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Objective: diuretics have the potential to reduce intravascular volume, decrease blood pressure The aim of our study is to evaluate the effectiveness of furosemide in postpartum patients with pre-eclampsia and chronic hypertension with superimposed pre-eclampsia. Methods: This is a retrospective cohort study. Data was extracted from the record of patients who delivered between 2017 and 2020 and had chronic hypertension or, chronic hypertension with superimposed pre-eclampsia, gestational hypertension, or pre-eclampsia. Patients who received intravenous furosemide in the postpartum period were compared to those who did not. The groups were also analyzed for fetal growth restriction, and pregnancy outcomes comparing those who did receive furosemide and those who did not. Results: The furosemide group had a statistically significant longer postpartum length of stay (p

Cytomegalovirus (CMV) is a prevalent viral pathogen. The majority of persons with acute CMV will experience an inapparent infection. Primary CMV infection will cause up to 7 percent of cases of mononucleosis syndrome and will manifest symptoms almost indistinguishable from those of Epstein-Barr virus-induced mononucleosis. CMV, or heterophil-negative mononucleosis, is best diagnosed using a positive IgM serology. Complications of acute CMV infection in immunocompetent persons are rare, except in newborns. The virus usually is spread through close personal contact; transmission risk can be reduced by following simple hygienic and handwashing techniques. Severe illness can occur after reactivation of the latent virus in immunosuppressed persons. The retina is the most common site of CMV-induced pathology in persons with human immunodeficiency virus infection. Advances in the treatment of human immunodeficiency virus infection with highly active antiretroviral therapy (HAART) have decreased the incidence of CMV retinitis but have resulted in a new set of ophthalmologic complications induced by restoration of immune competency and the pro-inflammatory response of the patient to CMV. If HAART restores the patient's CD4 cell count to above 100 to 150 per mm3 (100 to 150 x 10(6) per L), it may preclude lifelong treatment for CMV retinitis. [ABSTRACT FROM AUTHOR]

Background: Angiolipomas have been well described in patients with HIV exposed to protease inhibitors with possible resolution after switching to non-nucleoside reverse transcriptase inhibitor-based regimens. Resolution of symptoms have occurred with switches to non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens; however, little is known regarding the development of angiolipomas when switching from NNRTI- to modern, integrase strand transfer inhibitor-based regimens. We describe a patient who underwent switch therapy from tenofovir disoproxil fumarate/emtricitabine/efavirenz (TDF/FTC/EFV) to tenofovir alafenamide/FTC/bictegravir (TAF/FTC/BIC) who later developed angiolipomas., Case Presentation: A 55-year-old male had been on TDF/FTC/EFV for 8 years before switching to TAF/FTC/BIC. Nineteen months after antiretroviral switch, the patient presented with multiple lesions in the upper extremities and abdomen. Diagnostic biopsies revealed non-encapsulated angiolipomas and HHV-8 and non-alcoholic fatty liver disease was ruled out. New lesions continued to appear 29 months after ART switch, after which now lesions appeared and prior lesions remained stable with no increase in size noted. No surgical intervention or change in antiretroviral therapy was needed., Conclusions: Angiogenesis may have been suppressed with TDF/FTC/EFV treatment, however when switched to TAF/FTC/BIC, promoted the growth of angiolipomas. Clinicians should be aware of the impact of switching to modern ART therapies resulting in possible adipogenesis., (© 2024. The Author(s).)

Objectives: To describe risk factors/incidence of abnormal cervical/vaginal cytology/histology and cancer among women living with human immunodeficiency virus (WLHIV) ≥65 years compared to HIV-negative matched controls., Study Design: Retrospective cohort of patients who underwent Pap screening at the University of Maryland 01/2003-04/2019., Results: WLHIV and HIV-negative controls ( n = 70 each) underwent 140/151 Pap tests, respectively. Among WLHIV, 29% exhibited abnormal results and were less likely than HIV-negative women with normal Paps to have had serially negative Pap tests prior to age 65 ( p = .03). In both groups, 1.4% developed cervical cancer. Abnormal Paps were more frequent in WLHIV than in HIV-negative women (31% vs 10%, p < .0001, RR:3.2, 95%CI1.9-5.4) as was HRHPV (high-risk human papillomavirus) status (43% vs 19%, p = .0233, RR:2.3, 95%CI1.2-4.6). The RR for an abnormal Pap was 2.6 (95% CI:1.1-4.2) for VL >1000 copies/mL and 0.4 (95% CI:0.2-0.7) for CD4 count of >200 cells/μL. No individual with an initially normal Pap experienced an abnormal result over a mean of 42.5 and 43.5 months in the HIV-positive and HIV-negative groups, respectively., Conclusions: HIV status was associated with a higher rate of abnormal Pap/HRHPV; however, no significant difference in cervical/vaginal cancer. Elevated VL/low CD4 count were associated with greater risk for an abnormal Pap.

