Virulence factors of medically important fungi.

Human fungal pathogens have become an increasingly important medical problem with the explosion in the number of immunocompromised patients as a result of cancer, steroid therapy, chemotherapy, and AIDS. Additionally, the globalization of travel and expansion of humankind into previously undisturbed habitats have led to the reemergence of old fungi and new exposure to previously undescribed fungi. Until recently, relatively little was known about virulence factors for the medically important fungi. With the advent of molecular genetics, rapid progress has now been made in understanding the basis of pathogenicity for organisms such as Aspergillus species and Cryptococcus neoformans. The twin technologies of genetic transformation and "knockout" deletion construction allowed for genetic tests of virulence factors in these organisms. Such knowledge will prove invaluable for the rational design of antifungal therapies. Putative virulence factors and attributes are reviewed for Aspergillus species, C. neoformans, the dimorphic fungal pathogens, and others, with a focus upon a molecular genetic approach. Candida species are excluded from coverage, having been the subject of numerous recent reviews. This growing body of knowledge about fungal pathogens and their virulence factors will significantly aid efforts to treat the serious diseases they cause.     

Program characteristics of home-delivered meals programs for persons with HIV and AIDS

The nutritional status of persons with HIV and AIDS [PWAs] is constantly challenged throughout the progression of the illness. Home-delivered meals programs for PWAs are rapidly developing across the country to address this problem among the growing population of people with HIV infection and AIDS. This study examined client socio-demographic characteristics (sex, age, ethnicity), types of services offered by these programs, organizational and financial criteria, and characteristics of survey respondents.Data for this study was obtained from 15 of the 17 known home-delivered meals programs for PWAs in the United States through an original, cross-sectional survey instrument conducted by telephone interview between March 1994 and May 1994.Results from this study show an increase in the number of minority populations who participate in these programs (36% African-American and 12% Hispanic vs. 51% Caucasian), as well as women (17.2%) and children (7%). Geographic location was an important determinant for program eligibility. The number of meals served weekly varied greatly (from 510 to 12,600 per week). Other significant services included nutrition counselling, newsletters, and holiday-basket programs. Enhancing service-delivery systems was one of the more prevalent high-priority concerns cited, especially with regard to food quality and safety.These results show that these programs are catering increasingly to minority populations, women and children, and that they are expanding their services to meet the growing needs of their client populations. These findings suggest that there is a greater need for meals and other home-based services for persons living with HIV and AIDS.This research was supported by the Massachusetts Department of Public Health.He formerly was Director of Elder Health at the Massachusetts Department of Public Health, Boston, MA; he is a founder and serves on the Board of Directors of Community Servings     

Antimicrobial sensitivities in urinary tract infections in men

Six-thousand-seven-hunderd and forty-nine positive urine cultures from a large metropolitan Veterans Administration hospital were analyzed with respect to the organisms isolated and their antimicrobial sensitivies. A predicted therapeutic efficacy index was calculated for each antimicrobial agent tested. Gram-negative pathogens accounted for 84% of the infections. Proteus infections outnumbered those due to strains ofEscherichia coli. Gentamycin was found to be the most effective antimicrobial agent.     

Utility of an on-line computer system in a clinical setting for nutrient intake analyses

The present report describes a four-week trial at the Victoria General Hospital, Halifax, to determine the effect of access to a computer system on nutrient intake analyses, the problems in implementation of the system, and the response of the staff dietitians. An on-line system was obtained from the Ohio State University Hospitals and modified to reflect Canadian food and nutrient content, and to include some additional program features. Twelve hundred and eighty-six foods were characterized according to 15 food components, the system was responsive to nine interactive commands, and there were nine possible print-out formats of calculations. The results of the trial reinforced the expectation of greatly increased work efficiency, however, the system was not utilized to its potential. Some technical problems were largely overcome within the first week of operation. However, needs relating to the extensiveness of the food and nutrient data base, and the methodologies and time for obtaining and evaluating individual dietary intake information prevented maximum efficiency. The dietitians liked the comprehensiveness and detail of the system, however, routine dietary intake collections were too time-consuming for their present work schedules.     

Pediatric emergency information sheet using a microcomputer

Calculating the appropriate dosage of a drug and the right equipment size during an emergency situation can be a time-consuming, frustrating, and error-prone process, considering the shortage of time during a resuscitation. A microcomputer program was developed to aid in the care of pediatric patients in emergency or 'code' situations. This is accomplished by use of a printout of a patient-specific chart for most needed critical care drugs and equipment used during an emergency. This program is written in "C" language and is menu-driven.     

Birth registry

Birth registries are among the most common type of registry found in hospitals. Brigham and Women's Hospital has a high number of births annually. The following represents a brief overview of the status of this type of registry in healthcare today.