An Index Predicting Relapse and Need for Hospitalization in Patients with Acute Bronchial Asthma

In an attempt to define guidelines for the assessment of acute asthma, we evaluated 205 patients who presented to the emergency room for treatment of asthma. Of the 205, 120 were successfully treated and discharged from the emergency room, 45 were hospitalized, and 40 were treated and discharged from the emergency room but had relapses within 10 days. A predictive index using a combination of presenting factors was developed: pulse rate ≥120 per minute, respiratory rate ≥30 per minute, pulsus paradoxus ≥18 mm Hg, peak expiratory flow rate ≤120 liters per minute, moderate to severe dyspnea, accessory-muscle use, and wheezing. The index ranged from 0 to 7, increasing with the severity of symptoms. The index scores of the relapse group (4.9±1.0) and the admitted group (5.1±1.0) were both significantly different (P<0.001) from that of the successfully treated group (1.6±1.2). An index of 4 or higher was 95 per cent accurate in predicting the risk of relapse and 96 per cent accurate in predicting the need for hospitalizaron. (N Engl J Med. 1981; 305:783–9.) PATIENTS with severe bronchial asthma are usually hospitalized only after a trial of therapy in the emergency room has failed. Consequently, many patients spend long hours in a busy emergency room before a decision to hospitalize or discharge is made. In spite of this, relapse rates in patients treated and discharged from the emergency room remain as high as 26 to 30 per cent, necessitating further emergencyroom care. 1 , 2 . It has been well established that individual clinical and laboratory measurements may not reliably predict which patients have severe bronchial asthma or which are at risk for relapse after discharge. 1 , 3 4 5 6 7 In . . 

ICU survival of patients with the acquired immunodeficiency syndrome

The ICU records of 31 patients with the acquired immunodeficiency syndrome were reviewed. Of 23 (74%) patients admitted for respiratory failure requiring intubation and mechanical ventilation, 20 (87%) patients had Pneumocystis carinii and/or cytomegalovirus pneumonia. Of the eight patients admitted without respiratory failure, five (63%) were monitored after brain biopsy. Respiratory failure patients remained in the ICU for 10 ± 1 days, compared to 5 ± 1 days for those without respiratory failure (p < .05). Overall mortality was 24 patients (77%); 21 (91%) of 23 respiratory failure patients died, compared to three (38%) of the eight without respiratory failure (p < .01). All seven ICU survivors lived to hospital discharge

Acquired Immune Deficiency Syndrome in Low-Risk Patients: Evidence for Possible Transmission by an Asymptomatic Carrier

Two patients who contracted acquired immune deficiency syndrome (AIDS) could not be included in any of the known high-risk groups for this syndrome (ie, they were not homosexual, intravenous [IV] drug abusers, Haitian, or hemophiliacs). Patient 1, however, had regular sexual contact with her husband, an IV drug abuser who is asymptomatic despite a severe T-cell defect (T-helper cells, 33/cu mm; T-helper/T-suppressor ratio, 0.32; and a depressed lymphoproliferative response to mitogens and antigens). We hypothesize that he may be an asymptomatic carrier of an AIDS agent that he transmitted to his wife through intimate heterosexual contact. This mode of sexual transmission may provide a vector for the spread of AIDS to low-risk populations.(JAMA 1983;250:1310-1312

Tuberculous Brain Abscess and Toxoplasma Encephalitis in a Patient With the Acquired Immunodeficiency Syndrome

INFECTIOUS diseases of the central nervous system among immunocompromised patients are not uncommon but rarely involve more than one pathogen.1Mycobacterium tuberculosis is an infrequent cause of central nervous system infection among immunocompromised patients.2,3 When seen, meningitis is by far the most common presentation. Occurrence of a tuberculous brain abscess is rare.4-8Toxoplasma encephalitis has been recognized as one of the more common central nervous system infections among patients with the acquired immunodeficiency syndrome (AIDS). Concomitant infections, although uncommon, may be an emerging problem. The present report summarizes our experience with a patient who had a tuberculous brain abscess and concomitant Toxoplasma encephalitis.Report of a CaseA 22-year-old Haitian woman was admitted to the hospital with a nine-month history of fever, watery diarrhea, anorexia, and a 9.1-kg weight loss. A three-month history of tingling and progressive weakness of the left upper and lower extremities, with inabilit

HIV seroprevalence and risk behaviors among clients attending tuberculosis clinics in Miami-Dade County, Florida, 1989–1996

Miami-Dade County is a major HIV epicenter and a port of entry for immigrants from nations with high endemic rates of tuberculosis (TB). We analyzed data from an unlinked (blinded) serosurvey of clients attending four Miami TB clinics to elucidate the dynamic HIV seroprevalence patterns in relation to demographics and risk behaviors. Data were analyzed from 3,107 consecutive TB patients at four TB treatment clinics over eight years. Overall HIV seroprevalence was 23.6% with a significantly higher infection rate for men (26.6%) compared to women (17.3%) (p < 0.0001). In rank order, the HIV infection rates were 30.3% for black non-Hispanics, 24.7% for white non-Hispanics and 14.2% for Hispanics. U.S.-born clients had significantly higher HIV rates compared with foreign-born clients (32.4% vs. 18.5%, p < 0.0001). HIV rates declined over six years from (32.5% to 15.9%, p < 0.0001) with significant trends observed for men and women; and for blacks, whites and Hispanics. Seroprevalence was 15.7% for clients identifying heterosexual contact as their only risk. Highly significant increases in seroprevalence above this heterosexual-contact-only `baseline', were found for clients disclosing the following high-risk behaviors: male-to-male sex, drug injection, smoking crack cocaine, receiving or giving money/drugs for sex, and sexual contact with a drug injector or HIV-infected partner. While highly significant elevations in HIV seroprevalence were associated with each of these definitive risk behaviors, even the baseline HIV infection rate of 15.7% in heterosexual-contact-only clients was markedly higher than that of the general population. These findings underscore the need to obtain routine HIV serology on all TB patients