Background: People in low- and middle-income countries with serious health problems rarely have access to palliative care. Promising models of palliative care delivery have emerged in India despite widespread poverty and poor health care infrastructure. Objective: To explore structural and philosophical aspects of palliative care delivery in a low-resource setting. Design: One author spent six months as a participant observer at Pallium India (PI), a nongovernmental organization recognized for leadership in palliative care delivery in Kerala, India. We collected administrative data, conducted semistructured interviews with key stakeholders, and observed clinical encounters and other organization-led events. Results: We performed 73 interviews with patients, families, clinicians, staff, and volunteers, and observed 180 patient encounters. The majority of palliative care patients did not have cancer. Many had chronic diseases that were not immediately life threatening. Services addressed a broad range of patients' medical, psychological, social, and/or financial needs. PI's care delivery maximizes accessibility. Conclusions: PI employs an expansive definition of palliative care and adapts services to respond to patients' diverse needs. This accessible, people-centered care is necessary in low-resource settings to alleviate multifaceted suffering caused by gaps in the health care system, poor social support, and poverty.

Objectives: The childhood obstructive sleep apnea syndrome (OSAS) is associated with behavioral abnormalities. Studies on the effects of OSAS treatment on behavior are conflicting, with few studies using a randomized design. Further, studies may be confounded by the inclusion of behavioral outcome measures directly related to sleep. The objective of this study was to determine the effect of adenotonsillectomy on behavior in children with OSAS. We hypothesized that surgery would improve behavioral ratings, even when sleep symptom items were excluded from the analysis., Methods: This was a secondary analysis of Child Behavior Checklist (CBCL) data, with and without exclusion of sleep-specific items, from the Childhood Adenotonsillectomy Trial (CHAT). CBCL was completed by caregivers of 380 children (7.0+1.4 [range 5-9] years) with OSAS randomized to early adenotonsillectomy (eAT) versus 7 months of watchful waiting with supportive care (WWSC)., Results: There was a high prevalence of behavioral problems at baseline; 16.6% of children had a Total Problems score in the clinically abnormal range. At follow-up, there were significant improvements in Total Problems (p < .001), Internalizing Behaviors (p = .04), Somatic Complaints (p = .01), and Thought Problems (p = .01) in eAT vs. WWSC participants. When specific sleep-related question items were removed from the analysis, eAT showed an overall improvement in Total (p = .02) and Other (p = .01) problems. Black children had less improvement in behavior following eAT than white children, but this difference attenuated when sleep-related items were excluded., Conclusions: This large, randomized trial showed that adenotonsillectomy for OSAS improved parent-rated behavioral problems, even when sleep-specific behavioral issues were excluded from the analysis., (© Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.)

