1/47. tuberculosis treatment through directly observed therapy in a large multisite methadone maintenance treatment program: addressing the public health needs of a high-risk population.The rate of tuberculosis in patients receiving methadone treatment is significantly greater than the general population. The stabilization of former injection drug users occurs within methadone maintenance treatment programs, indicating the suitability of these sites for directly observed therapy (DOT). There are formidable barriers to the success of DOT, some are institutional, others patient-related. Strategies to address these obstacles need to be implemented. The integration of DOT into existing programs required support from the new york State Department of Health, institutional commitment, as well as continued staff and patient education and training.- - - - - - - - - - ranking = 1keywords = health (Clic here for more details about this article) |
2/47. Nosocomial transmission of hepatitis b virus infection through multiple-dose vials.The source of acute hepatitis b virus (HBV) infection in two women (55 and 72 years old) was investigated. They displayed no risk factors for acquiring HBV infection, other than treatment with local anaesthetic injections some months previously. The HBV strains were sequenced and showed distinct homology to strains seen in Swedish intravenous drug users (IVDU). Prior to these patients' acute infection, an outbreak of HBV had occurred among IVDU in the same county. Analysis of the HBV strains from six of these IVDUs showed their core promoter, precore and pre-S sequences (679 nucleotides) to be identical to those from the two patients. Cross-contamination between samples was excluded and the most likely source of infection was thought to be multiple-dose vials of local anaesthetic that had been contaminated with the HBV strain circulating among the IVDU population in the community. We believe that multiple-dose vials have no place in modern healthcare and recommend sequence homology analysis as an alternative or additional way to trace a source of HBV infection.- - - - - - - - - - ranking = 0.25keywords = health (Clic here for more details about this article) |
3/47. Atypical infective endocarditis.BACKGROUND: Although infective endocarditis has changed in the recent past as a result of microbiologic and risk factors, it continues to be clinically challenging. The disease is characterized by the formation of septic masses of platelets on the surfaces of heart valves. Several mechanisms can cause or contribute to the development of endocarditis. Although risk factors for infective endocarditis are well known, patients with atypical signs and symptoms continue to challenge us. methods: We describe a case report of a patient admitted to our inpatient service with back pain and presumed pyelonephritis. A medline literature search was conducted, using the key words "endocarditis," "back pain," and "bacterial," for the years 1986 to the present. RESULTS AND CONCLUSIONS: A 42-year-old woman with a history of intravenous drug abuse was admitted to the family practice service with back pain and pyelonephritis. She developed hypoxia and a new heart murmur and had continued fevers. blood cultures drawn in the emergency department grew methicillin-resistant staphylococcus aureus. A bone scan and magnetic resonance imaging led to the diagnosis of epidural abscess. What appeared to be a simple case of pyelonephritis with back pain became a case of infective endocarditis complicated by an epidural abscess.- - - - - - - - - - ranking = 4.7573030145969keywords = service (Clic here for more details about this article) |
4/47. Stories of AIDS outreach and case management: context and activities.research has shown that injection drug users (IDUs) are now at greater risk for contracting hiv infection. Studies also show that seroincidence has begun to decrease among IDUs in a number of cities due to risk-reduction interventions. One important intervention is the use of indigenous outreach workers, shown to be an effective method in reducing hiv risk behavior and promoting preventive actions among IDUs in various settings. This study explores continuities and changes in the activities of outreach workers and in their changing role as case managers in the long-standing Community Outreach Intervention Project in chicago. It examines their efforts to change risk behaviors and improve the health and living conditions of IDUs. This research is based on outreach and case-worker perspectives and related background data gathered from 10 outreach workers and the four ethnographers that supervise the project. Outreach and case workers describe the diverse populations and contexts in which they operate and the growing complexity and depth of the issues they face, especially in working with hiv and AIDS-afflicted clients. These descriptions demonstrate the important role "indigenous" outreach and case workers play in engaging out-of-treatment IDUs, supporting meaningful changes in their lives, and responding to their particular and emerging needs.- - - - - - - - - - ranking = 0.25keywords = health (Clic here for more details about this article) |
