[Quality of life in palliative care].

Palliative care aims to improve the quality of life of patients with a serious or terminal progressive disease, through global and multidisciplinary care. The notion of quality of life is multidimensional and unique to each individual patient, making them key players in their own care. Taking into account the different dimensions of a patient's quality of life is necessary in order to propose a personalised and appropriate care plan.

Nutritional therapy and infectious diseases: a two-edged sword.

The benefits and risks of nutritional therapies in the prevention and management of infectious diseases in the developed world are reviewed. There is strong evidence that early enteral feeding of patients prevents infections in a variety of traumatic and surgical illnesses. There is, however, little support for similar early feeding in medical illnesses.

Predicting AIDS-related events using CD4 percentage or CD4 absolute counts.

Background: The extent of immunosuppression and the probability of developing an AIDS-related complication in HIV-infected people is usually measured by the absolute number of CD4 positive T-cells. The percentage of CD4 positive cells is a more easily measured and less variable number. We analyzed sequential CD4 and CD8 numbers, percentages and ratios in 218 of our HIV infected patients to determine the most reliable predictor of an AIDS-related event.

Moraxella catarrhalis coaggregates with Streptococcus pyogenes and modulates interactions of S. pyogenes with human epithelial cells.

The pathogens Streptococcus pyogenes and Moraxella catarrhalis colonize overlapping regions of the human nasopharynx. We have found that M. catarrhalis can dramatically increase S.

Quorum sensing and its relevance to infectious diseases.

Quorum sensing allows bacteria to detect the density of their own species and alter their metabolism to take advantage of this density. Quorum sensing is used by a wide variety of bacteria including human pathogens. Quorum sensing genes are important for the pathogenic potential of Pseudomonas aeruginosa and Staphylococcus aureus, as well as other invasive bacteria.

A randomized controlled trial evaluating the efficacy and safety of intermittent 3-, 4-, and 5-day cycles of intravenous recombinant human interleukin-2 combined with antiretroviral therapy (ART) versus ART alone in HIV-seropositive patients with 100-300 CD4+ T cells.

The effect of length of therapy on the safety and efficacy profile of continuous intravenous (CIV) interleukin-2 (IL-2) in combination with antiretroviral therapy (ART) was evaluated in 81 HIV-seropositive patients with CD4(+) T-cell counts of 100-300/mm(3). Patients were randomized to CIV IL-2 (12 mIU/day) for 3, 4, or 5 days plus ART every 8 weeks for six cycles, or to ART alone. The mean percent increase in CD4(+) T-cell counts was 24.

Clot formation by group A streptococci.

Group A streptococci of several different M serotypes can cause human plasma to clot in nutrient-poor media. Addition of glucose to the medium prevents clot formation. Once formed, clots are stable for several days and can be lysed on addition of exogenous streptokinase or urokinase.

Prevention of subsequent urinary tract infections in women by the use of anti-adherence antimicrobial agents: a double-blind comparison of enoxacin with co-trimoxazole.

A prospective, double-blinded crossover study was carried out to test whether a brief course of antibiotic therapy could eliminate bacteria adherent to uroepithelial cells and thus prolong the interval between urinary tract infections (UTIs). Thirty-two women with frequent Gram-negative urinary tract infections were randomized to receive either co-trimoxazole or enoxacin twice a day for 10 days to treat their UTI. Their urines were collected for 30 days after the onset of their UTI and quantitatively analyzed for bacteria, antibiotics, and bacteria adherent to uroepithelial cells (UECs).

Inappropriate use of oxygen: loss of a valuable healthcare resource.

Oxygen (O2) use is well established in hospitalized patients with hypoxemia. However, its value in patients without hypoxemia is not well documented. The authors conducted a retrospective study to evaluate the excess use of O2 and the resulting loss of resources.

Disseminated cutaneous and meningeal sporotrichosis in an AIDS patient.

We report the first proven case of Sporothrix meningoencephalitis in an AIDS patient. The patient had dramatic, wide-spread ulcerative and infiltrative disease with progressive meningoencephalitis in spite of amphotericin and itraconazole therapy. Sporothrix was cultured from premortem cerebrospinal fluid and seen in the meninges and in brain vessels at autopsy.

Enhancing faculty participation and interest in quality improvement in academic centers.

Continuous quality improvement (CQI) is necessary in maintaining and improving the quality of medical care delivered. However, quality assurance (QA) in the past was performed superficially to meet requirements of the Joint Commission on Accreditation of Health Care Organizations and other regulatory agencies. Academic faculty participation in QA activity was also limited.

Norwegian scabies in a patient with AIDS.

Depression of cellular and humoral immunity can result in an overwhelming infection with the mite Sarcoptes scabiei. Infections in which the densities of mites are very high are known as Norwegian, or crusted, scabies. Cases of Norwegian scabies have been reported sporadically in patients with AIDS, but the appearance of the rash on these patients can be very misleading because of the diffuse papular or psoriasiform presentation.

Long-term suppression of Salmonella aortitis with an oral antibiotic.

An aneurysm of the aortic arch infected with Salmonella choleraesuis is presumed to be inevitably fatal unless the patient receives corrective surgery and antibiotic therapy. I report such a case in a patient who refused surgery and who has been maintained free of infectious symptoms for over 26 months using trimethoprim-sulfamethoxazole administered orally.