Increased levels of the proinflammatory cytokine IL-8 are detected in the sputum of patients with chronic obstructive pulmonary disease (COPD) and during the pathological pulmonary manifestations of HIV infection : To explore a potential interrelationship between smoking, highly active antiretroviral therapy (HAART) and HIV immune status, we collected sputum samples, along with complete pulmonary function tests from groups of HIV-infected women smokers who were either on or off HAART. Analysis of the patient's sputum for cell count along with quantitative measures of IL-8 was performed and correlated with concurrent assessment of pulmonary function test (PFT). We found that HIV-positive smokers had decreased measurements on PFT of the diffusing capacity of the lung for carbon monoxide (D(LCO)) compared to standard reference values that did not differ with HAART usage. HAART, when controlled for CD4, showed a suppressive effect on the levels of pro inflammatory cytokine IL-8 in sputum. We conclude that in the era of HAART, HIV along with concurrent tobacco smoking is associated with declines in PFT in HIV-infected women. The use of HAART in patients appears to mitigate the increases in IL-8 levels in relation to immune status based on CD4 count., (© FEMS 2015. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: Symptoms of severe intestinal dysmotility decrease patients' quality of life and may prevent them from sustaining adequate oral intake. Dronabinol is a synthetic cannabinoid that is labeled for use in AIDS-related anorexia and chemotherapy-associated nausea and vomiting that has additional efficacy in patients with other etiologies of nausea, vomiting, and anorexia., Presentation of Case: We present a 58-year-old female with a history of nausea, vomiting, abdominal pain, and inability to maintain oral intake after multiple laparotomies for ectopic pregnancy, recurrent caecal volvulus, and cholecystitis. After eight years of unsuccessful trials of medicines, dietary modifications, and a partial colectomy, she began a trial of dronabinol, which caused almost complete remission of her symptoms. When this medication was discontinued by her payer, she was unable to maintain oral intake and therefore, was admitted to the hospital for fluid resuscitation and resumption of dronabinol., Discussion: The use of dronabinol in this patient with severe intestinal dysmotility allowed her to maintain her nutritional status orally and obviated the need for enteral or parenteral feeding. Unfortunately, it was not covered by her insurance company for this indication., Conclusion: Dronabinol has the potential to improve quality of life for patients beyond those undergoing chemotherapy or suffering from AIDS. Lack of access to this medicine for patients with intestinal dysmotility after all other modalities have been tried can lead to morbid and expensive complications, such as inpatient admission and surgery for enteral access., (Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Complex cognitive impairments are common after stroke and they can significantly impede individuals' progress in rehabilitation. Treatment strategies that allow patients to compensate for such deficits are therefore an important part of multidisciplinary rehabilitation, as acknowledged by various clinical guidelines. In part due to the heterogeneity of poststroke cognitive impairments, the evidence base for treatments in this area is often unclear or inconsistent. There are no straightforward clinical tools or guidelines available to facilitate poststroke cognitive rehabilitation across cognitive domains. The present article proposes a cognitive assessment and rehabilitation pathway for stroke (CARPS), which aims to provide a structure to guide stroke rehabilitation teams in this difficult area of clinical practice. Practical treatment strategies are also discussed in some detail. Finally, the limitations of the proposed pathway are acknowledged, as is the importance of further research.

Patients report a wide variety of emotional responses following stroke. Some individuals find the process of adjusting to their changed circumstances extremely difficult, while others cope well. Predicting and understanding patients' adjustment to stroke therefore poses challenges within rehabilitation settings. While research has revealed some of the variables associated with increased emotional distress (i.e., post-stroke depression) after stroke, a general model of post-stroke emotional adjustment has not yet been put forward. This article proposes that the Social Cognitive Transition model provides a sound theoretical basis upon which to build an understanding of post-stroke adjustment. The essential elements of a Social Cognitive Transition Model for Stroke are summarised, and clinical examples are used to discuss this model. The implications for psychological assessment, formulation and treatment are also discussed.

Objectives: Cardiac rehabilitation (CR) programs have been shown to reduce mortality and morbidity rates among coronary heart disease patients, but adherence to these classes has been found to be poor. This review aims to summarize and integrate research findings investigating the possible sociodemographic, medical, and psychological variables that influence patient adherence to CR programs. It also aims to address the methodological failings of past reviews conducted in this area., Methods: Several databases were systematically searched for studies published between 1990 and 2009. Studies examining CR program adherence or completion, using data based on participant's actual recorded attendance were included., Results: Eighteen studies were identified that met inclusion criteria. Low mood, participant's age, and certain cardiac risk factors were found to be most consistently associated with poor adherence to CR. A good understanding of the consequences of heart disease was found to be associated with good adherence. Results were relatively inconsistent across studies because of differences in methods used., Conclusions: Certain risk factors for poor adherence to CR should be assessed and monitored by health professionals. Future studies should address the methodological difficulties present in previous research. Recommendations are made for standardizing methods in future research.

