Health and economic impact of HIV/AIDS on South African households: a cohort study

Background  

South African households are severely affected by human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) but health and economic impacts have not been quantified in controlled cohort studies.     

Intramyocardial dissecting haematoma: an unusual form of cardiac rupture

The intramyocardial dissecting haematoma is an unusual rupture of the left ventricular wall, complicating acute myocardial infarction. The mechanism is an hemorrhagic dissection among the spiral myocardial fibres creating a neocavitation limited by the myocardium. It appears in 9% of left ventricular wall ruptures, complicating acute myocardial infarction. Diagnosis is often difficult and in most of the cases it is post-mortem. We present the case report of a 69 year old patient who suffered a posterolateral acute myocardial infarction treated with primary PTCA/Stent plus AAS, clopidogrel, unfractioned heparin bolus and GP IIb- IIIa inhibitors. In the following few hours he suffered this unusual form of cardiac rupture that took him into cardiogenic shock and finally led to his death. The pathophysiology, diagnosis and management of this lethal complication of acute myocardial infarction (90% mortality in the medically treated group) which is only effectively treated by surgery are also reviewed.     

Pharmaceutical care in people who have had acute coronary episodes (TOMCOR study)]

BACKGROUND: This study evaluates the effects on coronary patients of a new practice in community pharmacies called Pharmaceutical Care (PhC) as compared to the traditional pattern of pharmacy practice. It attempts to ascertain whether pharmaceutical care is feasible in addition to ascertaining differences in effectiveness for coronary patients' pharmacotherapeutic health outcomes, potentially attributable to PhC. METHODS: A randomized prospective controlled-intervention study was conducted in 83 community pharmacies in the provinces of Asturias, Barcelona, Madrid and Biscay in a one-year monitoring of the drug-use of 735 patients at the start of the study (330 intervention patients and 405 control) and 600 at the end. RESULTS: Differences were fund in favor of the intervention group in: a) the use of health care services as a morbidity indicator such as frequency of hospital emergency room visits 1.27 I (CI95%; 1.10-1.44) and 1.63 C (CI95%; 1.36-1.90) or average length-of-stay in Intensive Care Units 2.46 I (CI95%; 1.56-3.36) and 5.87 C (CI95%; 3.57-8.17), both due to coronary causes; b) health-related quality of life score (physical functioning dimension difference of 4.7 (p < 0.05); c) average patient knowledge of coronary heart disease risk factors having improved by 10% (p < 0002-0.007 depending on dimension); d) patient knowledge of the name and identification of their drugs having improved by 10% (p < 0.001) along with their subjective perception of the antiagregans drugs relative importance having improved by 12% (p < 0.009) and effects of beta-blockers having improved by 25% (p < 0.02); e) average satisfaction with pharmaceutical care service and perception of pharmacist's professional competence having improved by 2% (p < 0.000 to 0.05 depending on dimension). CONCLUSIONS: A decrease in emergency health care demand due to coronary causes, a fewer number of patient hospitalizations and a shorter length-of-stay in Coronary Intensive Care Units due to hospitalization regarding coronary patients on pharmaceutical care would suggest that patients who suffered an acute coronary heart episode made a better use of drugs and would tend to be less ill. Furthermore, coronary patients who received pharmaceutical care services showed a better knowledge of the reasons for their pharmacotherapy and therefore took better advantage of health care resources and improved their health condition.     

Human immunodeficiency virus type 1-infected blood donors: epidemiologic, laboratory, and donation characteristics. The HIV Blood Donor Study Group

Transmission of human immunodeficiency virus type 1 (HIV-1) by homologous blood transfusion in the United States (US) is minimized by the deferral of potential donors who are at risk for HIV-1 infection and by the screening of all donations for HIV-1 antibody. HIV-1-seropositive donors at 20 blood centers were studied for information to be used in evaluating the safety of the US blood supply and making recommendations to increase that safety. From June 1988 to August 1989, 829 (0.04%) of 2,192,000 donors were found to be seropositive; 512 were interviewed. Of 388 seropositive men, 56 percent had had sex with men, 10 percent had used drugs intravenously, 8 percent had had sex with intravenous drug users, and 27 percent had no identified risk. Of 124 seropositive women, 58 percent had had sex with men at risk for HIV (81% of whom used drugs intravenously), 5 percent had used drugs intravenously, and 41 percent had no identified risk. Racial and ethnic minorities made up 68 percent of seropositive donors (black, 38%; Hispanic, 30%) and approximately 14 percent of all donors. The 157 persons with no identified risk had demographic characteristics and serologic test results for syphilis and hepatitis B that were more similar to those of HIV-1-seropositive donors with recognized risk than to those of seronegative donors. Three health care worker-blood donors (from an estimated 93,100 health care worker-donors) had infection that was probably acquired occupationally.(ABSTRACT TRUNCATED AT 250 WORDS)     

A highly sensitive and specific chemiluminescent enzyme-linked immunosorbent assay for diagnosis of active Trypanosoma cruzi infection

BACKGROUND: Chagas' disease is transmitted to man either by the bite of insects harboring Trypanosoma cruzi or by the transfusion of blood from infected donors. The conventional serologic testing as presently used in blood banks in South America is unsatisfactory, because of a high number of inconclusive and false-positive results. Other methods such as polymerase chain reaction and enzyme-linked immunosorbent assay (ELISA) with recombinant antigens have been proposed, but inherent difficulties have so far precluded their adoption in the large-scale screening required by blood banks. STUDY DESIGN AND METHODS: A highly sensitive and specific chemiluminescent ELISA using a purified trypomastigote glycoconjugate antigen and a complex epimastigote antigen was devised for the diagnosis of active T. cruzi infection. RESULTS: Chemiluminescent ELISA was 100-percent sensitive in the diagnosis of 100 cases of confirmed Chagas' disease. Inconclusive results and false-positive reactions were eliminated in a panel of 115 sera.The specificity of the chemiluminescent ELISA was 100 percent with a purified trypomastigote glycoconjugate antigen and 99.7 percent with a complex epimastigote antigen when applied to 1000 normal human sera and 288 heterologous sera from patients with other infections, including leishmaniasis, and vaccinated individuals. CONCLUSION: The chemiluminescent ELISAs provide a test that is highly sensitive (purified trypomastigote glycoconjugate and complex epimastigote antigens) and specific (purified trypomastigote glycoconjugate antigen) for Chagas' disease diagnosis. It can be used in blood bank screening and to monitor the treatment of patients undergoing chemotherapy.