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van Leth F Huisamen CB Badaro R Vandercam B de Wet J Montaner JS Hall DB Wit FW Lange JM;NN Study Group 《Journal of acquired immune deficiency syndromes (1999)》2005,38(3):296-300
BACKGROUND: The initial rate of plasma HIV-1 RNA (pVL) decline has been proposed as a marker of early efficacy of antiretroviral therapy (ART) and a possible predictor of late efficacy. We compared the rate of pVL decline in patients starting ART with nevirapine (NVP), efavirenz (EFV), or both drugs combined in addition to lamivudine (3TC) and stavudine (d4T). METHODS: Analysis of the viral decay constant (VDc) during the first 2 weeks of treatment in patients enrolled in the 2NN study who remained on allocated treatment. RESULTS: The median VDc (log10 copies per day, [interquartile range]) was similar for NVP (0.30 [0.25-0.36], EFV (0.31 [0.27-0.37]), and NVP + EFV (0.30 [0.27-0.36]). Patients with a baseline pVL >100,000 copies/mL were 8.7 (95% confidence interval [CI]: 6.2-12.3) times more likely to have a VDc >75th percentile. A high VDc was not associated with plasma drug concentration or with a decreased risk of virologic failure at week 48 after the start of therapy (hazard ratio = 0.8, 95% CI: 0.6-1.2). CONCLUSION: NVP, EFV, or NVP + EFV in combination with 3TC and d4T show similar rates of pVL decline during the first 2 weeks of treatment. The VDc with these regimens is not predictive of late virologic efficacy. 相似文献
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A case of multiple myeloma presenting as a plasmacytoma and mimicking a pituitary tumor is reported. The importance of recognizing
the existence of plasmacytoma in the differential diagnosis of sellar and parasellar tumors is stressed, as it leads to important
differences in management. The literature is reviewed. Patients presenting with plasmacytoma with symptoms of a pituitary
adenoma have an average age of 58 years; the male to female ratio is 3:1; diplopia, headache, and progressive visual loss
are the most important symptoms; third, sixth, and fourth cranial nerve palsies are the most common signs; and pituitary function
is usually normal. CT scan of the sellar region is the imaging modality of choice; pathologically, light and electron microscopy
are invaluable in making the correct diagnosis. Making the correct diagnosis allows further appropriate investigation for
systemic disease and consequent management. 相似文献
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Ashvin K. Patel George G. Rowe Shiraz P. Dhanani Peter Kosolcharoen Lou Ellen W. Lyle James H. Thomsen 《The American journal of cardiology》1982,49(7):1801-1805
Ninety-eight patients were studied with two dimensional echocardiography combined with pulsed Doppler echocardiography to assess the usefulness and limitations of the Doppler technique in the diagnosis of pulmonary regurgitation. The diagnosis of pulmonary regurgitation by pulsed Doppler echocardiography depended on subjective interpretation of the audio signal and objective interpretation of the time interval histogram for the presence of wide frequency dispersion. During cardiac catheterization in 53 of the 98 patients, indocyanine green was injected into the pulmonary artery, and simultaneous sampling was performed from the right ventricle and femoral artery to diagnose pulmonary regurgitation. Pulmonary regurgitation was confirmed by pulmonary arteriogram in one patient. Among 62 patients with adequate pulsed Doppler echocardiographic studies, diastolic turbulence was noted in 21. When diastolic turbulence was less than 50 percent of the period of diastole, no pulmonary regurgitation was demonstrated in patients studied by indicator-dilution technique. However, three of the four patients with diastolic turbulence greater than 50 percent had positive evidence of pulmonary regurgitation. Audio output was more sensitive than the time interval histogram, and only five patients' findings suggested pulmonary regurgitation. Three of these patients underwent dye-dilution studies; two studies were positive for pulmonary regurgitation and one was negative.Thus, interpretation of pulmonary regurgitation based on the time interval histogram alone produces a large number of false positive results. When diastolic turbulence is greater than 50 percent of the period of diastole, both the sensitivity and specificity of diagnosis of pulmonary regurgitation are increased. Combining audio output and the time interval histogram results in improved diagnostic capability. 相似文献
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Washington DL Harada ND Villa VM Damron-Rodriguez J Dhanani S Shon H Makinodan T 《Military medicine》2002,167(3):235-241
Our objective was to describe racial/ethnic variations in Department of Veterans Affairs (VA) ambulatory care use and its association with the presence of unmet health care needs. Using the 1992 National Survey of Veterans, we examined race/ethnicity and unmet health care need for ambulatory care users of VA and non-VA facilities. Black and Hispanic veterans were more likely to report any VA use. In unadjusted analyses, American Indian/Eskimo, Hispanic, and black veterans were 4.4, 2.5, and 1.9 times more likely, respectively, than white veterans to report an inability to get needed care. Adjusting for VA ambulatory care use diminished the disparity in inability to get needed care between American Indian/Eskimo or Hispanic veterans and white veterans and eliminated the disparity between black and white veterans. Our findings support the VA's role as a medical safety net provider and suggest that VA ambulatory care use is effective in mitigating health-related racial disparities for some veterans. Additional facilitators for reducing unmet need should be explored. 相似文献
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Dhanani S Damron-Rodriguez J Leung M Villa V Washington DL Makinodan T Harada N 《Military medicine》2002,167(6):501-505
Minority recruitment is crucial to successful clinical research and associated community-based outreach programs. Reaching and retaining a diverse sample is particularly challenging when research targets not only ethnic or racial minorities but also subcultural groups such as veterans of different war periods. We describe various strategies that address the special challenges of minority recruitment through our experience engaging an ethnically diverse sample of 258 veterans as part of an evaluation of ambulatory care services at Department of Veterans Affairs health care facilities. Most veterans were recruited by liaison with the community center, which accounted for 29% of the total sample. Other strategies included on-site recruitment (21%), word of mouth (21%), mailings to veterans' organizations (12%), and newspaper advertisements (7%). Strategies varied in their effectiveness at reaching specific racial or ethnic groups and veterans from different cohorts of war service. 相似文献
10.
Easter J McClure EB Monk CS Dhanani M Hodgdon H Leibenluft E Charney DS Pine DS Ernst M 《Journal of child and adolescent psychopharmacology》2005,15(4):563-570
INTRODUCTION: Anxiety disorders in adults involve aberrant processing of emotional information that is hypothesized to reflect perturbations in the amygdala. This study examines the relationship between face-emotion recognition and anxiety in a sample of children and adolescents participating in a brain-imaging study of amygdala structure and function. METHODS: This study recruited 15 children and adolescents with ongoing anxiety disorders and 11 psychiatrically healthy comparisons group-matched on age, gender, and IQ. Face-emotion recognition was assessed using the Diagnostic Analysis of Nonverbal Accuracy Scale (DANVA). RESULTS: Children and adolescents with anxiety disorders exhibited significantly poorer performance on the face-emotion recognition task compared to healthy controls (z = 2.2; p < 0.05). This difference was found only for expressions posed by adults but not children. Discussion: Reduced accuracy on a face-emotion recognition test is consistent with perturbed amygdala function in pediatric anxiety disorders. CONCLUSION: As this study was conducted in a sample undergoing a neuroimaging investigation of amygdala integrity, future analyses will examine associations among amygdala function, clinical anxiety, and face-recognition abilities. 相似文献