Objective: To evaluate signalment, history, clinical and pathologic findings, and seasonal weather patterns in association with fatal gastrointestinal parasitism in goats., Design: Retrospective case series., Animals: 152 goats that were > 1 day of age., Procedures: Characteristics including age and counts of coccidia oocysts and trichostrongyle ova (eggs) per gram of feces (EPG) in goats that died because of gastrointestinal parasitism and goats that died because of other causes were compared. Weather data and annual incidence of caprine fatal gastrointestinal parasitism were investigated., Results: Death was attributed to gastrointestinal parasitism in 31 of 152 (20%) goats (median age, 5 months; range, 1 month to 7 years); deaths were attributed to coccidiosis (n = 7 goats; median age, 4 months; median EPG, 2,225), trichostrongylosis (6 goats; median age, 1.25 years; median EPG, 3,700), or dual infection (18 goats; median age, 6.7 months; median EPG, 8,088 coccidia and 5,475 trichostrongyles). Sudden onset of weakness or death was a common historical finding; diarrhea was evident in 15 goats. Common postmortem findings in these goats included cachexia, tissue pallor, poorly formed feces, and mesenteric lymphadenomegaly. Wet weather in spring and summer was associated with increased annual incidence of fatal gastrointestinal parasitism in goats., Conclusions and Clinical Relevance: Gastrointestinal parasitism is an important cause of death in goats. Clinical signs may not develop until just prior to death, and diagnosis is achieved via parasitologic evaluation of feces and necropsy. Seasonal weather patterns should be considered on an annual basis when designing parasite control programs for goats.

Forty-four nodular and noninvasive cutaneous fungal granulomas were identified in 34 horses over a 14.5-year period. Cutaneous fungal granulomas were most common in young horses (mean age 6.1 +/- 4.2 years; range 1-19 years). There was no apparent breed or sex bias. Granulomas were either single or multiple, and most often occurred in the skin of the head and neck. The characteristic histological finding was a nodular dermal mass with a mean diameter of 7.3 mm (range 2.5-20 mm) and an intact overlying epithelium. Lesions most often exhibited intense lymphocytic inflammation, with admixed pyogranulomatous inflammation associated with a small to moderate number of fungal elements. Causative fungi were both pigmented and nonpigmented organisms of variable morphology. Penetrating plant material was identified in three cases. Granulomas caused by nonpigmented fungi were most common in horses from wet regions. Both pigmented and nonpigmented fungi were found in granulomas from horses in dry regions. Cutaneous fungal granulomas occurred in February through November, with peaks in April and July. No correlation of yearly incidence with annual average temperature or rainfall was detected. This study confirms that equine cutaneous fungal granuloma is relatively common in horses in the Pacific Northwest. Morphology of causative fungi was variable, but the signalment, history, and clinical and overall histological features were very similar. Surgical excision was curative.

The objective of this study was to examine the median age of menopause, factors associated with postmenopausal status, and the prevalence of menopausal symptoms in HIV-infected women. We surveyed 120 HIV-infected women between 40 and 57 years old who attended an inner city infectious diseases clinic. Ninety-five percent of the women surveyed were African American and almost half of the women (44%) had used methadone, heroin, cocaine, marijuana, or a combination of these drugs within the past 6 months. Eighty-seven percent had smoked cigarettes at least some time during their life and 45% drank alcohol between the ages of 40 and 49 years old. Thirty women were postmenopausal (having no menstrual periods in the previous 12 consecutive months), 31 were perimenopausal (having 1-11 periods within the previous 12 months), and 59 were premenopausal (having 12 or more periods within the previous 12 months). The median age of menopause was 50 years old (95% confidence interval = 49, 53). In a multivariate model, methadone use within the past 6 months was associated with postmenopausal status. We did not find an association between postmenopausal status and body mass index, number of pregnancies, CD4 cell counts, HIV viral load, individual and grouped antiretroviral therapies, cigarette smoking, and current or past oral contraceptive use. In multivariate analysis, postmenopausal status was associated with hot flashes and cocaine use was associated with vaginal dryness.

As part of a longitudinal study of the outcomes of very low birth weight children (<1.5 kg), we sought to examine the perinatal, childhood, and young adult predictors of internalizing symptoms among very low birth weight young women and their normal birth weight controls. The cohort included 125 very low birth weight and 124 normal birth weight 20-year-old subjects. Perinatal, childhood, and young adult predictors were examined via stepwise multivariate analyses. Results revealed very low birth weight to be a significant predictor of parent-reported internalizing symptoms of their daughters but only among white subjects who had mothers with high levels of psychological distress. Additional significant predictors of 20-year internalizing symptoms included child I.Q. and internalizing symptoms at age 8 years and family expressiveness. When the results were analyzed according to the young adult self-report, additional predictors of internalizing symptoms included a history of asthma and exposure to violence. Perinatal risk factors were not found to be predictive of internalizing symptoms at age 20 years. Future studies should prospectively examine social and environmental factors associated with the neonatal intensive care experience that might explain the effect of very low birth weight on later psychopathology.