Novel abnormality in subpopulations of circulating lymphocytes. T gamma delta and CD2-, 3+, 4-, 8- lymphocytes in histoplasmosis-associated immunodeficiency.

A patient, who had developed anergy after disseminated histoplasmosis and who had gone on to develop a cardiomyopathy, demonstrated an unusually large proportion of T lymphocytes bearing the gamma and delta chains of the T cell receptor (TCR-gamma/delta). These gamma delta + cells composed over half of the circulating lymphocytes and were clearly divisible into two subgroups based on the level of expression of the gamma and delta chains and their ability to bind one of the monoclonal antibodies reactive with the TCR-delta chain. In addition, the patient showed an abnormally high proportion of circulating lymphocytes having the CD2-, 3+, 4-, 8- phenotype which has been only recently described.

Rupture of a pulmonary artery mycotic aneurysm associated with candidal endocarditis.

Candidal endocarditis can develop if candidemia occurs during Swan-Ganz catheterization. Candida endocarditis may persist for many months and is fatal unless the infected valve is resected. Herein is reported the first case of rupture of a mycotic pulmonary artery aneurysm caused by chronic candidal endocarditis.

Inhibition of neutrophil shape change by an inhibitor of chemotaxis.

Human mononuclear cells exposed to staphylococcal peptidoglycan in serum-free culture rapidly produce an inhibitor of neutrophil chemotaxis which we have previously described. We found that this inhibitor of chemotaxis has its most potent effect on the inhibition of neutrophil shape change from a spherical to a polarized configuration. In order to quantify this shape change inhibition, we developed an assay using flow cytometric techniques.

Expansion of a T lymphocyte subpopulation (CD3+,4-,8-) after immunodepression associated with disseminated histoplasmosis.

A major subpopulation of T lymphocytes bearing a high density of CD3 (T3/Leu 4) with no detectable CD4 (T4/Leu 3a) or CD8 (T8/Leu 2a) was found in a patient with cardiomyopathy. Previously the patient had developed disseminated histoplasmosis which had been associated with a profound anergic state. The proportion of CD3+ lymphocytes that bore the phenotype CD3+,4-,8- has been increasing in the absence of reactivation of the histoplasmosis.

Empirical use of imipenem as the sole antibiotic in the treatment of serious infections.

Seventy-three patients with eighty-five infections were treated with imipenem as the sole antimicrobial agent. Some of these infections were caused by pseudomonads and enterococci resistant to other cephalosporins. The vast majority of the Gram-positive and the Gram-negative bacteria that were isolated had a minimal inhibitory concentration (MIC) of less than 1 mg/l, and all MICs for initial isolates were below the levels of imipenem that were achieved in plasma and other body fluids with a dose of 500 mg every 6 h.

Human mononuclear cells exposed to staphylococci rapidly produce an inhibitor of neutrophil chemotaxis.

Serum-free cultures of human peripheral blood mononuclear cells from normal volunteers produce an inhibitor of neutrophil chemotaxis when exposed to heat-killed staphylococci. Human neutrophils were exposed to 100-fold dilutions of supernatants from 6-hr cultures, washed repeatedly, and assayed for chemotactic responsiveness with a radiolabel assay. Dilutions of supernatants from cell cultures exposed to staphylococci resulted in a mean chemotaxis of 856 +/- 83 cpm (n = 21), while that for medium-treated neutrophils was 1,354 +/- 100 cpm (n = 21, P less than .

Pathogenesis and treatment of endocarditis.

The rabbit model has been invaluable for in vivo studies in the pathogenesis and treatment of bacterial endocarditis. Both of the features of the mature bacterial vegetations in this rabbit model, i.e.

The hyperimmunoglobulin E recurrent-infection (Job's) syndrome. A review of the NIH experience and the literature.

The hyperimmunoglobulin E recurrent-infection syndrome (HIE) entails a disorder of recurrent bacterial infections of the skin and sinopulmonary tract commencing in infancy or early childhood in the presence of serum levels of IgE which are at least 10 times normal (greater than 2,000 IU/ml). Variable concomitants of HIE are coarse facies, chronic eczematoid rashes, cold cutaneous abscesses, mild eosinophilia, mucocutaneous candidiasis, and a neutrophil chemotactic defect. The bacteria which commonly infect these patients are Staphylococcus aureus and Haemophilus influenzae although Streptococcus pneumoniae and enteric gram-negative rods are seen in some cases.

Two inhibitors of neutrophil chemotaxis are produced by hyperimmunoglobulin E recurrent infection syndrome mononuclear cells exposed to heat-killed staphylococci.

Mononuclear cells from normal volunteers and from patients with the hyperimmunoglobulin E recurrent infection syndrome (HIE) were cultured for 18 h with and without opsonized, heat-killed Staphylococcus aureus (OS). The supernatants from normal mononuclear cell cultures without OS revealed no inhibitory activity for neutrophil chemotaxis, whereas those from HIE patients revealed the previously reported 61,000-dalton factor. However, when normal cells were cultured with OS, they produced a proteinaceous, 56 degrees C-stable, 30,000- to 45,000-dalton factor which preferentially inhibited neutrophil versus monocyte chemotaxis.