Prognosis Of People Research Articles

Lipids, metabolic syndrome, and risk factors for future cardiovascular disease among HIV-infected patients

The availability of potent combination antiretroviral therapy has changed the long-term prognosis for people living with HIV/AIDS. There is increasing concern, however, about the effect of HIV therapy on lipid disorders and subsequent development of coronary artery disease. Virtually all classes of antiretroviral drugs have been associated with some aspect of atherogenic changes in the lipid profiles. This article reviews the current literature on HIV-associated dyslipidemias and the metabolic syndrome, their potential effect on future coronary heart disease, and reviews strategies for management.

Alternative routes to healing in Bangladesh

The mission to find 'the secret of the village' is one attraction of engaging in mental health services in Bangladesh. Over the last 15 years much attention in world psychiatry has been given to the fairly robust finding that the prognosis of people with established and severe mental illness is better in 'developing countries' than in 'developed' ones (e.g. World Health Organization, 1979; Leff et al, 1990; Jablensky et al, 1992). Earlier assumptions that 'developing' is a simple variable were almost certainly a result of racist ignorance (Kulhara, 1994). Developing countries are not homogeneous. The variation in mental health outcomes seems to be clearer in more remote villages and tribal areas (Chatterjee et al, 2003), especially those that have less contact with Western (colonial) models of psychiatry and ways of life. More studies on this topic across a wider range of rural and urban settings would have much to offer. Is there something poisonous that comes with lots of expensive services? Or is there something missing?

The urological management of the patient with acquired immunodeficiency syndrome

In people infected with the human immunodeficiency virus (HIV) both the CD4 T-cell count and the viral load are used to monitor disease progression to acquired immunodeficiency syndrome (AIDS). CD4 counts of <500/mm(3) are associated with opportunistic infections and certain malignancies, so-called 'AIDS-defining' conditions. Highly active antiretroviral therapy, using combinations of reverse transcriptase inhibitors and/or protease inhibitors, can improve considerably the prognosis of people who are HIV-positive, but such therapy is not yet widely available in many developing countries. People with AIDS are predisposed to urinary tract infection (UTI) by uncommon bacteria and pathogens, e.g. fungi, parasites and viruses, which may affect any urogenital organ; treatment should be culture-specific and long-term, because there is a tendency to recurrence, infection with multiple organisms and resistant isolates. Voiding dysfunction in patients with AIDS is usually a result of neurological complications caused by opportunistic infections, and has a poor prognosis. Of patients with AIDS, 30-50% develop a cancer, especially Kaposi's sarcoma (KS) and non-Hodgkin's lymphoma (NHL). KS may involve any urogenital organ, but is usually part of systemic disease. Small lesions on the external genitalia can be treated with laser, cryotherapy or surgical excision, larger lesions with radiotherapy, and disseminated or visceral KS with multidrug chemotherapy. NHL may involve the kidneys, testes and retroperitoneal lymph nodes, thus obstructing the ureters, which may require ureteric stenting or percutaneous nephrostomy. NHL can be treated with radiotherapy and combination chemotherapy. Urolithiasis in patients with AIDS may be caused by indinavir, a protease inhibitor, but the more common types of stones may also occur. Fluid-electrolyte and acid-base disturbances are common in patients with advanced AIDS, secondary to vomiting, diarrhoea, malnutrition or septicaemia. HIV-associated nephropathy occurs in 10-30% of patients, and often leads to renal failure. Testicular atrophy is common, leading to infertility, erectile dysfunction (ED) and decreased libido. Treatment for ED must include counselling about strategies to reduce the transmission of HIV. The risk of HIV transmission after parenteral exposure to blood from an HIV-positive patient is relatively low (0.2-0.4%); the urologist can reduce the risk of transmission during surgery by adopting certain precautions. After occupational exposure to HIV, chemoprophylaxis with antiretroviral medication can significantly reduce the probability of HIV transmission.

Treatment of onchocerciasis.

Onchocerciasis ('river blindness') has for several centuries been the scourge of people living in certain areas of the world where the disease is endemic. The treatment available up to 10 years ago, diethylcarbamazine, had very severe secondary effects. The availability of ivermectin--a well tolerated and highly effective microfilaricidal drug--has completely changed this scenario. Ivermectin is now considered to be the drug of choice for the treatment of onchocerciasis. The prognosis for people with onchocerciasis has changed greatly. It is now possible to avoid the heavy infection loads seen previously, and patients, especially expatriates, may have their symptoms relieved by treatment. Ivermectin, used in mass treatment, may also improve the epidemiological situation, reducing the level of microfilariae in the skin of infected people and thus reducing the source for vector infestation. However, the treatment has to be repeated because the drug has no macrofilaricidal effect. Research today is focused on the finding of a drug able to destroy the adult worms that go on producing microfilariae for the length of their lives.

Evidence for psychosis of good prognosis in people of Caribbean origin living in the UK

Evidence for psychosis of good prognosis in people of Caribbean origin living in the UK

Drug Treatment of Resistant Schizophrenia

Despite the advances achieved since the introduction of chlorpromazine, schizophrenia may respond inadequately to standard drug treatments. The reasons for this include noncompliance, poor tolerance and the development of distressing side effects or the resistance of the illness itself. Treatment-resistant schizophrenia is increasingly the focus of new research developments. The older or classic antipsychotic drugs have a broad spectrum of action on central and peripheral nervous system receptors. Their action on dopamine receptors was an early clue to the pathogenesis of schizophrenia. More recently, multiple subtypes of dopamine receptors have been identified. These, plus serotonin receptors, have been identified in brain structures thought to be implicated in schizophrenic illnesses. Atypical antipsychotic agents whose pharmacological action is either more specific, or which have novel receptor binding profiles show characteristic effects in both animal models and clinically. These drugs may improve symptoms in otherwise resistant illness or where intolerance prevents the use of standard treatments. There are a number of adjunctive somatic treatment strategies using established agents such as lithium and electroconvulsive therapy the use of which is now being explored systematically. The most exciting current development is the re-emergence of clozapine as a highly effective atypical antipsychotic drug which can be used safely if special surveillance is undertaken to monitor for its potentially severe toxic effects. These recent advances offer hope of improvement in the prognosis of people suffering from severe and intractable forms of schizophrenia.

Medical Complications of Spinal Cord Injury

Recent medical advances have greatly improved the prognosis for people who sustain spinal cord injury (about 10 000 people initially survive spinal cord injury each year in the US). Physicians may become involved with the acute care of spinal cord injured persons or care for complications which develop later. Certain conditions such as heterotopic bone formation and autonomic dysreflexia are seen almost exclusively in this group of patients; other complications such as urinary tract and soft tissue infections occur quite often. Common medical complications of spinal cord injured persons are reviewed, as well as their diagnosis and treatment.

PROGNOSIS OF PEOPLE, PERSONS, AND PATIENTS.

PROGNOSIS OF PEOPLE, PERSONS, AND PATIENTS.