Objective: To examine the neurosensory and cognitive status of extremely low-birth-weight (ELBW; < 1,000 g) children born from January 1, 1992, through December 31, 1995, and to identify the significant predictors of outcome., Design: An inception cohort of ELBW infants admitted to the neonatal intensive care unit (NICU) and observed to 20 months' corrected age., Setting: A tertiary level urban NICU and follow-up clinic at a university hospital., Population: Of 333 ELBW infants without major congenital malformations admitted to the NICU, 241 (72%) survived to 20 months' corrected age. We studied 221 children (92%) at a mean of 20 months' corrected age. The mean birth weight was 813 g; mean gestational age, 26.4 weeks., Main Outcome Measures: Assessments of cognitive and neurosensory development., Results: Major neurosensory abnormality was present in 54 children (24%), including 33 (15%) with cerebral palsy, 20 (9%) with deafness, and 2 (1%) with blindness. The mean (+/- SD) Bayley-Mental Developmental Index (MDI) score was 74.7 +/- 17. Ninety-two children (42%) had a subnormal MDI score (<70). Neurodevelopmental impairment (neurosensory abnormality and/or MDI score <70) was present in 105 children (48%). Multiple stepwise logistic regression analysis that considered sex, social risk, birth weight, and neonatal risk factors revealed significant predictors of a subnormal MDI score to be male sex (odds ratio [OR], 2.73; 95% confidence interval [CI], 1.52-4.92), social risk (OR, 1.48; 95% CI, 1.09-2.00), and chronic lung disease (OR, 2.18; 95% CI, 1.20-3.94). Predictors of neurologic abnormality were a severely abnormal finding on cerebral ultrasound (OR, 8.09; 95% CI, 3.69-17.71) and chronic lung disease (OR, 2.46; 95% CI, 1.12-5.40); predictors of deafness were male sex (OR, 2.79; 95% CI, 1.02-7.62), sepsis (OR, 3.15; 95% CI, 1.05-9.48), and jaundice (maximal bilirubin level, >171 micromol/L [>10 mg/dL]) (OR, 4.80; 95% CI, 1.46-15.73)., Conclusion: There is an urgent need for research into the etiology and prevention of neonatal morbidity.

Numerous studies have documented memory deficits in very low birthweight (VLBW, < 1500 g) children, yet we know little about the nature of these memory problems. To clarify memory sequelae and examine memory deficits in relation to the degree of low birth weight, we administered the California Verbal Learning Test-Children's Version (CVLT-C) to a regional sample of 57 < 750 g birthweight children and to groups of 53 750-1499 g birthweight children and 49 term-born controls. Group comparisons revealed significant differences between the < 750 g birthweight group and term-born children on measures of list learning, delayed recall, and inaccurate recall. In addition, the percentage improvement in correct recognitions relative to long-term delayed recall was greater in the < 750 g group than in the term-born controls. Similar differences were observed between VLBW children with and without abnormal neonatal cerebral ultrasounds (high- and low-risk groups). Differences in learning rate between the VLBW and term-born groups, and between high- and low-risk VLBW children, were evident even when vocabulary skill was covaried or when children with neurosensory deficits or IQ < 80 were excluded from analysis. The findings document deficits in verbal memory in the subset of VLBW children at greatest biological risk, and suggest that acquisition processes are selectively impaired.

A tool for measuring a family's asthma self-management behaviour has been developed for a study examining the relationships of asthma self-management behaviour, knowledge, and psychosocial factors with various indices of morbidity in children with asthma. The tool involves a structured interview which includes three typical situations of asthma self-management (scenarios). Each of the scenarios is divided into graded challenges. A scoring schedule was developed according to the critical incidents of self-management inherent in each situation. This schedule was then applied to the verbatim transcripts of the subjects' responses. These were presented to 380 asthmatic children aged 5-11 yr and their primary caregivers. Inter-rater reliability, inter-rater agreement and test-retest reliability coefficients indicate that the scores obtained are stable across raters and time. Correlations between scores on different scenarios suggest there is a common factor of self-management competency across all scenarios, but families are better at some aspects of self-management than others. The distribution of scores for each scenario is presented. The place of this tool as a means of assessing self-management behaviour is discussed.

AAMI has proposed guidelines for establishing minimum processing doses for radiation sterilization of medical devices. The AAMI recommendations do not include computer programs for analysis of the large quantities of data that may be generated during implementation of the dose-setting methodologies. Such utility programs have been developed, using two standard languages--FORTRAN IV and BASIC.