, support the concept of universal blood and body-fluid precautions by all health care workers whether or not HIV infection is known.
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Affiliation(s)
- G D Kelen
- Division of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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47
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Kingston D. Memorandum on the infections hazards of the common communion cup with especial reference to AIDS. Eur J Epidemiol 1988; 4:164-70. [PMID: 3402575 DOI: 10.1007/bf00144745] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Bacteriological studies on the communion cup have shown that there is a low level of contamination with mouth organisms on the rim. The death rate of bacteria on the cup surface would not be significant, but the wine had a bactericidal effect on most but not all organisms tested. However droplets of saliva did not readily mix with the wine. In considering the spread of AIDS, extensive studies of people infected with human immunodeficiency virus (HIV) in hospital or at home have shown that the established routes of spread are the injection of blood or blood products, sexual intercourse or at birth. There are only very rare examples of spread by other means. The virus is rarely isolated from the saliva and a study of homosexuals indulging in oral sexual intercourse suggests that it is very poorly infectious when taken into the mouth or swallowed. It is concluded that the risk of transmission of HIV by the common communion cup can be neglected under ordinary circumstances. Suggestions are made for improving the hygiene of the communion service which may be useful under special circumstances: there is no evidence that disease is spread in this way under normal conditions.
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Affiliation(s)
- D Kingston
- Division of Communicable Diseases, Clinical Research Centre, Harrow, UK
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48
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Lepage P, Van de Perre P. Nosocomial transmission of HIV in Africa: what tribute is paid to contaminated blood transfusions and medical injections? Infect Control Hosp Epidemiol 1988; 9:200-3. [PMID: 3372990 DOI: 10.1086/645833] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We reviewed the published data on the possible impact of medical injections and blood transfusions on the spread of human immunodeficiency virus (HIV) in Africa. We also compared these results to our experience in Rwanda, central Africa. The importance of medical injections in the epidemic of HIV infection seems to differ from one area to another. The excess of injections experienced by HIV seropositive subjects in Zaire could be secondary to the parenteral treatment of early HIV-related illness or to the treatment of sexually transmitted diseases, rather than being the cause of HIV infection, as suggested by Rwandese studies. In contrast, blood transfusions have been shown to represent an important source of nosocomial HIV infection in many African countries. Effective and relatively inexpensive measures to diminish the iatrogenic spread of HIV infection in developing countries are summarized.
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Affiliation(s)
- P Lepage
- Department of Pediatrics, Centre Hospitalier de Kigali, Rwanda
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49
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Roach PJ, Fleming C, Hagen MD, Pauker SG. Prostatic cancer in a patient with asymptomatic HIV infection: are some lives more equal than others? Med Decis Making 1988; 8:132-44. [PMID: 3283490 DOI: 10.1177/0272989x8800800209] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- P J Roach
- Department of Medicine, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts
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50
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Abstract
Cerebral astrocytoma has been found in two patients with AIDS related conditions. The fortuity of this unusual association is discussed, insofar as immunosuppression could favour the growth of certain neoplasms.
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Affiliation(s)
- J Gasnault
- Department of Neurosurgery, Hôpital Sainte-Anne, Paris, France
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