5/47. Fatal tetanus in a drug abuser with "protective" antitetanus antibodies.tetanus is a rare disease in the united states. From 1995-1997, the average annual incidence of tetanus was 0.15/1,000,000 population. Injecting-drug users, particularly those who use heroin, are among the highest risk population for acquiring tetanus. We present a case of an injecting-drug user who was seen in the emergency department with worsening diffuse midthoracic back pain and spasms. He subsequently developed acute respiratory failure and central nervous system hypoxic injury. serum obtained before administration of tetanus immune globulin showed a tetanus antibody titer greater than 16 times the level considered protective. Because of limited human data on the minimum protective level of neutralizing antibody, as well as reports of tetanus among individuals with "protective" antibody titers, the diagnosis of tetanus should not be excluded solely on the basis of antitetanus titers.- - - - - - - - - - ranking = 0.020777955095477keywords = individual (Clic here for more details about this article) |
6/47. Kaposi's sarcoma-like lesions and other nodules as cutaneous involvement in AIDS-related visceral leishmaniasis.A 40-year-old human immunodeficiency virus (hiv)-positive man had three relapses of visceral leishmaniasis (VL). In the third he developed nodular skin lesions of three types, some reminiscent of Kaposi's sarcoma. biopsy of each type disclosed abundant dermal macrophages with a huge number of intracellular and extracellular Leishman-Donovan bodies. Rapid improvement of lesions was achieved after antiparasitic treatment. AIDS leads to atypical forms of leishmaniasis. Leishmania has been detected both in normal and pathological skin of these patients due to dissemination during VL. It is suspected that a considerable proportion of the population may be infected in endemic areas, Leishmania being opportunistic in immunosuppressed individuals. It is important to recognize the range of lesions that may occur in patients with hiv and VL, many of which are non-specific and may cause diagnostic difficulty.- - - - - - - - - - ranking = 0.020777955095477keywords = individual (Clic here for more details about this article) |
7/47. Peripartum seizure and hiv infection.Two patients with new-onset seizure within hours of parturition subsequently tested positive for human immunodeficiency virus (hiv). The peripartum period appears to predispose asymptomatic hiv-infected individuals to seizure. Such patients, especially with suggestive risk factors, should be screened for hiv-antibody.- - - - - - - - - - ranking = 0.020777955095477keywords = individual (Clic here for more details about this article) |
8/47. porphyria cutanea tarda and hiv: two cases associated with hepatitis c.hepatitis c virus (HCV) is a probable etiologic factor for the development of porphyria cutanea tarda (PCT), a photosensitive skin disease causing blistering, skin fragility, milia, and scarring. In a review of the literature, the hepatitis c status of patients coinfected with hiv and PCT was not known. Two patients with PCT who were seropositive for hiv and HCV are discussed herein. The appropriateness of performing porphyrin studies in patients diagnosed with hiv and photosensitivity and of prompting physicians to test for hiv and HCV infection in individuals who are diagnosed with PCT is discussed. Because hiv has been isolated from cutaneous blister fluid in patients with PCT and hiv, caregivers should be aware of the infection risk associated with the vesicles and erosions in these patients.- - - - - - - - - - ranking = 0.020777955095477keywords = individual (Clic here for more details about this article) |
9/47. soft tissue infections among injection drug users--san francisco, california, 1996-2000.soft tissue infections (STIs), including abscesses and cellulitis, are a common complication of injection drug use. In 1997, 54 (32%) of 169 injection drug users (IDUs) in one san francisco neighborhood had a drug-injection-related abscess or cellulitis (1). To characterize STIs among IDUs, data from san francisco General Hospital (SFGH) discharge and billing records were analyzed. This report summarizes the results of that analysis and presents the case report of one IDU with an STI. The findings indicate that STIs are among the most common diagnoses among patients admitted to SFGH. Preventing STIs among IDUs in san francisco will require coordinated action involving health-care providers, public health agencies, substance abuse treatment, community outreach, syringe exchange programs, IDUs, and community-based organizations.- - - - - - - - - - ranking = 0.5keywords = health (Clic here for more details about this article) |
10/47. Unexplained deaths among injection drug users: a case of probable clostridium myonecrosis.A series of unexplained deaths associated with soft-tissue inflammation and severe systemic sepsis was reported among injection drug users (IDUs) in the United Kingdom and the Republic of ireland in 2000. Health canada has identified one reported fatality in an IDU that matched the case definition. Although the cause of the epidemic in the UK and ireland is not fully understood, contributing factors include injecting into muscle or beneath the skin, rather than directly into a vein, and the use of acid to dissolve the heroin. This single Canadian case is considered to be a sporadic event that occurs at a low background rate among IDUs. These cases serve to remind primary health care providers to be vigilant in cases of soft-tissue infection among IDUs and not to underestimate the potential severity of the situation.- - - - - - - - - - ranking = 0.25keywords = health (Clic here for more details about this article) |
| | Next -> |